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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]

Aims: To investigate effectiveness of the nurse clinician as a Non‐Medical Surgical Assistant compared with the Medical Surgical Assistant. Background: Non‐Medical Surgical Assistants are clinicians who are not medical practitioners. The surgical assistant works directly with the primary surgeon intraoperatively. Design A pragmatic, retrospective, observational study on patients undergoing Laparoscopic Inguinal Hernia Repair or Primary Unilateral Total Hip Arthroplasty. Each patient received intraoperative care from a consultant surgeon and a Medical Surgical Assistant or Non‐Medical Surgical Assistant. All surgical assistants were registered with the Australian Health Practitioner Regulation Agency. Methods: Data were collected between 01/07/2014 and 30/06/2017. The effect that surgical assistant choice had on patient outcomes was estimated using regression statistical models. Six dependent variables, including length of stay, for clinical outcome assessment were specified. Results/Findings The groups were equivalent in age, gender, and American Society of Anaesthesiologists scores. There were more emergency procedures in the Medical Surgical Assistant group and more hip surgery in the Non‐Medical Surgical Assistant group. Patient outcome assessment showed no statistically significant differences for surgical assistant types. Conclusion: The nurse clinician in the role of Non‐Medical Surgical Assistant was shown to be effective with equivalent patient outcomes compared with the Medical Surgical Assistant. SUMMARY STATEMENT: What is already known about this topic? There is limited international research and no research conducted in Australia, investigating quality of care of the Non‐Medical Surgical Assistant.Existing research on Non‐Medical Surgical Assistants has been limited to a single specialty, which is often cardiac surgery.International research reports equal patient outcomes for the Non‐Medical Surgical Assistant using the comparator of the Medical Surgical Assistant; however, the Non‐Medical Surgical Assistant does not exclusively have a nursing‐based qualification in these studies. What this paper adds? Our study focuses on the two most common surgical specialties in Australia and the Non‐Medical Surgical Assistant with a nursing qualification of either a Registered Nurse or Nurse Practitioner.The results show that the choice of nursing or medical surgical assistant did not affect patient outcomes. The implications of this paper: In Australia, Registered Nurses and Nurse Practitioners can provide effective care in the role of surgical assistant compared with the Medical Surgical Assistant.While patient outcomes are equal, the Registered Nurse and Nurse Practitioner in Australia are not remunerated by the government similarly to the medical personnel undertaking the role of surgical assistant. This raises issues of inequity in the Australian health‐care system for patients accessing surgical care and making the role of surgical assistant unsustainable to non‐medical health‐care personnel.Findings are relevant to the Medicare Benefits Schedule Review Taskforce and access to the Medical Benefits Schedule for Non‐Medical Surgical Assistants. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine presence of clinical complications related to dysphagia and to explore their operational outcomes. Background Dysphagia is a common complication of stroke. The management of poststroke dysphagia is multidisciplinary with nurses playing a key role in screening for dysphagia risk, monitoring tolerance of food and fluids and checking for the development of complications such as fever, dehydration and change in medical status. Dysphagia often results in further complications including aspiration pneumonia and the need for nasogastric feeding. Dysphagia-related complications have been shown to have a significant impact on morbidity and mortality, length of stay and cost of admission. Design Retrospective cohort study. Methods A total of 110 patients presenting with an ischaemic stroke were chart-audited. Results Aspiration pneumonia poststroke was found to be significantly associated with increased overall length of stay, poorer functional outcomes poststroke as well as being associated with a high risk of mortality. The presence of a nasogastric tube was also associated with reduced functional outcomes poststroke and increased risk of death. Conclusion High prevalence and cost of complications associated with stroke highlight the complexity of providing nursing and allied health care to this patient population. This provides a snapshot of dysphagia-related complications experienced by stroke patients. Relevance to clinical practice This paper highlights that poststroke complications can significantly impact on patient outcomes and operational factors such as cost of admission; therefore, poststroke care requires a multidisciplinary approach to management. Furthermore, preventing and managing complications poststroke is a key element of nursing care and has the potential to significantly reduce incidence of mortality, length of stay and cost of hospital admission. [ABSTRACT FROM AUTHOR]

