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Background: Patient‐ and family‐centred care practices are a recommended part of contemporary care for the acutely ill hospitalized adult patients. However, how patient‐ and family‐centred care is enacted in an adult hospital setting is not well understood. Aims and Objectives: The aim of this study is to explore the perceptions of patients, family members and nurses regarding family participation and collaboration in patient care within an acute care setting, including the barriers and facilitators. Design This study used a mixed‐methods sequential design. Methods: Observer‐as‐participant observations and semistructured interviews were undertaken. Integration of the data was achieved through triangulation. Results: Triangulation revealed two metathemes. The first metatheme, 'continuum of family involvement', explained the central viewpoint of how family participation and collaboration in the care of acutely ill hospitalized adult patients was enacted. The second metatheme, 'nurses value family involvement', helped to explain and understand the barriers and facilitators to enacting family participation in the acute care setting. Conclusion: Promoting family participation in the acute care setting requires supporting multiple levels of engagement. Developing a relationship, clear communication and open sharing of information amongst patients, family members and nurses is critical to supporting family involvement. SUMMARY STATEMENT: What is already known about the topic? Health service policy emphasizes that patients and families should be treated with dignity and respect, be active partners in all aspects of care and contribute to the development and improvement of health care.In the acute care setting, both patients and family members express the desire for a larger role in health‐care decision making; yet how this is enacted in an adult hospital setting is not well understood.Research in other settings has demonstrated the clinical benefits of family involvement in care include decreased mortality, reduced hospital length of stay, improved adherence to treatment regimens and decreased readmission rates. What this paper adds? Supporting meaningful family participation in the acute care setting requires supporting multiple levels of engagement. When families felt empowered and participated in care, patients and family members believed it helped nurses to keep the patient safe and individualize care.The tripartite relationship amongst patients, family members and acute care nurses is essential in empowering family members to participate in the care of acutely ill hospitalized adult patients. However, nurses' values, beliefs and attitudes towards involving families in patient care are seen to be crucial to the possibility of embedding family participation in the acute care setting. The implications of this paper: Policies that incorporate the patient and families' voice and behavioural change interventions may lead to the normalization of patient‐ and family‐centred practices in the adult acute care hospital setting. [ABSTRACT FROM AUTHOR]

Tuckett A, Hegney D, Parker D, Eley RM, Dickie R. International Journal of Nursing Practice 2011; 17: 444-454. The top eight issues Queensland Australia's aged-care nurses and assistants-in-nursing worried about outside their workplace: A qualitative snapshot The attainment of a work-life balance is an important issue for recruitment, retention and workforce planning. This paper aims to report on the free text data provided by the aged-care sector nurses around perceptions of important work-life issues. Data were written responses of aged-care nurses to the open-ended request at the end of a survey, which asked them to list up to five political/social/environmental issues concerning them outside of their work. For aged-care nurses, when asked to list political/social/environmental issues they were concerned about outside of work in late 2007, there emerged considered issues around work and life. Among the top eight themes there is an intriguing balance between the themes work, industrial relations, aged care/elder care and health-care services compared with the themes environment, water, societal values and housing. Qualitative insights into the political/social/environmental issues aged-care nurses are concerned about outside of your work suggest their desire for a labour/life or work/life harmony. Aged-care nurses place an equal importance on the nature of labour and the basics of life. The findings provide information for aged-care sector managers and workforce planners on areas in need of consideration to recruit and retain a workforce within aged care. [ABSTRACT FROM AUTHOR]

chang a.m., gardner g.e., duffield c. & ramis m.-a. (2010) A Delphi study to validate an Advanced Practice Nursing tool. Journal of Advanced Nursing 66(10), 2320–2330. Aim. This paper is a report of a study conducted to validate an instrument for measuring advanced practice nursing role delineation in an international contemporary health service context using the Delphi technique. Background. Although most countries now have clear definitions and competency standards for nurse practitioners, no such clarity exists for many advanced practice nurse roles, leaving healthcare providers uncertain whether their service needs can or should be met by an advanced practice nurse or a nurse practitioner. The validation of a tool depicting advanced practice nursing is essential for the appropriate deployment of advanced practice nurses. This paper is the second in a three-phase study to develop an operational framework for assigning advanced practice nursing roles. Method. An expert panel was established to review the activities in the Strong Model of Advanced Practice Role Delineation tool. Using the Delphi technique, data were collected via an on-line survey through a series of iterative rounds in 2008. Feedback and statistical summaries of responses were distributed to the panel until the 75% consensus cut-off was obtained. Results. After three rounds and modification of five activities, consensus was obtained for validation of the content of this tool. Conclusion. The Strong Model of Advanced Practice Role Delineation tool is valid for depicting the dimensions of practice of the advanced practice role in an international contemporary health service context thereby having the potential to optimize the utilization of the advanced practice nursing workforce. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Around the world, recovery has become a focus in mental health policy. The participation of people accessing mental health services (consumers) and carers of such individuals in decision-making related to services forms part of this recovery orientation and studies suggest positive outcomes following such participation., However, little is known about consumer and carer desires at the earliest stages of development of new services., What this paper adds to existing knowledge? Consumers and carers desire changes to how mental health services are provided., Many factors affect consumer and carer experiences, including language use, physical design of spaces, accessibility, consideration of individual needs, practical help and how well care is continued from hospital to community settings., Carers may feel sidelined in treatment and be distressed as a result. They wish to be respected and involved in recovery., Consumers and carers wish for focus on broader health, with care taken to address physical health, psychological needs, social needs and treatment of the whole person rather than just an illness., What are the implications for practice? Consumers and carers desire partnership with professionals in recovery. Tokenistic participation should be avoided., Flexibility in how services are provided and less formality may help engage consumers and carers. Specifically, professionals may help by linking consumers and carers to services that address practical needs., Professionals should communicate with carers to draw on their expertise about the individual accessing the mental health service and help carers understand how they can assist the individual's recovery., Abstract Introduction Recovery-oriented mental health policies recognize consumer and carer participation in service decision-making as essential, but little is known about the views of these individuals in the earliest stages of service development. Aim This study sought consumer and carer perspectives addressing the establishment of a mental health research, treatment and teaching facility in their region. Methods Two 2-hr focus groups were conducted, with separate groups held for mental health consumers ( n = 9) and carers ( n = 9), respectively. Discussions pertained to mental health literacy, gaps in current services, desires for an ideal facility (in terms of physical design and services offered) and what would help in recovery. Results Inductive thematic analysis was used to generate three themes: care outside of consultations, carer involvement in recovery and holistic approaches to mental health care. Consumers desired a facility that could cater to individual needs. Carers felt excluded in recovery and unable to provide effective support. Both groups preferred holistic approaches to mental health, expressing ambivalence towards medication and hospitalization. Discussion Consumers and carers have many needs that conventional practices may not meet. Implications for practice They have clear desires for equal partnership in recovery and for transformation of conventional treatment methods. [ABSTRACT FROM AUTHOR]

Aim To develop and psychometrically test a survey instrument to identify the factors influencing the provision of end-of-life care by critical care nurses. Background Following a decision to withdraw life-sustaining treatment, critical care nurses remain with the patient and their family providing end-of-life care. Identification of factors influencing the provision of this care can give evidence to inform practice development and support nurses. Design A cross-sectional survey of critical care nurses. Method An online survey was developed, reviewed by an expert panel and pilot tested to obtain preliminary evidence of its reliability and validity. In May 2011, a convenience sample of critical care nurses ( n = 392, response rate 25%) completed the survey. The analytical approach to data obtained from the 58 items measured on a Likert scale included exploratory factor analysis and descriptive statistics. Results Exploratory factor analysis identified eight factors influencing the provision of end-of-life care: emotional support for nurses, palliative values, patient and family preferences, resources, organizational support, care planning, knowledge and preparedness. Internal consistency of each latent construct was deemed satisfactory. The results of descriptive statistics revealed a strong commitment to the inclusion of families in end-of-life care and the value of this care in the critical care setting. Conclusion This paper reports preliminary evidence of the psychometric properties of a new survey instrument. The findings may inform practice development opportunities to support critical care nurses in the provision of end-of-life care and improve the care that patients and their families receive. [ABSTRACT FROM AUTHOR]

