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Wilson A, Gyi AA. International Journal of Nursing Practice 2010; 16: 92–98 The status and perspective of diabetes health education in China: Inspiration from Australia This paper discusses possible approaches to improving diabetes care and developing effective education models in China based on the experience of diabetes education in Australia. The prevalence of diabetes mellitus in China is increasing rapidly. China is currently second on the list of the top 10 countries with the highest diabetes burden. Enormous impact of diabetes on China health system is daunting and the urgent action is needed. Diabetes education is the keystone of diabetes care and structured self-management education is considered to be the key to successful outcomes. Although many diabetes education programmes have been initiated in China, barriers have been identified for implementation of the programmes. These include: lack of public awareness of diabetes; lack of standards of practice for diabetes educators; and lack of evaluation programmes to assess their performance. We suggest four possible approaches to addressing the current problems of diabetes education in China. [ABSTRACT FROM AUTHOR]

Aim: To explore how nurses and nursing knowledge contributed to the success of an Australian nurse‐led medical hotel quarantine facility during the COVID‐19 pandemic. The facility was established to accommodate returning travellers who were COVID‐19 positive or at risk of becoming positive, to travellers requiring complex care and expanded to community members who could not quarantine at home. Design: This descriptive qualitative study explored how nurses and nursing knowledge in the quarantine facility contributed to the low transmission incidence of COVID‐19 infection. Method: Twelve semi‐structured interviews were conducted via ZOOM from February to May 2022 with all levels of nursing staff (nurse managers to assistants in nursing) who had worked in the facility for 3 months or more. The nurses were asked to describe their experiences, the challenges they faced and how they overcame them. The data were rich and were analysed using Braun and Clarke's six‐step thematic analysis. Results: Four broad themes were generated demonstrating how nurses played a pivotal role in the success of the facility. First: nursing knowledge was evident through the development of policies, which minimized risks to nurses and patients. Second: a community of learning was developed as nurses supported upskilling and capacity building of staff, particularly new graduates with the facility. Third: a supportive management structure promoted teamwork and a positive workplace culture. And finally: the nurses were encouraged to develop techniques that promoted self‐care which enabled them to develop resilience. Conclusion: This was a nurse‐led service that developed strategies to manage care delivery and overcame unanticipated difficulties in a unique clinical setting. Reporting Method: The quality of the research design was ensured by using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this paper is to examine the use of mental health triage scales in Australian emergency departments (EDs) and to explore the use of the Australasian Triage Scale (ATS) with existing mental health triage scales. Background. Since the introduction of mainstreaming and deinstitutionalisation in Australian mental health care, the number of clients presenting to Australian EDs has been increasing. It has become apparent that the lack of mental health descriptors in existing triage scales diminishes the ability of ED triage staff to accurately assess clients with a mental illness. In response to this, specialised mental health triage scales have been developed and introduced into practice. Concurrently, mental health descriptors have been incorporated into the ATS used across Australian EDs. Design. A review of English language literature was conducted. Method. The data bases Proquest, Synergy and CINAHL were searched using the key words ‘emergency department’, ‘triage’, ‘mental health’ and again using the term ‘emergency mental health triage’. Results. There is a paucity of literature surrounding the use of mental health triage scales in Australian EDs; 18 articles were found to be directly relevant to the subject matter. Conclusion. Currently clients with a mental illness presenting to the ED may be triaged against one of four mental health triage scales. Research has shown that the mental health descriptors in the ATS are not as reliable as a specialised mental health triage scale. Relevance to clinical practice. This has implications for clinical practice on two levels. First, it affects the initial triage assessment in the ED and the ability for mental health clinicians to respond in a timely manner and this will have an impact on clinical outcomes. Second, the use of the mental health triage criteria in the ATS may misrepresent ED workloads and affect data pertaining to ED performance. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to describe how nurses' dialogue compares with that of doctors in the Australian reality television program Emergency and to explain how this dialogue and the use of narration and direct‐to‐camera monologues contribute to the portrayal of nurses. The final aim was to outline how these findings can inform the actions of nurses, nursing organizations and writers and journalists. Design: A descriptive study conducted in 2021 and 2022. Methods: Character network analysis was used to describe the verbal interaction of nurses and doctors and identify major, minor and background characters. Narration and direct‐to‐camera monologues were analysed through frequency counts. Cultivation theory was used to interpret the results. Results: Fifty‐four characters were identified, with 19 of these being nurses. Doctors spoke 87.9% of the dialogue. Most of the dialogue (43%) was monologue by doctors directly to the camera. All major characters were doctors, and only one nurse was a minor character. The mean number of mentions by the narrator of a nurse per episode was 4, and 30 for a doctor. Conclusion: The portrayal of nurses in Emergency is inaccurate and the production methods are used to privilege the role of doctors. This finding comes after decades of research showing inaccurate images of nursing in television. Drawing on recent Australian inquiries and the challenges experienced by mental health and aged care nursing, several approaches for collaborative action to improve these images are suggested. Impact This is the first study of the portrayal of nursing in reality television. These results suggest that much effort is still required even in contemporary reality television to accurately reflect the work and contribution of nurses. It is the shared responsibility of individual nurses, nursing organizations and writers and journalists to accurately portray nurses in the media. No patient or public contribution: This network analysis of a postproduction television program did not allow patient or public involvement in the design or analysis. [ABSTRACT FROM AUTHOR]