Hegney D, Tuckett A, Parker D, Eley RM. International Journal of Nursing Practice 2010; 16: 188–202 Workplace violence: Differences in perceptions of nursing work between those exposed and those not exposed: A cross-sector analysis Nurses are at high risk of incurring workplace violence during their working life. This paper reports the findings on a cross-sectional, descriptive, self-report, postal survey in 2007. A stratified random sample of 3000 of the 29 789 members of the Queensland Nurses Union employed in the public, private and aged care sectors resulted in 1192 responses (39.7%). This paper reports the differences: between those nurses who experienced workplace violence and those who did not; across employment sectors. The incidence of workplace violence is highest in public sector nursing. Patients/clients/residents were the major perpetrators of workplace violence and the existence of a workplace policy did not decrease levels of workplace violence. Nurses providing clinical care in the private and aged care sectors experienced more workplace violence than more senior nurses. Although workplace violence was associated with high work stress, teamwork and a supportive workplace mitigated workplace violence. The perception of workplace safety was inversely related to workplace violence. With the exception of public sector nursing, nurses reported an inverse relationship with workplace violence and morale. [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]

Harvey N, Holmes CA. International Journal of Nursing Practice 2012; 18: 188-194 Nominal group technique: An effective method for obtaining group consensus This paper aims to demonstrate the versatility and application of nominal group technique as a method for generating priority information. Nominal group technique was used in the context of four focus groups involving clinical experts from the emergency department (ED) and obstetric and midwifery areas of a busy regional hospital to assess the triage and management of pregnant women in the ED. The data generated were used to create a priority list of discussion triggers for the subsequent Participatory Action Research Group. This technique proved to be a productive and efficient data collection method which produced information in a hierarchy of perceived importance and identified real world problems. This information was vital in initiating the participatory action research project and is recommended as an effective and reliable data collection method, especially when undertaking research with clinical experts. [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]

Indigenous women are disproportionately affected by the prevalence and severity of domestic and family violence (DFV) perpetrated by men against women in Australia. The impact of their experiences is further exacerbated by the level of social and cultural marginalisation affecting Indigenous communities, families and individuals along with regional, rural or remote living. The pervasive, ongoing impact of colonisation, dispossession and transgenerational trauma continues to shape the experiences of Indigenous women and their communities, including their help‐seeking decisions and opportunities, and their level of trust in and access to adequate and culturally sensitive support services. In this paper, we explore the experiences of Indigenous women affected by DFV in two regional Australian settings through face‐to‐face interviews with women (n = 13) and community stakeholders (n = 18). The findings of this study highlight the complex role of social and cultural marginalisation, spiritual (dis)connectedness and role of family as both a stressor and a protective factor. Implications for policy and practice are discussed. [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]

Aim: To determine the reporting accuracy of pressure injury categorisation by bedside clinicians, compared with nurse experts. Background: Pressure injuries are an enduring complication of hospitalisation. The categorisation of pressure injury affects treatment and management decision‐making and use of resources, and severe hospital‐acquired pressure injury incidence is used to benchmark quality of care. However, it is unclear how accurately pressure injuries are categorised by clinicians in practice. Design: Secondary analysis of hospital pressure injury incident and validation data. Methods: All pressure injuries reported in adults between 2016 and 2019 that were subsequently validated by nurse experts were analysed. Absolute agreement is reported using percentages, with inter‐rater agreement reported using Kappa measure of agreement. The GRRAS reporting guideline was followed. Results: Of 6186 pressure injuries that were analysed, the category was reported correctly in 67.3% (n = 4163), with an overall moderate level of inter‐rater agreement by category (Κ =.567, p <.001). Of those found to be non‐pressure injuries when validated (18.3%, n = 1129), most were reported originally as stage II (41.2%, n = 465) or stage I (30.5%, n = 344), and 13.4% (n = 151) were categorised initially as unstageable. The majority reported initially as stage I, stage II, suspected deep tissue injury or mucosal pressure injury were validated, whereas half of those reported initially as stage III or IV were validated and less than a third of those reported initially as unstageable pressure injuries were validated. Conclusions: This study provides important insight into the accuracy of pressure injury categorisation. Whilst moderate agreement of categorisation was found between reporting clinicians and nurse experts, pressure injury differential diagnosis and categorisation of severe injuries were inadequate. Relevance to Clinical Practice: These results may be used for benchmarking and provide a focal point for future education and practice improvement efforts. Patient or Public Contribution: Neither patients nor the public were directly involved in the project. [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]

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]