Aims. This paper is a report of the study of nurses' attitudes to the use of seclusion. More specifically, the aim was to address the relationship between burnout, job satisfaction and therapeutic optimism and justification of the use of seclusion. Background. Research findings demonstrate that nurses continue to view seclusion as a necessary intervention. Factors that might be associated with attitudes have not been examined. Methods. Questionnaires were distributed to nurses employed in inpatient units across eight mental health services in Queensland in 2008. Heyman Attitudes to Seclusion Survey, Elsom Therapeutic Optimism Scale, Maslach's Burnout Inventory and Minnesota Satisfaction Questionnaires were completed (N = 123). Data analysis involved descriptive statistics and Pearson product-moment correlation coefficients. Results. Most participants considered certain behaviours particularly those involving harm to self, others or to property as appropriate reasons for the use of seclusion and were consistent with their perceptions of the likely practice on their unit. An association was found between therapeutic optimism and emotional exhaustion (burnout) and justifications for the use of seclusion. Participants with higher optimism scores and lower scores for emotional exhaustion were significantly less likely to support the use of seclusion in specific situations. Conclusions. The relationship between therapeutic optimism and emotional exhaustion gives new information that might influence strategies and approaches taken with the aim of reducing seclusion use. Further research is warranted to explore these relationships and their implications. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a correlational study of the relationships between work-related injury-risk events and modifiable risk factors in a nursing population after controlling for socioeconomic factors. Background. Nurses are at high risk for work-related injury. Work-related injury is strongly influenced by psychosocial factors and physical job-related exposures, but the magnitude of effect from modifiable factors remains unclear. Method. Data were based on the Work Outcomes Research Cost-benefit survey conducted in Australia during 2005 and 2006. The study sample of 5724 represented ~14% of nurses in Queensland, Australia. Logistic regression was used to determine the magnitude of association of psychological distress (represented by the Kessler 6 score: six-item scale of psychological distress), the number of health conditions and various socioeconomic factors with work place injury. Results. High psychological distress was associated with a 5% probability of injury. As the number of health conditions increased, the probability of injury increased; 3 and ≥6 health conditions increased the chance of injury by 5% and 15% compared with no health conditions. Compared with the total sample, nurses who reported high levels of psychological distress demonstrated greater sensitivity to the number of health conditions. Computation of the marginal effects showed little difference in the likelihood of injury when the total sample was compared with nurses with <5 years of work experience. Conclusion. Effective occupational health and safety workplace programmes that target modifiable factors such as psychological distress and physical health conditions may improve the health capital of nurses and productivity levels within the profession. [ABSTRACT FROM AUTHOR]

Al-Motlaq M, Mills J, Birks M, Francis K. International Journal of Nursing Practice 2010; 16: 472-477 How nurses address the burden of disease in remote or isolated areas in Queensland Nurses have a role in addressing the burden of disease in remote or isolated areas of Queensland. Activities to prevent chronic and acute disease and injury, while promoting a health lifestyle, are a part of nurses' work that help to meet the goal of keeping a population healthy. The findings presented in this paper, as part of a broader study into the role of nurses working in remote or isolated areas of Queensland, describe how registered nurse in these locations address local burden of disease. Participants discussed the increased workload that engaging in health promotion and disease prevention activities creates for them when providing health-care services for their communities. Establishing stronger working relationships with visiting members of the primary health-care team, while addressing organizational barriers, might have a significant impact on the nurses' ability to help reduce the burden of disease in these areas. [ABSTRACT FROM AUTHOR]

Problem: Nurses are fundamental in presenting information to their patients to ensure understanding of information, and health directions enabling improved health outcomes. Limited research exists exploring how nurses assess patient's health literacy in Australia. Aim: To explore Australian nurses' perceptions of patients' health literacy and how nurses assess health literacy to provide patient education. Design: A qualitative study underpinned by phenomenology. Methods: Registered Nurses (N = 19) across five Queensland hospitals participated in semi‐structured interviews which explored nurses' assessment of patient's health literacy level and their practices of delivering education. The transcripts were analysed using an inductive process with interpretative analysis. Results: Four themes were identified: how we assess patient health literacy; challenges with health literacy assessment; consumer focused assessment; and building assessment strategies. Participants relied on cues from the patient to identify when information has not been understood. Participants felt that online training programs in the workplace would assist in education for assessment techniques; identification of patients with low health literacy; and how to best communicate with patients that have low health literacy. Conclusion: Formal health literacy assessments should be introduced to hospitals in Australia, but training is required to enable the nurse, the confidence and ability for health literacy assessment. Tailored education based on health literacy assessment would enhance the patient's understanding and improve discharge planning, which may reduce health service costs and readmissions. Reporting method: The Consolidated criteria for reporting qualitative research (COREQ) guidelines for qualitative research were followed. Patient or public contribution: Registered Nurses (N = 19) participated in qualitative interviews, providing data for analysis. Relevance to clinical practice: This study shows that nurses are already conducting informal assessments, simply by using observation and looking for cues. More education for nurses about health literacy and how to tailor their discussions with patients will improve communication. [ABSTRACT FROM AUTHOR]

Aims: To explore healthcare professionals' perceptions of the feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients. Background: Early mobilisation is beneficial to minimise intensive care unit acquired‐weakness in critically ill patients and family engagement can help with meeting early mobilisation goals, but it is not widely practiced. Understanding healthcare professionals' perceptions of feasibility and acceptability of family engagement in early mobilisation of adult critically ill patients is required to inform future implementation strategies to promote early mobilisation. Design: A descriptive qualitative study. Methods: Face‐to‐face, individual, semi‐structured interviews were conducted between August 2021 and March 2022 with healthcare professionals working in two intensive care units in Australia. The interviews were analysed using the inductive content analysis, and descriptive statistics were used to summarise participant characteristics. The COREQ checklist was followed when reporting this study. Results: Eleven ICU nurses, five physiotherapists and four physicians participated in the interviews. Three main categories were identified: (i) healthcare professionals' readiness, (ii) mediators of engagement and (iii) foundations for successful implementation. Most participants demonstrated a positive attitude towards an implementation of family engagement in early mobilisation for adult critically ill patients; however, capability and capacity of healthcare professionals, family members' willingness, availability and readiness and the care context were considered factors that could influence the successful implementation. Conclusion: From the perspectives of healthcare professionals, family engagement in early mobilisation is feasible and acceptable to enact but implementation is influenced by contextual factors including, healthcare professionals' capability and capacity and family members' willingness, availability and readiness. Collaborative teamwork and preparing family members and healthcare professionals are needed to support this practice. Relevance to Clinical Practice: The findings provide important information to further identify potential strategies of family engagement in early mobilisation and to help and mitigate factors that impede implementation. [ABSTRACT FROM AUTHOR]

Aims: To understand the enablers and barriers for delivering fundamental care to hospitalized older patients. Design: Explanatory sequential mixed methods design, with qualitative data used to elaborate quantitative results. Methods: Set in one medical and one surgical unit of a tertiary hospital in southeast Queensland, Australia. Observations of nursing practice using the Work Sampling Technique were conducted over two 2‐week periods in 2019. Data were analyzed and presented to groups of nurses who appraised the findings of the observations. Results: There were 1176 and 1278 observations of care in the medical unit over two time periods and 1380 and 1398 observations over the same period in the surgical unit. Fundamental care activities were recorded in approximately 26% (i.e. medical) and 22% (i.e. surgical) of all observations. Indirect care was highest, recorded in 41% (i.e. medical) and 43% (i.e. surgical) of observations. Nurses prioritized the completion of reportable activities, which is perceived as a potential enabler of fundamental care. Potential barriers to fundamental care included frequent delays in indirect care and difficulty balancing care requirements across a group of patients when patients have high fundamental care needs. Conclusion: The cultural acceptance of missed nursing care has the potential to erode public confidence in health systems, where assistance with fundamental care is expected. Relational styles of nurse leadership should focus on: (1) making fundamental care important work in the nurses' scope thereby offering an opportunity for organizational change, (2) promoting education, demonstrating the serious implications of missed fundamental care for older patients and (3) investigating work interruptions. Impact Fundamental care is necessary to arrest the risk of functional decline and associated hospital‐acquired complications in older patients. However, nurses commonly report fundamental care as missed or omitted care. Understanding the challenges of implementing fundamental care can assist in the development of nurse leadership strategies to improve older patients' care. Fundamental care was observed between 22% (i.e. surgical) and 26% (i.e. medical) of all observations. Nurses explained that they were focused on prioritizing and completing reported activities, experienced frequent delays when delivering indirect care and found balancing care requirements across groups of patients more challenging when patients had fundamental care needs. Clinical nurses working in acute health services with increasing populations of older patients can lead improvements to fundamental care provision through relational leadership styles to demonstrate how this work is in nurses' scope of practice, promote education about the serious implications of missed fundamental care and investigate the root cause of work interruptions. [ABSTRACT FROM AUTHOR]

Robinson R, Barnett T. International Journal of Nursing Practice 2012; 18: 205-209 Health related quality of life and the support needs of carers of cardiac surgical patients: An exploratory study In this descriptive, repeated-measures study, we assessed changes in Health-Related Quality of Life (HRQL) of cardiac surgical patients' caregivers over time and their need for support. Ninety-six primary carers of cardiac patients who had received elective surgery at one tertiary referral hospital were recruited. The majority were female spouses of patients who had undergone bypass and/or cardiac valve surgery. Participants completed a self-administered questionnaire that included the SF-36v2 quality of life health survey and asked about their need for support 6 weeks and 6 months following patient discharge. Carers reported a significant improvement in five out of eight HRQL dimensions ( Physical functioning, Physical role, Vitality, Social functioning, Role-emotional) over the study period ( P < 0.05). Those who completed the survey at 6 weeks but not 6 months reported higher scores across all dimensions. Carers' need for support need was higher at 6 weeks than 6 months. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine nurses' perceptions of physical and verbal violence perpetrated by patients and visitors and to investigate themes surrounding gender and the incidence of violence. Background: The prevalence of violence towards nurses is a concern for nurses and hospital administrators. However, nurses who work in acute care and mental healthcare settings are particularly at high risk. This study examines the occurrence, type of violence and gender issues in a regional public hospital of Queensland Australia. Design: An exploratory, qualitative design. Methods: Focus group interviews with 23 nurses from Emergency Department (ED), Intensive Care Unit (ICU) and Psychiatry Department (PD) working in Queensland regional public hospital, Australia. Qualitative data were transcribed and thematically analysed manually and by NVivo. COREQ research reporting checklist followed. Results: Participants reported frequent incidents of verbal and physical violence on a daily basis. Severe incidence included punching, kicking, biting and scratching, as well as threats of using weapons, such as knives. Patients were more likely to exhibit physical violence, especially towards male nurses, while hospital visitors including patient's family were more likely to exhibit verbal violence. Allocating male nurses in volatile areas and to care for violent patients raises concerns that the male nurses may be seen by their patients as "bodyguards" and not as a professional nurse. Conclusion: Findings indicate that staff believe that violence is increasing, feel the burden to accept that violence as part of the job and that the bureaucratic processes of the organisation make it difficult to address violence or get support. Organisations need to be vigilant in ensuring assistance is accessible and simplified. Relevant to clinical practice: This study contributes new knowledge to the discussion concerning of gender issues. Identifying gender issues could assist in developing the necessary interventions to reduce workplace violence. [ABSTRACT FROM AUTHOR]

Objectives: To investigate family members' prioritisation of care in residential aged care facilities (RACFs). Introduction and background: Family members are often involved in the care of their older relatives even after these relatives transit to a RACF. Understanding family members' priorities regarding care (i.e., what is most important to them) can provide valuable insights into how to better meet residents' needs. Design: A multisite mixed‐methods study comprising qualitative methods and Q methodology. The qualitative component of the study was guided by the COREQ checklist. Methods: Participants comprised 27 family members of residents living in one of five participating Australian RACFs. Participants rank‐ordered 34 cards, each representing an aspect of care, on a predefined grid from "Least important" (−4) to "Most important" (+4). Participants also engaged in a think‐aloud task, demographic questionnaire, post‐sorting interview and semi‐structured interview. Q data were analysed using inverted factor techniques to identify factors that each represent a portion of shared meaning. Factors were interpreted as viewpoints using data from the think‐aloud task and interviews. These data were further analysed using inductive content analysis to reveal influences on prioritisation decision‐making. Results: Three distinct viewpoints were identified through Q methodology: prioritisation of residents' physical needs, maintaining residents' independence, and human connection. Inductive content analysis revealed four influences on prioritisation decision‐making: residents' capabilities and support requirements, unmet needs, family bridging the gaps, and family knowledge of residents. Conclusions: The study indicated that to meet residents' needs and family members' priorities, individualised approaches to care are warranted. It also demonstrated the vital role family members play in residents' care when needs are not fully met. Relevance to Clinical Practice: Strategies to improve individualised care in clinical practice include flexibility of routines, supporting family members' involvement in care, workforce training focused on family–staff communication, and safer staffing ratios. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: To explore adult general surgical patients' perceptions of, and satisfaction with, discharge education provided by healthcare providers. Background: Discharge education is essential for general surgical patients as it equips them with the required knowledge and skills to engage in their care after discharge. Insufficient knowledge to self‐manage or assess their symptoms can result in postdischarge complications, unplanned hospital readmission and overall dissatisfaction with the hospital experience. Design: A constructivist‐interpretivist paradigm using qualitative interviews. Methods: Telephone interviews were conducted with 13 patients between August 2018 and November 2018 and analysed using inductive content analysis. COREQ guidelines were adopted for the conduct and reporting of the study. Results: Four themes were uncovered: (a) The quality of discharge information influences patients' postdischarge experience; (b) The negative impact of contextual influences on delivery of discharge education; (c) Patients actively participating in their surgical journey; (d) Patients' preferences with the delivery of discharge education. Conclusion: Inadequate discharge education leads to patients' inability to self‐manage their recovery process. Information sharing with patients fosters shared understanding towards goals and expectations. Relevance to clinical practice: Understanding patients' view may inform the design of patient‐centred discharge education interventions for patients to self‐manage their recovery postdischarge. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. Background: While there are evidence‐based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without. Design: Critical incident technique. Methods: Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south‐east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed. Results: Three themes emerged from 23 reflective accounts of fall events: "direct observation is confounded by multiple observers" and "knowing the person has cognitive impairment is not enough," and "want to rely on the guideline but unsure how to enact it." While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment. Conclusions: Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. Relevance to clinical practice: To reduce falls, nurses can involve the family to support "knowing the patient" to enable prediction of impulsive actions; shift the focus of in‐service from lectures to specific case presentations, with collaborative analysis on person‐focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living. [ABSTRACT FROM AUTHOR]