Aim In this paper, we describe a trial protocol used to assess feasibility related to: study administration (recruitment, randomization, retention, compliance, eligibility criteria, suitability of protocol instructions and data collection questionnaires); resource and data management (suitability of site, time and budget allocation, management of personnel and data); intervention fidelity (treatment dose, violations); and effect size. Background Pressure injury can lead to increases in hospital length of stay and cost. The sacrum is identified as one of the most common anatomical pressure injury sites for hospitalized patients. Silicone foam border dressings have been proposed as one strategy to reduce pressure injury incidence; however, rigorous testing of benefit in a general medical-surgical population is required. Design Randomized controlled trial. Methods Eighty patients will be recruited after assessment of high risk of pressure injury in a large tertiary hospital in south-east Queensland, Australia. Eligible, consenting participants will be randomly allocated to either a control group (routine care) or an intervention group (routine care and a sacral prophylactic dressing). The primary outcomes comprise feasibility criteria as identified above. The secondary measure is the presence and severity of sacral pressure injury via blind assessment of digital photographs. Research ethics approval was received in October 2013. Discussion Prophylactic dressings applied to the sacrum may be an effective method for reducing pressure injury in high-risk general medical-surgical patients. However, more rigorous studies to confirm benefit are required. This pilot study will determine the feasibility and effect size to inform a larger randomized controlled trial. [ABSTRACT FROM AUTHOR]

Students of nursing enter their programmes of study with preconceived ideas of what a career in their chosen profession will entail. The literature suggests that images from the media and past experiences contribute to these perceptions. Although it is positive images of the profession that will usually attract an individual to a career in nursing, often more negative perceptions will direct students away from potentially rewarding areas of specialization. This paper describes career projections of nursing students enrolled in the first year of four preservice nursing programmes at the rural campus of one Australian university. Part of a larger study, the data reported here indicate that most respondents intend to practice in the areas of midwifery, paediatrics and emergency nursing. Oncology, community nursing, aged care and mental health nursing all ranked poorly across three rounds of surveys. These findings have implications for practicing nurses and nurse educators who seek to dispel inaccurate images of these important specializations. [ABSTRACT FROM AUTHOR]

Background: Changed behaviours in residential aged care facilities (RACF) are frequently reported in the literature. How RACF staff routinely respond to these observed changed behaviours represents a significant gap. Objective: To analyse the frequency of changed behaviour reported within RACF behavioural report logs and to ascertain how staff typically manage these behaviours. Methods: Residents (N = 25) with varying levels of cognitive function were recruited from a 160 bed RACF in Queensland, Australia. A retrospective analysis of behavioural report logs was conducted to elucidate prevalence of reported changed behaviours as categorised by RACF staff. Thematic analysis of staff recorded behavioural mitigation strategies was used to categorise staff actions. A case analysis was also conducted to highlight the challenges faced by RACF staff managing persistent acute changed behaviours using identified common mitigation strategies. The STROBE guidelines were followed for reporting. Results: There were 395 behaviours recorded in a two‐month period. Physical agitation, interfering while wandering, trying to get to inappropriate places, verbal refusal of care, physical aggression, and verbal disruption were most frequently reported by staff. Management strategies included redirection, PRN psychotropic medication, reassurance, routine care practices, offering of beverages, repositioning, and rarely analgesia. A 24‐h case analysis highlighted how staff utilised redirection and multiple doses of a PRN benzodiazepine with limited effectiveness. Conclusion: This study reveals current mitigation strategies employed by RACF staff in response to acute changed behaviours often associated with dementia. Agitation and wandering are prevalent and are difficult for staff to manage effectively. Relevance to clinical practice: This study highlights that careful consideration should be taken to avoid overuse of PRN benzodiazepines in management of changed behaviours. Short‐term mitigation strategies, such as redirection, may not be effective if underlying causes such as pain, physiological, mental, emotional, or social needs are not met. Patient and public contribution: A RACF participated in project design and review. [ABSTRACT FROM AUTHOR]