Abstract: Background: The validity of instruments is crucial in ensuring that data collected are sound and that these data represent what the instrument claims to measure. When an instrument is revised or used in a different population, it is useful to re‐examine its construct validity. Aim: To test the psychometrics properties of an instrument—the revised Families’ Importance In Nursing Care—Nurses’ Attitudes, designed to measure nurse’ attitudes towards involving family in nursing care in an adult acute care setting. Design and methodology: A cross‐sectional survey design was used in April–May 2016 with a sample of Enrolled and Registered Nurses (N = 212) to test the factor structure of the revised Families’ Importance In Nursing‐Nurses’ Attitudes instrument. The instrument had 26 items with a five‐point Likert response scale. Principle components analysis and exploratory factor analysis were performed with oblique rotations to assess the internal structure of the instrument. Setting: A regional referral hospital in Queensland, Australia. Results: Using Principal Components Analysis and Principal Axis Factoring, we obtained the same factor structure to that originally identified for the instrument. Our results suggested the removal of six items to refine the instrument and achieve simple structure. Conclusion: The removal of several items, relabeling of factors and residual cross‐loading issues suggest that further revisions to the instrument are needed. [ABSTRACT FROM AUTHOR]

Abstract: Aim: This research aimed to explore factors that influence sustainability of health service innovation, specifically emergency nurse practitioner service. Background: Planning for cost effective provision of healthcare services is a concern globally. Reform initiatives are implemented often incorporating expanding scope of practice for health professionals and innovative service delivery models. Introducing new models is costly in both human and financial resources and therefore understanding factors influencing sustainability is imperative to viable service provision. Design: This research used case study methodology (Yin, ). Methods: Data were collected during 2014 from emergency nurse practitioners, emergency department multidisciplinary team members and documents related to nurse practitioner services. Collection methods included telephone and semi‐structured interviews, survey and document analysis. Pattern matching techniques were used to compare findings with study propositions. Findings: In this study, emergency nurse practitioner services did not meet factors that support health service sustainability. Multidisciplinary team members were confident that emergency nurse practitioner services were safe and helped to meet population health needs. Organizational support for integration of nurse practitioner services was marginal and led to poor understanding of service capability and underuse. Conclusion: This research provides evidence informing sustainability of nursing service models but more importantly raises questions about this little explored field. The findings highlight poor organizational support, excessive restrictions and underuse of the service. This is in direct contrast to contemporary expanding practice reform initiatives. Organizational support for integration is imperative to future service sustainability. [ABSTRACT FROM AUTHOR]

Aims and objectives To report a study protocol and the theoretical framework normalisation process theory that informs this protocol for a case study investigation of private sector nurse practitioners. Background Most research evaluating nurse practitioner service is focused on public, mainly acute care environments where nurse practitioner service is well established with strong structures for governance and sustainability. Conversely, there is lack of clarity in governance for emerging models in the private sector. In a climate of healthcare reform, nurse practitioner service is extending beyond the familiar public health sector. Further research is required to inform knowledge of the practice, operational framework and governance of new nurse practitioner models. Design The proposed research will use a multiple exploratory case study design to examine private sector nurse practitioner service. Methods Data collection includes interviews, surveys and audits. A sequential mixed method approach to analysis of each case will be conducted. Findings from within-case analysis will lead to a meta-synthesis across all four cases to gain a holistic understanding of the cases under study, private sector nurse practitioner service. Normalisation process theory will be used to guide the research process, specifically coding and analysis of data using theory constructs and the relevant components associated with those constructs. Conclusions This article provides a blueprint for the research and describes a theoretical framework, normalisation process theory in terms of its flexibility as an analytical framework. Relevance to clinical practice Consistent with the goals of best research practice, this study protocol will inform the research community in the field of primary health care about emerging research in this field. Publishing a study protocol ensures researcher fidelity to the analysis plan and supports research collaboration across teams. [ABSTRACT FROM AUTHOR]

Aims and objectives This study aimed to establish the scale of alcohol-related injuries originating in the home. Background Despite recent media and public attention on alcohol-related injuries occurring at licensed venues, many occur in other locations including the home. Design A retrospective observational study. Methods Emergency department surveillance data sourced from the Queensland Injury Surveillance Unit were interrogated for alcohol-related emergency department presentations from 2003-2012 (n = 12,296). Descriptive analysis was undertaken to assess alcohol involvement in injury, and analysis of variance was used to determine the differences among group means and their associated presentations. The relationship between demographic variables and injury location was assessed using p value of <0·05 as statistically significant. Results Of all injuries that were positively identified as being alcohol related, 41·07% occurred at the 'other' location, 36·14% 'at home', 13·00% on the street and 9·78% at licensed premises. Of these, males ( n = 2635; 59%) represented a higher proportion than females ( n = 1807; 41%). Of injuries identified as domestic violence by spouse or partner ( n = 510), 59·5% occurred 'at home'. Conclusions This is the first study to investigate alcohol-related injuries occurring at home. The home accounts for a greater proportion of injuries than the frequently assessed licensed premises location. Further research is required to validate these findings in a wider setting. Relevance to clinical practice A public health campaign is required to minimise harm associated with alcohol-related injuries in the home, and nurses are positioned to inform health policy makers around this issue. Furthermore, emergency department nurses are in a unique position to provide brief interventions around safe alcohol consumption and injury prevention. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to examine the decision-making of nursing students during team based simulations on patient deterioration to determine the sources of information, the types of decisions made and the influences underpinning their decisions. Background Missed, misinterpreted or mismanaged physiological signs of deterioration in hospitalized patients lead to costly serious adverse events. Not surprisingly, an increased focus on clinical education and graduate nurse work readiness has resulted. Design A descriptive exploratory design. Methods Clinical simulation laboratories in three Australian universities were used to run team based simulations with a patient actor. A convenience sample of 97 final-year nursing students completed simulations, with three students forming a team. Four teams from each university were randomly selected for detailed analysis. Cued recall during video review of team based simulation exercises to elicit descriptions of individual and team based decision-making and reflections on performance were audio-recorded post simulation (2012) and transcribed. Results Students recalled 11 types of decisions, including: information seeking; patient assessment; diagnostic; intervention/treatment; evaluation; escalation; prediction; planning; collaboration; communication and reflective. Patient distress, uncertainty and a lack of knowledge were frequently recalled influences on decisions. Conclusions Incomplete information, premature diagnosis and a failure to consider alternatives when caring for patients is likely to lead to poor quality decisions. All health professionals have a responsibility in recognizing and responding to clinical deterioration within their scope of practice. A typology of nursing students' decision-making in teams, in this context, highlights the importance of individual knowledge, leadership and communication. [ABSTRACT FROM AUTHOR]

Aim To test the psychometric properties of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index. Background Pressure injury risk assessment is a crucial aspect in determining the relative risk of patients and the need for preventative intervention. In the intensive care setting there are few risk assessment scales that have been developed specifically for critically ill patients. Design Instrument development. Methods A convenience sample of 26 intensive care patients was used. Data were collected in December 2012. Five intensive care nurses scored each patient with all four scales. Intraclass correlation coefficients and standard errors of measurement were used to assess inter-rater reliability and agreement of the sum, risk category and item scores. Convergent validity of the COMHON Index was investigated by examining correlations between the sum scores and similar constructs of the scales. Results Inter-rater reliability of the COMHON Index was higher than the other scales and strong correlations were found between it and the Braden and Norton scales but not the Waterlow score. Two items common to all scales (mobility; neurological status) demonstrated significant correlations between the COMHON, Braden and Norton scales but not the Waterlow score. One item (nutrition) was significantly correlated between the COMHON and Braden scales. Conclusion Inter-rater reliability and agreement of the COMHON Index were the highest of the four scales, with the Norton and Braden performing similarly and the Waterlow score the least well. The strong and significant associations between the Braden, COMHON and Norton scales suggest they are measuring similar constructs. [ABSTRACT FROM AUTHOR]

Aims To assess the medication knowledge of emergency department nurses and determine the factors affecting their nurse-initiated medication practices. Background Nurse-initiated medications is a vital practice for all nurses in emergency departments which improves pain assessment, provides safe pain management and reduces time-to-analgesia and other meaningful treatments. Design Mixed methods. Between September 2014-January 2015, data were collected by questionnaire assessing medication knowledge and face-to-face interviews determining factors affecting practice. Results Nurse-initiated medications frequency of the Registered Nurses ranged from 0-36 times per week dependent on employed hours and emergency department area worked. Medication knowledge was consistent among nurses, but there was an overall deficit in nurses' knowledge of mechanism of action. Four major themes were identified from the 24 interviews: patient-centred care, caution and safety as principles of practice; continuing support and education; improvement of practice over time. All nurses regard the practice positively and to be extremely beneficial to patients. Although apprehensive at the start of their nurse-initiated medications practice, confidence improved with exposure and experience. Nurses sought additional information from colleagues and the available evidence-based resources. Conclusion Medication knowledge is not the sole determinant of nurse-initiated medications practice. The practice is motivated by multiple factors such as patients' needs, safety and nurses' confidence. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess changes in perceptions of confidence and preparedness for practice of preregistration nursing students before and after the introduction of a capstone subject, and factors associated with perceptions of preparedness. Background Preregistration nursing student 'readiness' or 'preparedness' for practice has been highlighted in the literature in recent years, along with employer concerns that university graduate nurses are not work ready. Few studies have examined Australian preregistration nursing students' perceptions of preparedness for clinical practice following their final clinical placement or assessed whether preregistration student nurses' perceptions of preparedness change as the result of undertaking a capstone subject. Design A capstone subject was introduced at a regional northern Australian university in 2013. Perceptions of preparedness were assessed in two different cohorts of final year nursing students; one of which undertook a capstone subject. Methods Two separate cohorts of third year nursing students were surveyed regarding their perceptions of preparedness for practice at the conclusion of their final 240 hour clinical placement. The 2012 cohort did not experience a capstone subject, whereas the 2013 cohort were the first nursing students to experience the new capstone subject. Results Both cohorts were uncomfortable performing invasive procedures and reported low levels of confidence in the area of professional identity. An overall trend of decreasing confidence as patient assignment size increased was observed for both cohorts, and higher confidence was associated with previous health care experience. Perceptions of preparedness for practice did not increase significantly following the introduction of a capstone subject. Conclusions Although Australian undergraduate nursing student report feeling prepared for practice there are areas of knowledge, skills and patient care in which confidence is low. The results of this study highlight the importance of experience in building confidence and competence. Relevance to clinical practice This study highlights that while final year nursing students report feeling prepared for practice there are areas where additional support can be provided. It is recommended that nurse educators and health care facilities tailor their programs to provide support focused on the areas highlighted by this study. [ABSTRACT FROM AUTHOR]

Accessible Summary Recent evidence suggests that the interactional work of mental health nursing has been eroded and redirected to the task-based roles of medicine., This study utilized work sampling methodology to observe the proportion of time nurses working in a mental health setting spend in direct care, indirect care and service-related activities., Nurses spent 32% of their time in direct care, 52% in indirect care and 17% in service-related activities., Mental health nurses need to re-establish their therapeutic availability to maximize consumer experiences and outcomes., Abstract The foundation of mental health nursing has historically been grounded in an interpersonal, person-centred process of health care, yet recent evidence suggests that the interactional work of mental health nursing is being eroded. Literature emphasizes the importance of person-centred care on consumer outcomes, a model reliant upon the intimate engagement of nurses and consumers. Yet, the arrival of medical interventions in psychiatry has diverted nursing work from the therapeutic nursing role to task-based roles delegated by medicine, distancing nurses from consumers. This study used work sampling methodology to observe the proportion of time nurses working in an inpatient mental health setting spend in the activities of direct care, indirect care and service-related activities. Nurses spent 32 of their time in direct care, 52% in indirect care and 17% in service-related activities. Mental health nurses need to re-establish their therapeutic availability to maximize consumer experiences and outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the impact of an educational programme focused on social behaviours and relationships on organisational learning culture in the residential aged care context. Background The number of aged care homes will continue to rise as the frail older elderly live longer, requiring more formal care and support. As with other small- to medium-sized health services, aged care homes are faced with the challenge of continuous development of the workforce and depend upon registered nurses to lead staff development. Design A mixed-method evaluation research design was used to determine the impact of an educational programme focused on social aspects of learning on organisational learning culture. Methods One hundred and fifty-nine (pre) and 143 (post) participants from three aged care homes completed the Clinical Learning Organisational Culture survey, and three participant-researcher registered nurse clinical educators provided regular journal entries for review. Results While each site received the same educational programme over a six-month period, the change in organisational learning culture at each site was notably different. Two aged care homes had significant improvements in affiliation, one in accomplishment and one in recognition. The educators' journals differed in the types of learning observed and interventions undertaken, with Eucalyptus focused on organisational change, Grevillea focused on group (student) change and the Wattle focused on individual or situational change. Conclusion Clinical educator activities appear to have a significant effect on organisational learning culture, with a focus on the organisational level having the greatest positive effect on learning culture and on individual or situational level having a limited effect. Relevance to clinical practice Clinical educator facilitation that is focused on organisational rather than individual interests may offer a key to improving organisational learning culture. [ABSTRACT FROM AUTHOR]

Aim The aim was to explore the relationship between nursing casualization and the culture of communication for nurses in a healthcare facility. Background Casualization, or non-standard work, is the use of temporary, contract, part-time and casual labour. An increase in casual labour has been part of a global shift in work organization aimed at creating a more flexible and cheaper workforce. It has been argued that flexibility of labour has enabled nurses to manage both non-work related needs and an increasingly complex work environment. Yet no research has explored casualization and how it impacts on the communication culture for nurses in a healthcare facility. Design Critical ethnography. Methods Methods included observation, field notes, formal interviews and focus groups. Data collection was undertaken over the 2 years 2008-2009. Results The concepts of knowing and belonging were perceived as important to nursing teamwork and yet the traditional time/task work model, designed for a full-time workforce, marginalized non-standard workers. The combination of medical dominance and traditional stereotyping of the nurse and work as full-time shaped the behaviours of nurses and situated casual workers on the periphery. The overall finding was that entrenched systemic structures and processes shaped the physical and cultural dimensions of a contemporary work environment and contributed to an ineffective communication culture. Conclusion Flexible work is an important feature of contemporary nursing. Traditional work models and nurse attitudes and practices have not progressed and are discordant with a contemporary approach to nursing labour management. [ABSTRACT FROM AUTHOR]