Background: Pressure injuries on mucous membranes are caused by pressure from medical devices at the site of injury and differ to those on the skin. Intensive care patients, who have multiple devices in situ, are particularly vulnerable. There is a significant knowledge gap regarding mucous membrane pressure injury (MMPI) incidence in acute hospital settings. Aim: To analyse MMPI incidence and characteristics in a tertiary acute general hospital. Methods: A secondary data analysis of hospital clinical incident reports was conducted. The sample included all adults with MMPIs between 2015 and 2019. The STROBE reporting guideline was followed. Results: There were 414 reports of MMPI. Most (91.5%, n = 379) were hospital‐acquired with the majority found in intensive care patients (74.4%, n = 282). Hospital‐acquired MMPI incidence was 0.1% (11 MMPI per 10,000 hospital episodes). In intensive care, the incidence was 2.4% (235 MMPI per 10,000 intensive care episodes). The median time from device insertion until reporting of an MMPI was 3 days. The most common sites of mucosal injury were the lips (35.6%) and mouth (28.8%). In all cases except one, MMPI was associated with medical device use at the site of injury. Five device types were identified (oral endotracheal tube‐related 70.3%; urinary catheter 15.5%; gastric tube 8.3%; nasal prongs 3.5%; tracheostomy tube 2.4%). In intensive care, oral endotracheal tube‐related devices were most often associated with MMPI (84.8%), whereas in non‐intensive care MMPI it was the urinary catheter (51.4%). Conclusions: While hospital‐acquired MMPI incidence is relatively low, it is considerably higher in intensive care patients compared to those in non‐intensive care settings. The most common sites are the lips and mouth. Relevance to clinical practice: Mucous membrane pressure injuries represent a significant proportion of all hospital‐acquired pressure injuries. Patient or public contribution: Neither patients nor the public were directly involved in this project. [ABSTRACT FROM AUTHOR]

Aims. To explore the attitudes, experiences and opinions of registered nurses regarding supervision of undergraduate nursing students while administering medication in the healthcare setting. Background. Medication errors present a considerable risk to safety in the healthcare setting. By virtue of their role in the administration of medication, registered nurses are considered as major contributors to this problem. Undergraduate nursing students administer medication in the clinical setting, but little attention has been paid to the implications for patient safety. Design. This research was conducted using exploratory qualitative methodology. Methods. Focus group interviews were conducted with 13 registered nurses. The participants were asked to describe their experiences and opinions regarding the supervision of undergraduate nursing students. Data were analysed using the framework approach. Results. Three main themes from this work are presented in this paper: 'standard of supervision', 'a beneficial experience' and 'preparation'. Conclusions. The participants regarded supervision as an important process in fostering student learning and ensuring safety. Preparation on the part of the healthcare facility, students and the university were essential to maximise the benefits for all concerned. Relevance to clinical practice. The ability to administer medication safely is an important skill for all registered nurses. Nursing students need the opportunity to develop these skills as part of their undergraduate educational programme. Registered nurses must supervise students in a rigorous and supportive manner to enhance learning and to promote quality care. [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]

To enhance the understanding of the skills and attitudes of mental health nurses working in the Australian Mental Health Nurse Incentive Program. The Mental Health Nurse Incentive Program places qualified mental health nurses alongside community-based general practitioners, private psychiatric practices and other appropriate organisations to provide clients with mental health conditions with a more integrated treatment plan. An exploratory, qualitative approach was undertaken, given the paucity of relevant research in this area. Exploratory individual interviews were conducted with ten mental health nurses working in this scheme. Data analysis was organised and managed using QSR NVivo qualitative analysis software. Respondents identified specific skills and attitudes required for practice under the Mental Health Nurse Incentive Program. Eight areas of skill and attitude were identified as essential for mental health nurses working in this field. This study highlights that many of these skills and attitudes are specific to the setting where mental health nurses are working. Mental health nurses working under this programme have a role to play in the dissemination of knowledge about their practice. More needs to be done by governments and other institutions to ensure that general practitioners and other health professionals understand the role played by mental health nurses in the provision of care. The extent to which the Mental Health Nurse Incentive Program becomes a sustainable strategy to promote quality and accessible mental health care will depend to some degree on the capacity to identify the skills and attitudes necessary for practice. The findings presented in this paper provide a significant contribution to articulating the essential characteristics required for this area of practice. [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]

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]

Bunya nuts are the seeds of Araucaria bidwillii, a conifer native to South‐East Queensland, Australia. They are one of the 19 species of Araucaria family found around the world, with the nuts from South America being the most commonly consumed. They are traditionally eaten boiled or roasted. This study aims to profile the sensory properties of bunya nuts with chestnut as a comparator. Since chestnuts do not come from a conifer tree, it is expected that there will be differences. Different methods of preparation are also expected to change the sensory attributes. Representative samples were collected from a variety of locations in South‐East Queensland, prepared and presented to a panel of 14 experienced tasters applying conventional sensory descriptive profiling. During training, the panel developed a lexicon of 23 sensory attributes together with definitions and reference. Profiles of the boiled and roasted bunya nuts revealed higher scores for hardness on the first bite than chestnuts and, when chewed, became more crumbly, dry, and grainy. They had a savory aroma and flavor, and roasted samples exhibited a roasted aroma. Bunya nut samples were less sweet than chestnut samples. Differences in the sensory properties due to method of preparation were also observed. Boiled bunya nuts were softer and moister, with lower scores for crumbly and grainy. This research is foundational in providing technical information on the sensory profile of this important Indigenous Australian nut and provides a strong basis to support novel food sector opportunities for the bunya nut as a reemerging food source not only in Australia, but also South America. Practical Application: There is an increase demand for local, sustainable, and natural foods. Bunya nuts are native to Australia and are part of the Araucaria family, which includes 19 species that can be found around the world. To the best of our knowledge there is no study characterizing Araucaria nuts in terms of sensory attributes. This study builds a lexicon for bunya nuts and compares to chestnuts. It also shows how different preparation methods affect its sensory attributes, as well as possible future uses in product development. The outcomes might provide information to support studies on Araucaria nuts in other countries. [ABSTRACT FROM AUTHOR]