Aims and Objectives To explore the perspectives of nursing directors in mental health in Queensland, Australia, regarding the skills and attributes of graduates of comprehensive nursing programme to provide an industry perspective and thus augment knowledge from theoretical and professional dimensions. Background There is a worldwide shortage of appropriately qualified nurses with the knowledge, skills and attitudes to work effectively in mental health services. Within Australia, this has been well documented since the introduction of comprehensive nursing education. The underrepresentation of mental health content in undergraduate curricula has been identified as the primary reason for nursing graduates not being adequately prepared for practice in this field. To date, this issue has primarily been addressed from the perspective of university academics, with the voice of industry relatively silent in the published literature. Design Qualitative exploratory. Method In-depth telephone interviews with Director of Nursing (Mental Health) in Queensland, Australia. Results The concerns of participants were expressed in six main themes: (1) foundational knowledge of mental health and disorders, (2) recovery-oriented skills, (3) physical as well as mental health skills, (4) therapeutic strategies, (5) resilience and self-development and (6) advanced knowledge and skills. Conclusions The education of comprehensive nursing education needs to be reviewed as a matter of priority to ensure graduates with the attributes required to provide high-quality care for consumers of mental health services. Relevance to clinical practice A skilled and knowledgeable workforce is an essential component of high-quality mental health services. Research highlighting the current deficits and issues is therefore of the highest priority. [ABSTRACT FROM AUTHOR]

Aims and Objectives. To examine wound assessment and management in patients following surgery and to compare these practices with current evidence-based guidelines for the prevention of surgical site infection across one healthcare services district in Queensland, Australia. Background. Despite innovations in surgical techniques, technological advances and environmental improvements in the operating room, and the use of prophylactic antibiotics, surgical site infections remain a major source of morbidity and mortality in patients following surgery. Design. A retrospective clinical chart audit Methods. A random sample of 200 medical records of patients who had undergone surgery was undertaken over a two-year period (2010-2012). An audit tool was developed to collect the data on wound assessment and practice. The study was undertaken across one healthcare services district in Australia. Results. Of the 200 records that were randomly identified, 152 (76%) met the inclusion criteria. The excluded records were either miscoded or did not involve a surgical incision. Of the 152 records included, 87 (57.2%) procedures were classified as 'clean' and 106 (69.7%) were elective. Wound assessments were fully documented in 63/152 (41.4%) of cases, and 59/152 (38.8%) charts had assessments documented on a change of patient condition. Of the 15/152 (9.9%) patients with charted postoperative wound complications, 4/15 (26.6%) developed clinical signs of wound infection, which were diagnosed on days 3 to 5. Conclusions. The timing, content and accuracy of wound assessment documentation are variable. Standardising documentation will increase consistency and clarity and contribute to multidisciplinary communication. Relevance to clinical practice. These results suggest that postoperative wound care practices are not consistent with evidence-based guidelines. Consequently, it is important to involve clinicians in identifying possible challenges within the clinical environment that may curtail guideline use. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the self-reported wound care practices of acute care nurses practising in a large metropolitan hospital in Queensland, Australia. Background Wound infections occur in up to 30% of surgical procedures and are the third most commonly reported hospital-acquired infection. The growing complexity and cost of wound care demand that nurses use wound care knowledge based on best practice guidelines. Design Descriptive cross-sectional survey design. Methods A convenience sample of 250 medical and surgical nurses working in an acute care facility was invited to complete a 42-item survey. The survey was based on an extensive literature review and an environmental scan of wound care issues in major hospitals, Australia. Results The survey was completed by 120 acute care nurses with a response rate of 48%. Ninety (75·6%) respondents reported that 'wound appearance' was the most important factor guiding their choice of dressing product. Only 6 (5·0%) respondents considered the cost of a dressing product 'highly important'. Fifty-nine (50·4%) respondents reported being 'unaware' of the national standards pertaining to wound management, and only 41 (34·7%) respondents reported that their knowledge of wound products was 'good' or 'excellent'. The majority ( n = 89, 75·4%) of respondents used the hospital's wound care specialist nurses as the primary source of information in regard to managing acute wounds. Conclusions Although acute care nurses have a sound knowledge of wound healing processes, it appears that many do not use the recommended clinical guideline pertaining to wound care. Relevance to clinical practice While it is important for nurses to detect early wound complications, treatment plans based on wound assessments need to be informed by current clinical guidelines. In implementing the guideline, it is essential to first identify barriers and facilitators to knowledge transfer. [ABSTRACT FROM AUTHOR]

Aims and objectives To report on registered nurses' situation awareness as a precursor to decision-making when recording changes in patients' conditions. Background Progress notes are important to communicate patients' progress and detail changes in patients' conditions. However, documentation is often poorly completed. There is little work that examines nurses' decision-making during documentation. This study focused on describing situation awareness as a precursor to decision-making during documentation. Design This study used Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) work on situation awareness to guide and conceptualise information. The study was situated in a naturalistic paradigm to provide an interpretation of nurses' decision-making. Methods Think-aloud research methods and semi-structured interviews were employed to illuminate decision-making processes. Audio recordings and interview texts were individually examined for evidence of cues, informed by Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) descriptions of situation awareness. Results As patients' conditions changed, nurses used complex mental models and pattern-matching of information, drawing on all 3 levels of situation awareness during documentation. Level 1 situation awareness provided context, level 2 situation awareness signified a change in condition and its significance for the patient, and level 3 situation awareness was evident when nurses thought aloud about what this information indicated. Three themes associated with changes in patients' conditions emerged: deterioration in condition, not responding to prescribed treatments as expected and issues related to professional practice that impacted on patients' conditions. Conclusion Nurses used a complex mental model for decision-making, drawing on 3 levels of situation awareness. Hamm's cognitive continuum theory, when related to situation awareness, is a useful decision-making theory to provide a platform on which to draw together components of situation awareness and provide a framework on which to base decision-making regarding documentation. Relevance to clinical practice Understanding how RNs employ situation awareness and providing a framework for decision-making during documentation may assist effective documentation about changes in patients' conditions. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the recovery of trauma intensive care patients up to six months posthospital discharge. Background Injury is a leading cause of preventable mortality and morbidity worldwide, with approximately 10% of hospitalised trauma patients being admitted to intensive care. Intensive care patients experience significant ongoing physical and psychological burden after discharge; however, the patterns of recovery and the subgroups of intensive care patients who experience the greatest burden are not described. Design This prospective cohort study was conducted in one tertiary referral hospital in south-east Queensland, Australia. Methods Following ethics approval, injured patients who required admission to intensive care provided consent. Participants completed questionnaires prior to hospital discharge ( n = 123) and one ( n = 93) and six months ( n = 88) later. Data included demographic and socioeconomic details, pre-injury health, injury characteristics, acute care factors, postacute factors [self-efficacy, illness perception, perceived social support and psychological status as measured by the Kessler Psychological Distress Scale (K10) and the PTSD Civilian Checklist] and health status ( SF-36). Results All participants required ongoing support from healthcare providers in the six months after discharge from hospital, and approximately half required support services such as accommodation and home modifications. Approximately 20% of participants reported post-traumatic stress symptoms, while approximately half the participants reported psychological distress. Average quality of life scores were significantly below the Australian norms both one and six months postdischarge. Conclusions Trauma intensive care patients rely on ongoing healthcare professional and social support services. Compromised health-related quality of life and psychological health persists at six months. Relevance to clinical practice Effective discharge planning and communication across the care continuum is essential to facilitate access to healthcare providers and other support services in the community setting. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory from the perspectives of senior nurses. Background Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who is performing the procedure and typically, an anaesthetist is not present. Design A qualitative exploratory design was employed. Methods Semi-structured interviews with 23 nurses from 16 cardiac catheterisation laboratories across four states in Australia and also New Zealand were conducted. Data analysis followed the guide developed by Braun and Clark to identify the main themes. Results Major themes emerged from analysis regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements. Conclusions The most critical issue identified in this study is that current guidelines, which are meant to apply regardless of the clinical setting, are not practical for the cardiac catheterisation laboratory due to a lack of access to anaesthetists. Furthermore, this study has demonstrated that nurses hold concerns about the legitimacy of their practice in situations when they are required to perform tasks outside of clinical practice guidelines. To address nurses' concerns, it is proposed that new guidelines could be developed, which address the unique circumstances in which sedation is used in the cardiac catheterisation laboratory. Relevance to clinical practice Nurses need to possess advanced knowledge and skills in monitoring for the adverse effects of sedation. Several challenges impact on nurses' ability to monitor patients during procedural sedation and analgesia. Preprocedural patient education about what to expect from sedation is essential. [ABSTRACT FROM AUTHOR]