Aim: To evaluate an emancipatory Practice Development approach for strengthening nursing surveillance on a single medical‐surgical ward. Background: Registered nurses keep patients safe in acute care settings through the complex process of nursing surveillance. Our interest was understanding how frontline teams can build safety cultures that enable proactive nursing surveillance in acute care wards. Design: A year‐long emancipatory Practice Development project. Methods: A collaborative relationship was established around a shared interest of nursing surveillance capacity and researcher embedded on a medical‐surgical ward. Critical analysis of workplace observations and reflection with staff generated key sites for collective action. Ward engagement was supported by creative Practice Development methods including holistic facilitation, critical reflection and action learning. An action learning set was established with a group of clinical nurses, facilitating practitioner‐led change initiatives which strengthened nursing surveillance and workplace learning. Evaluation supported an iterative approach, building on what worked in an acute care context. Immersive researcher evaluation, drawing on multiple data sources, generated an analysis of how ward nursing surveillance capacity can be strengthened. COREQ criteria guided reporting. Results: The ward moved through a turbulent and transformative process of resistance and retreat towards a new learning culture where nursing surveillance was visible and valued. Staff developed and sustained innovations including the 'My MET Call series', a 'Shared GCS initiative', an enhanced 'Team Safety Huddle', and staff‐led Practice Development workshops. These new practices affirmed nurses' agency, asserted nurses' clinical knowledge, positioned nurses to participate in team decision‐making and humanised care. Conclusion: Working collaboratively with frontline staff enabled bottom‐up sustainable innovation to strengthen nursing surveillance capacity where it mattered most, at the point of care. Relevance to clinical practice: Emancipatory Practice Development enables the profound impact of small‐scale, microsystem level practice transformation. It is an accessible methodology for clinical teams to develop effective workplace cultures. [ABSTRACT FROM AUTHOR]

Aims and objectives. To demonstrate the usefulness of a theoretical framework for humanising care of dementia patients. Background. The term humanisation of care has been increasingly used to describe an approach to health care that is informed by core dimensions of what it means to be human. Recent developments in dementia care highlight the importance of maintaining personhood in people with dementia. Design. A conceptual framework is proposed by which the humanisation of care can be understood and applied. Eight dimensions that articulate core features of what needs to be attended to in order for a person to feel more deeply 'met' as a human being are discussed. Evidence from an evaluative study of a dementia outreach service is used to illustrate the usefulness of the humanising framework. Methods. Case study examples demonstrate the value of this framework by describing how a dementia outreach service enables care staff in residential aged care facilities to change their focus in the provision of care to residents with dementia. Each of the eight dimensions of humanisation/dehumanisation is used to illustrate how the dementia outreach service team have led to the improvements in resident care. Results. Positive outcomes can be achieved by providing humanised care to residents with dementia. Conclusion. The paper highlights the potential for the humanising framework to be used in dementia care and shows how the framework can be helpfully translated into practice so that carers are supported to adopt an inclusive view of care delivery. Relevance to clinical practice. A comprehensive framework, grounded in a strong philosophical foundation, can name a breadth of criteria for humanly sensitive care and can be translated into practice in such a way as to potentially transform the provision of care to residents in residential aged care facilities. [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]

Parker D, Tuckett A, Eley R, Hegney D. International Journal of Nursing Practice 2010; 16: 352–358 Construct validity and reliability of the Practice Environment Scale of the Nursing Work Index for Queensland nurses This article reports on construct validity and reliability of 30 items of the Practice Environment Scale of the Nursing Work Index (PES-NWI). Australia, like other countries, is experiencing a shortage of nurses; a multifactor approach to retention of nurses is required. One significant factor that has received increasing attention in the last decade, particularly in the USA, is the nursing practice environment. The reliability of the 30 items of the PES-NWI was assessed by Cronbach's alpha and factor analysis was performed using principal component analysis. The PES-NWI was completed by nurses working in the aged-care, private and public sectors in Queensland, Australia. A total of 3000 surveys were distributed to a random sample of members of the Queensland Nurses Union. Of these, 1192 surveys were returned, a response rate of 40%. The PES-NWI was shown to be reliable demonstrating internal consistency with a Cronbach's alpha of the total scale of 0.948. The 30 items loaded onto five factors explaining 57.7% of the variance. The items across the factors differed slightly from those reported by the original author of the PES-NWI. This study indicates that the PES-NWI has construct validity and reliability in the Australian setting for nurses. [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]

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]

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: Describe and compare current surgical wound care practices across two hospitals in two health services districts, Australia. Background: Surgical site infections (SSI) are a complication of surgery and occur in up to 9.5% of surgical procedures, yet they are preventable. Despite the existence of clinical guidelines for SSI prevention, there remains high variation in wound care practice. Design: Prospective comparative design using structured observations and chart audit. Methods: A specifically developed audit tool was used to collect data on observed wound care practices, documentation of wound assessment and practice, and patients' clinical characteristics from patients' electronic medical records. Structured observations of a consecutive sample of surgical patients receiving wound care with a convenience sample of nurses were undertaken. The manuscript adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. Results: In total, 154 nurses undertaking acute wound care and 257 surgical patients who received wound care were observed. Across hospitals, hand hygiene adherence after dressing change was lowest (Hospital A: 8/113, 7%; Hospital B: 16/144, 11%; χ2: 8.93, p =.347). Most wound dressing practices were similar across sites, except hand hygiene prior to dressing change (Hospital A: 107/113, 95%; Hospital B: 131/144, 91%; (χ2: 7.736, p =.021) and use of clean gloves using nontouch technique (Hospital A: 88/113, 78%; Hospital B: 90/144, 63%; χ2: 8.313, p =.016). The most commonly documented wound characteristic was wound type (Hospital A: 43/113, 38%; Hospital B: 70/144, 49%). What nurses documented differed significantly across sites (p <.05). Conclusions: Clinical variations in wound care practice are likely influenced by clinical context. Relevance to clinical practice: Using an evidence‐based approach to surgical wound management will help reduce patients' risk of wound‐related complications. [ABSTRACT FROM AUTHOR]

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]

Aims and objectives: To investigate whether awareness of manual respiratory rate monitoring affects respiratory rate in adults, and whether count duration influences respiratory rate estimates. Background: Nursing textbooks typically suggest that the patient should ideally be unaware of respiratory rate observations; however, there is little published evidence of the effect of awareness on respiratory rate, and none specific to manual measurement. In addition, recommendations about the length of the respiratory rate count vary from text to text, and the relevant empirical evidence is scant, inconsistent and subject to substantial methodological limitations. Design: Experimental study with awareness of respiration monitoring (aware, unaware; randomised between-subjects) and count duration (60 s, 30 s, 15 s; within-subjects) as the independent variables. Respiratory rate (breaths/minute) was the dependent variable. Methods: Eighty-two adult volunteers were randomly assigned to aware and unaware conditions. In the baseline block, no live monitoring occurred. In the subsequent experimental block, the researcher informed aware participants that their respiratory rate would be counted, and did so. Respirations were captured throughout via video recording, and counted by blind raters viewing 60-, 30- and 15-s extracts. The data were collected in 2015. Results: There was no baseline difference between the groups. During the experimental block, the respiratory rates of participants in the aware condition were an average of 2.13 breaths/minute lower compared to unaware participants. Reducing the count duration from 1 min to 15 s caused respiratory rate to be underestimated by an average of 2.19 breaths/minute (and 0.95 breaths/minute for 30-s counts). The awareness effect did not depend on count duration. Conclusions: Awareness of monitoring appears to reduce respiratory rate, and shorter monitoring durations yield systematically lower respiratory rate estimates. Relevance to clinical practice: When interpreting and acting upon respiratory rate data, clinicians should consider the potential influence of these factors, including cumulative effects. [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]

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]