Aims Structural equation modelling tested hypothesized causal relationships between age, gender, pain, depression, self-efficacy, outcome expectations, functional status and quality of life in older Australians postorthopaedics surgery across three stages of their rehabilitation. Background Self-efficacy is important in forming personal beliefs about capabilities to perform functional activities, which is believed to maintain individual's quality of life. Research examining how efficacy beliefs influence functional status in older people following orthopaedic events is limited. Design A descriptive, longitudinal method was used for this study. Methods A convenience sample of 101 older people with orthopaedic surgery to lower extremities was recruited from private rehabilitation units in Brisbane, Australia. Data were collected from September 2008-November 2009. Standardized questionnaires were used to measure efficacy beliefs, functional status, and quality of life. Results Structural equation modelling revealed that depression, efficacy beliefs, age, and gender significantly influenced quality of life, as self-efficacy and gender have a direct relationship on functional status. Across three stages in the model, outcome expectation at stage 2 was the most significant predictor of functional recovery after discharge. Older men with higher quality of life at admission was positively related to self-efficacy and negatively associated with depression at stage 2: quality of life influenced outcome expectations and pain positively at stage 3. Conclusion Rehabilitation programmes play a significant role in assisting older people in resuming functional activities and quality of life following orthopaedic surgery. Enhancing self-efficacy may facilitate older people's participation and adher-ence to rehabilitation programmes during hospitalization and following discharge. [ABSTRACT FROM AUTHOR]

This was the first Australian study investigating the acceptability, feasibility and sustainability of a nurse-led model of chronic disease management in general practice. A concurrent mixed-methods design was used within a 12-month intervention of nurse-led care in three general practices. Adult patients with type 2 diabetes, hypertension and/or stable ischaemic heart disease were randomized into nurse-led or standard care. Semi-structured interviews explored perceptions of key stakeholders towards this model including patients in the nurse-led arm, and all practice staff pre- and posttrial. The data were thematically analysed and the emergent themes were: importance of time; collaborative relationships; nurse job satisfaction, confidence and competence; patient self-management and choice. Our findings showed that nurses provided chronic disease management that was acceptable, feasible and sustainable. The collaborative involvement of doctors was intrinsic to patient acceptability of nurse-led care that facilitated job satisfaction, and therefore retention and growth within this nursing speciality. [ABSTRACT FROM AUTHOR]

Aims and objectives. The purpose of this study was to explore the impact of chronic pain on the partner and family of a person with chronic pain. Background. Chronic pain impacts not only on the individual but also their partner and/or other family members. Families of people with chronic pain have reported feeling powerless, alienated, emotionally distressed, and isolated. These impacts have affected their relationship with the person with chronic pain. Design. An interpretive qualitative design using in-depth interviews and thematic analysis was undertaken. Methods. Purposive sampling and in-depth interviewing were undertaken to develop a rich description of the experience. Results. Findings indicate the impact of chronic pain on the family is extensive, resulting in physical, social, and emotional changes. Four themes were revealed: (1) Family loss, (2) Life changes, (3) Emotional impact of pain, and (4) Future plans. Conclusion. This study reinforces and expands current knowledge regarding the impact of chronic pain on partners and families. Understanding this phenomenon opens opportunities for nurses and other health workers to develop and implement strategies to better support partners/families in the future. Relevance to clinical practice. Nurses can help reduce the negative impact of pain by including families in assessment, education, referral and treatment processes, and by offering support and education to partners/families. [ABSTRACT FROM AUTHOR]

Aim. To determine effectiveness of clinical placements in non-mental health facilities in producing improvement in attitudes toward people with a mental illness and toward mental health nursing in nursing students. Background. Clinical placements in mental health settings have favourably impacted students' attitudes and confidence in mental health settings. Placement shortages have created discussion about using non-mental health settings to gain this experience, as mental illness is common in all health settings. To date, no research findings support or refute the efficacy of non-mental health settings in influencing confidence and attitudes. Design. A within-subject design was used. Participants provided self-report data soon after the beginning and at the conclusion of the mental health component. Methods. A questionnaire was administered to a cohort of undergraduate nursing students ( n = 66) to measure attitudes, preparedness for practice and interest in mental health nursing as a career, using a pre- and post-test design. Results. Only 25% of participants completed clinical experience in a mental health facility. Minor improvement in attitudes, confidence and appreciating the nursing role in mental health were identified, but the impact on attitudes was considerably less favourable than when clinical experience was undertaken in a mental health facility. Conclusion. Participants who completed clinical experience in a non-mental health facility did not demonstrate more favourable views about mental health nursing. Relevance to clinical practice. Clinical placements in mental health are essential preparation for undergraduate students to maximise improvement in attitudes to the care of people diagnosed with a mental illness and to mental health nursing. [ABSTRACT FROM AUTHOR]

eley d., eley r., bertello m. & rogers-clark c. (2012) Why did I become a nurse? Personality traits and reasons for entering nursing. Journal of Advanced Nursing 68(7), 1546-1555. Abstract Aims. This article is a report of a mixed method study of the association between personality traits of nurses and their reasons for entering nursing. Background. The worldwide nursing shortage prompts research into better understanding of why individuals enter nursing and may assist in exploring ways to increase their recruitment and long term retention. Design. A mixed method sequential explanatory design employed semi-structured interviews and a validated personality inventory measuring temperament and character traits. Methods. Registered Nurses ( n = 12) and nursing students ( n = 11) working and studying in a regional area of Queensland Australia were purposively sampled for the interviews in 2010 from their participation in the survey in 2009 investigating their personality traits. Qualitative data collection stopped at saturation. A thematic content analysis of the qualitative data using the framework approach was interpreted alongside their personality trait profiles. Results. Two dominant themes were identified from the participant interviews about reasons for entering nursing; 'opportunity for caring' and 'my vocation in life'. These themes were congruent with key temperament and character traits measured in the participants. All nurses and students were very high in traits that exude empathy and altruistic ideals regardless of other characteristics which included highly pragmatic and self-serving principles. Conclusions. Qualitative and quantitative findings suggest that a caring nature is a principal quality of the nursing personality. Recruitment and retention strategies whilst promoting multiple benefits for the profession should not forget that the prime impetus for entering nursing is the opportunity to care for others. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study sought to compare two well-known and well-used self-report quality of life questionnaires in terms of completion rates, reliability and assessment of quality of life. Background. People with dementia have a meaningful experience of quality of life and several disease-specific instruments have been designed to capture self-report assessments. Design. A quantitative survey design, with a convenience sample of older people with dementia from four long-term care facilities. Method. Sixty-one participants were recruited for survey on the Dementia Quality of Life questionnaire and the Quality of Life in Alzheimer's Disease questionnaire. Results. The Quality of Life in Alzheimer's Disease questionnaire had a higher rate of completion (98·4%) than the Dementia Quality of Life questionnaire (68·9%). Those unable to complete the latter measure had significantly greater cognitive impairment ( F1,59 = 30·35, p < 0·001) than those completing the measure. Internal reliability was good for the Quality of Life in Alzheimer's Disease questionnaire (0·86), but there were varying levels found for the five Dementia Quality of Life questionnaire subscales (0·79-0·48). The Quality of Life in Alzheimer's Disease questionnaire was significantly correlated with all the Dementia Quality of Life questionnaire subscales and overall item. Conclusions. Although it is recognised that there is no superior instrument in assessing quality of life, this study found both the Quality of Life in Alzheimer's Disease questionnaire and Dementia Quality of Life questionnaire to be useful self-report instruments. Relevance to clinical practice. Assessment of quality of life should include the perspective of the person with dementia. The Quality of Life in Alzheimer's Disease questionnaire and Dementia Quality of Life questionnaire appear to measure similar aspects of quality of life. Where assessments are sought from participants with more advanced cognitive and functional impairment, it may be favourable to employ the Quality of Life in Alzheimer's Disease questionnaire. [ABSTRACT FROM AUTHOR]