Aims and objectives To examine the quality and safety of nurse practitioner services of two newly implemented nurse practitioner models of care at a correctional facility. Background Nurse practitioners could help to meet the physical and mental health needs of Australia's growing prison population; however, the nurse practitioner role has not previously been evaluated in this context. Design A quality assurance study conducted in an Australian prison where a primary health nurse practitioner and a mental health nurse practitioner were incorporated into an existing primary healthcare service. The study was guided by Donabedian's structure, processes and outcomes framework. Methods Routinely collected information included surveys of staff attitudes to the implementation of the nurse practitioner models ( n = 21 staff), consultation records describing clinical processes and time use ( n = 289 consultations), and a patient satisfaction survey ( n = 29 patients). Data were analysed descriptively and compared to external benchmarks where available. Results Over the two-month period, the nurse practitioners provided 289 consultations to 208 prisoners. The presenting problems treated indicated that most referrals were appropriate. A significant proportion of consultations involved medication review and management. Both nurse practitioners spent more than half of their time on individual patient-related care. Overall, multidisciplinary team staff agreed that the nurse practitioner services were necessary, safe, met patient need and reduced treatment delays. Conclusions Findings suggest that the implementation of nurse practitioners into Australian correctional facilities is acceptable and feasible and has the potential to improve prisoners' access to health services. Structural factors (e.g., room availability and limited access to prisoners) may have reduced the efficiency of the nurse practitioners' clinical processes and service implementation. Relevance to clinical practice Results suggest that nurse practitioner models can be successfully integrated into a prison setting and could provide a nursing career pathway. [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 The aim of this study was to gauge whether, and to what extent, population flow occurred as a result of the implementation of alcohol management plans in Indigenous communities. Background Alcohol management plans involving carriage limits and dry places were introduced into 15 Queensland Indigenous communities between 2002-2004. Controls on alcohol availability were further tightened between 2008-2010, seeing the closure of eight mainly remote community taverns/canteens. Design A retrospective observational study was undertaken using data from the Queensland Injury Surveillance Unit. Methods Population flow was measured by changing patterns of alcohol-related injuries in a mining region near dry Indigenous communities following the introduction of alcohol management plans and a control mining region distant from Indigenous communities with alcohol management plans. Data were analysed using descriptive and inferential statistics. Logistic regression was used for the comparison of the characteristics between the emergency department presentations. The rates of alcohol-related injury presentations per 1000/population were calculated and age-standardised to the Australian population. Results Between the five-year periods 2003-2007 and 2008-2012, alcohol-related injury presentations to the Mount Isa emergency department trebled from an age-adjusted average annual rate of 9·5/1000 in the region's population to 27·1/1000 population. In the control region, alcohol-related emergency department injury presentations did not increase to the same degree with age-adjusted average annual rates of 1·42/1000 and 2·21/1000, respectively. Conclusions The 10-year pattern of emergency department presentations for alcohol-related injuries increased significantly in the Mount Isa region compared with the control region. Further research should investigate the impacts of population flow related to Indigenous community alcohol management plans. Relevance to clinical practice Although initiatives such as alcohol management plans have been implemented to reduce alcohol use and related consequences in Indigenous communities, there needs to be a greater consideration of the impact of these policies in nearby towns in the future. [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 impacts of nurses' psychological capital and managerial support, plus specific safety interventions (managerial safety priorities, safety training satisfaction), on nurses' in-role safety performance. Background Most hospitals in industrialized countries have adopted selective (often the least costly) aspects of safety, usually related to safety policies. However, patient safety remains a challenge in many countries. Research shows that training can be used to upskill employees in psychological capital, with statistically significant organizational and employee benefits, but this area is under-researched in nursing. Design Data were collected using a survey-based, self-report strategy. The emerging patterns of data were then compared with the findings of previous research. Methods Quantitative survey data were collected during 2014 from 242 nurses working in six Australian hospitals. Two models were tested and analysed using covariance-based Structural Equation Modelling. Results Psychological capital and safety training satisfaction were important predictors of nurses' in-role safety performance and as predictors of nurses' perceptions of whether management implements what it espouses about safety ('managerial safety priorities'). Managerial support accounted for just under a third of psychological capital and together, psychological capital and managerial support, plus satisfaction with safety training, were important to nurses' perceptions of in-role safety performance. Conclusion Organizations are likely to benefit from upskilling nurses and their managers to increase nurses' psychological capital and managerial support, which then will enhance nurses' satisfaction with training and in-role safety performance perceptions. [ABSTRACT FROM AUTHOR]

Aims and Objectives To understand: (1) staff perceptions of best practice for information transfer for multitrauma patients on discharge from the emergency department; (2) what information should be conveyed at transfer and (3) how information is transferred. Background Information transfer for multitrauma patients is an integral factor for continuity of care, safety, quality assurance and patient outcomes; however, this has not been the focus of previous studies. Design This was a qualitative study using focus group interviews. Methods Data were collected during focus group interviews across five clinical areas. Themes were derived from the data with consensus from three data coders. Purposive sampling was used and included staff caring for trauma patients during patient transition out of the emergency department. Participants were representatives of the emergency department, perioperative care, intensive care unit, high dependency care unit and the trauma service unit. Twenty-six registered nurses and two medical officers participated. Results Five focus group interviews were held. Themes emerged from the data including 'Variability', 'Continuity' and 'Putting the pieces together'. The first three themes were all influenced by the fourth theme of 'Values/Context'. Considered together these themes influenced staff perception of the quality of information transfer for multitrauma patients on discharge from the emergency department. Conclusions Staff perceived best practice for information transfer to be clear, concise, relevant documentation that travelled with the patient and interactive communication at handover that adhered to agreed principles and a minimum data set specific to trauma patients. Relevance to clinical practice Clinicians involved in handover need to actively listen, avoiding 'doing' at the same time, be aware of essential questions to ask about the patient. An agreed expectation between different clinical areas needs to exist about information transfer to reduce variability. The minimum data required to provide ongoing safe care for multitrauma patients are identified. [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]

Aims and objectives To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Background Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. Design A modified Delphi study. Methods Focus group interviews with 150 acute care registered nurses at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care registered nurses following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Results Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Conclusions Among a large and diverse group of experienced acute care registered nurses consensus was achieved on a structured core physical assessment to detect early changes in patient status. Relevance to clinical practice Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside. [ABSTRACT FROM AUTHOR]

Aims and Objectives The study aims to evaluate the effects of a communication skills training programme on community aged care staff's knowledge of communication support in dementia and on staff's care experience. Background Dementia can lead to impairments in communication. Therefore, quality community-based dementia care requires that staff be skilled communicators, equipped to facilitate interactions with people with dementia. The current investigation evaluated the effectiveness of the MESSAGE Communication Strategies in Dementia for Care Staff training programme with respect to knowledge of communication support and the staff/caregiver experience. Design A multi-centre controlled pretest/post-test design with randomised cohort allocation was used. Outcome measures were completed at baseline, immediately after training (training group only), and at three-month follow-up. Methods Thirty-eight care staff working in community aged care participated and completed all outcome measures (training = 22; control = 16).Training and control groups completed the following outcome measures: knowledge of communication support strategies, self-efficacy, preparedness to provide care, strain in nursing care and attitude to dementia care. Staff in the training group provided written feedback on the training. Results A significant improvement in knowledge scores from baseline was found for the training group both immediately after training and at three-month follow-up. There was also a significant training effect for self-efficacy and preparedness to provide care. No significant difference was found for the control group for any measure. No significant training effects were found for measures of strain or attitudes to dementia care. Feedback from staff suggests that the training was well received. Conclusions The MESSAGE training was positively received by staff and had a significant effect on care staff knowledge, and confidence to provide care for people with dementia. Relevance to clinical practice The easily accessible multimedia training programme is well received by staff and has the potential to improve quality of care. [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]

Aim. To systematically evaluate the impact of several design features on chart-users' detection of patient deterioration on observation charts with early-warning scoring-systems. Background. Research has shown that observation chart design affects the speed and accuracy with which abnormal observations are detected. However, little is known about the contribution of individual design features to these effects. Design. A 2929292 mixed factorial design, with data-recording format (drawn dots vs. written numbers), scoring-system integration (integrated colour-based system vs. non-integrated tabular system) and scoring-row placement (grouped vs. separate) varied within-participants and scores (present vs. absent) varied between-participants by random assignment. Methods. 205 novice chart-users, tested between March 2011-March 2014, completed 64 trials where they saw real patient data presented on an observation chart. Each participant saw eight cases (four containing abnormal observations) on each of eight designs (which represented a factorial combination of the within-participants variables). On each trial, they assessed whether any of the observations were physiologically abnormal, or whether all observations were normal. Response times and error rates were recorded for each design. Results. Participants responded faster (scores present and absent) and made fewer errors (scores absent) using drawn-dot (vs. written-number) observations and an integrated colour-based (vs. non-integrated tabular) scoring-system. Participants responded faster using grouped (vs. separate) scoring-rows when scores were absent, but separate scoring-rows when scores were present. Conclusion. Our findings suggest that several individual design features can affect novice chart-users' ability to detect patient deterioration. More broadly, the study further demonstrates the need to evaluate chart designs empirically. [ABSTRACT FROM AUTHOR]