Aim. To explore patients' non-adherence to psychiatric medication with mental health nurses. Background. The ability of consumers to maintain normal sexual behaviours is complicated by abnormally high incidence of sexual problems arising from the medications they are prescribed. Sexual side effects of psychiatric medications are identified as a major reason for non-adherence to psychiatric medication regimes yet it remains an issue mental health nurses tend to avoid in their practice with consumers. Design. An exploratory, descriptive qualitative approach. Method. Individual interviews were conducted with 14 nurses currently working with adult consumers of mental health services. Data analysis followed the framework approach developed by Ritchie and Spencer as the process for identification of the main themes. Results. Problems with sexual function in relation to psychiatric medication issues was one major theme to emerge from this research. More specifically the participants referred to: assessment of sexual function, the side effects of psychiatric medication, consumer embarrassment, and, the pros and cons of information. Participants recognised that sexual side effects were likely to have an impact on adherence to medication and that this was an important consideration but most did not discuss this issue with consumers. Consumer embarrassment and the belief that knowledge itself might cause non-adherence were the two main reasons for not discussing this topic. Conclusions. Problems with sexual function of consumers presents an important practice consideration for nurses working in mental health settings. There is an urgent need for strategies to enhance awareness and confidence among nurses in exploring this topic with consumers. Relevance to clinical practice. Mental health nurses can adopt a leadership role in recognising the relevance of sexuality in care and treatment for consumers of mental health services. Strategies to assist in developing skill and confidence in this domain are required as a matter of priority. [ABSTRACT FROM AUTHOR]

crilly j., chaboyer w. & wallis m. (2012) A structure and process evaluation of an Australian hospital admission avoidance programme for aged care facility residents. Journal of Advanced Nursing 68(2), 322-334. Abstract Aim. To describe and evaluate the structures and processes involved in a hospital in the Nursing Home programme. Background. Older Australians are the largest consumers of healthcare, and as a result of the ageing process are at risk of developing hospital acquired iatrogenic complications. Hospital admission avoidance programmes that aim to provide care for patients in their own environment include Hospital in the Home and, more recently, Hospital in the Nursing Home. Methods. In 2006, a qualitative evaluation of a nurse-led Hospital in the Nursing Home programme using semi-structured interviews with 19 stakeholders was undertaken. Data analysis involved using start codes and content analysis. Findings. Effective referral and communication strategies were important for Hospital in the Nursing Home implementation. Furthermore, the Hospital in the Nursing Home programme manager had acute care and community experience and worked in an advanced practice role. These elements were integral to the programme's operation. Conclusion. As the population ages, reducing hospital admissions for aged-care facility residents has the potential to improve patient outcomes. A structurally and procedurally sound programme is a key element in achieving this aim. [ABSTRACT FROM AUTHOR]

The aim of this study was to gain an understanding of the experiences and perspectives of intensive care nurses caring for critically ill obstetric patients. Current literature suggests critically ill obstetric patients need specialised, technically appropriate care to meet their specific needs with which many intensive care nurses are unfamiliar. Furthermore, there is little research and evidence to guide the care of this distinct patient group. This study used a descriptive qualitative design. Two focus groups were used to collect data from 10 Australian intensive care units nurses in May 2007. Open-ended questions were used to guide the discussion. Latent content analysis was used to analyse the data set. Each interview lasted no longer than 60 minutes and was recorded using audio tape. The full interviews were transcribed prior to in-depth analysis to identify major themes. The themes identified from the focus group interviews were competence with knowledge and skills for managing obstetric patients in the intensive care unit, confidence in caring for obstetric patients admitted to the intensive care unit and acceptance of an expanded scope of practice perceived to include fundamental midwifery knowledge and skills. The expressed lack of confidence and competence in meeting the obstetric and support needs of critically ill obstetric women indicates a clear need for greater assistance and education of intensive care nurses. This in turn may encourage critical care nurses to accept an expanded role of clinical practice in caring for critically ill obstetric patients. Recognition of the issues for nurses in successfully caring for obstetric patients admitted to an adult intensive care setting provides direction for designing education packages, ensuring specific carepaths and guidelines are in place and that support from a multidisciplinary team is available including midwifery staff. [ABSTRACT FROM AUTHOR]

To explore the perceptions of loneliness according to people with early-stage dementia, living in community and long-term care and also the views of their family carers. Research that specifically explores the influence of loneliness on dementia is limited and indicates the prevalence of loneliness and the negative relationship between loneliness and cognitive decline. There is a paucity of research that explores loneliness from the perspective of the person with dementia. A descriptive exploratory qualitative approach was used. Data were collected through semi-structured audio-taped interviews. A purposive sample of 70 people with a diagnosis or probable dementia and 73 family carers were recruited from community and long-term care from South East Queensland, Australia. Four themes were identified: staying connected to others; losing the ability to socially engage; experiencing loneliness; and overcoming loneliness. The results emphasise the importance of familiar human relationships in reducing the feelings of loneliness in people experiencing dementia. People with dementia are at risk of loneliness, but placing them with unfamiliar people and environments may not improve their situation. Better refinement of care that takes into account the potential for loneliness and an understanding of premorbid social tendency may assist in the implementation of individualised and evidence-based strategies to assist people with dementia to lead a better quality of life. To maintain well-being, the social needs of the person with dementia as well as the family need to be considered. [ABSTRACT FROM AUTHOR]

This Australian study explored management for older people with dementia in an acute hospital setting. As the population ages, increasing numbers of older people with dementia are placed into an acute care hospital to manage a condition other than dementia. These people require special care that takes into account the unique needs of confused older people. Current nursing and medical literature provides some direction in relation to best practice management; however, few studies have examined this management from the perspective of hospital staff. A descriptive qualitative approach was used. Data were collected using semi-structured audio-taped interviews with a cross section of thirteen staff that worked in acute medical or surgical wards in a large South East Queensland, Australia Hospital. Analysis of data revealed five subthemes with the overarching theme being paradoxical care, in that an inconsistent approach to care emphasised safety at the expense of well-being and dignity. A risk management approach was used rather than one that incorporated injury prevention as one facet of an overall strategy. Using untrained staff to sit and observe people with dementia as a risk management strategy does not encourage an evidence-based approach. Staff education and environmental resources may improve the current situation so that people with dementia receive care that takes into account their individual needs and human dignity. Nurses can assist older people with dementia by encouraging evidence-based care practices to become the part of hospital policy. [ABSTRACT FROM AUTHOR]