Aims: To explore the family violence practice of home visiting nurses and identify the personal and professional characteristics of nurses undertaking family violence work. Design A qualitative research design using interpretive description. Methods: The family violence nursing practice and characteristics of home visiting nurses in Victoria, Australia, were explored by analysing semi‐structured interviews (n = 37) conducted over 4 months in 2019–2020. Twenty‐five nurses and 12 nurse managers worked in urban, regional city and rural/remote settings. The data were analysed using reflexive thematic analysis. Results: We categorized the characteristics of home visiting nurses into two broad themes with sub‐themes: 'Things you can learn'; and 'You just bring yourself'. Conclusion: By researching the characteristics of home visiting nurses undertaking family violence work, this study has identified the personal characteristics managers should consider when recruiting nurses to this specialist role. Identifying the personal and professional skills required will improve nurses' working experience by reducing the risk of a potential skill/role mismatch. These insights may enhance the effectiveness of home visiting nurses so that the Enhanced Maternal and Child Health program contributes effectively to the support of women experiencing family violence. Impact Interviewing home visiting nurses and their managers has enabled a clearer insight into this specialist practitioner's previously unexplored work. Identifying the nurses' personal, professional, and clinical characteristics should inform the development of position roles and identify nurses who are best suited for this role. This knowledge will ensure that the Maternal and Child Health program effectively supports women experiencing family violence. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the nature of collaboration between registered nurses and general practitioners in Australian general practice. Background There is international recognition that collaboration between health professionals can improve care coordination, enhance health outcomes, optimise the work environment and reduce healthcare costs. However, effective collaboration requires a clear understanding of each team member's role. Design A qualitative approach guided by Naturalistic Inquiry was used to elicit and interpret participant narratives. Methods Eight general practitioners and fourteen registered nurses working in general practice were purposefully recruited. Data were collected via individual, semi-structured face-to-face interviews during February to May 2015. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. Results Data revealed three overarching themes. This study presents the data for the overarching theme 'Understanding the general practice registered nurse's role'. Many general practitioner participants lacked clarity around the role and scope of practice of the registered nurse. At the same time, nursing participants often articulated their role as an assistant rather than as an independent health professional. This limited collaboration and the nurses' role within the team. Collaboration was enhanced when general practitioners actively sought an understanding of the registered nurses scope of practice. Conclusion Clarifying the nurses' role promotes collaboration and supports nurses to work to the full extent of their practice. This is important in terms of optimising the nurses' role within the team and reinforcing their professional identity. Relevance to clinical practice Identification of key issues around understanding the nurses' role may help inform strategies that improve collaboration and workplace relations. [ABSTRACT FROM AUTHOR]

Aim: To explore transition experiences of Middle Eastern qualified midwives into practice in Australia. Design: This was a qualitative study using multiple case narrative approach underpinned by structuration theory. Methods: A total of 19 Middle Eastern qualified midwives from different states of Australia participated in this study. Individual semi‐structured interviews were conducted between November 2020 and September 2021, digitally recorded and then transcribed. Transcriptions were analysed in three stages, with three main categories generated in the second stage and a core category that was developed in third. Results: Entering the Australian workforce, Middle Eastern qualified midwives had to reframe their professional identities to fit the new system by adjusting to three aspects of the practice, including preparation for practice, scope of practice and context of practice. While they were prepared by medically oriented curricula, worked in systems that had limitations for midwives to practise in antenatal and postnatal and lacked regulation standards, they learned to practise autonomously in their full scope in a standardized context in Australia. Conclusion: Middle Eastern qualified midwives in Australia re‐evaluated their practice in their home countries, realized the gaps and adjusted to new ways of practising in Australia. Impact To effectively use the potential of Middle Eastern midwives for workforce sustainability in Australia, support should be available to enable them to develop the necessary competencies for safe practice in Australia including provision of context‐specific transition programmes prior to registration and supporting mentorship after their integration into the Australian healthcare workforce. Patient or public contribution: Patient or public contribution does not apply to this study as its purpose was to explore the transition experiences of Middle Eastern qualified midwives themselves. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To (i) determine prevalence of distress among caregivers of people living with cancer, (ii) describe caregivers' most commonly reported problems and (iii) investigate which factors were associated with caregivers' distress. Background: The psychological distress associated with a cancer diagnosis jointly impacts those living with cancer and their caregivers(s). As the provision of clinical support moves towards a dyadic model, understanding the factors associated with caregivers' distress is increasingly important. Design: Cross‐sectional study. Methods: Distress screening data were analysed for 956 caregivers (family and friends) of cancer patients accessing the Cancer Council Western Australia information and support line between 1 January 2016 and 31 December 2018. These data included caregivers' demographics and reported problems and their level of distress. Information related to their care recipient's cancer diagnosis was also captured. Caregivers' reported problems and levels of distress were measured using the distress thermometer and accompanying problem list (PL) developed by the National Comprehensive Cancer Network. A partial‐proportional logistic regression model was used to investigate which demographic factors and PL items were associated with increasing levels of caregiver distress. Pearlin's model of caregiving and stress process was used as a framework for discussion. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed. Results: Nearly all caregivers (96.24%) recorded a clinically significant level of distress (≥4/10) and two thirds (66.74%) as severely distressed (≥7/10). Being female, self‐reporting sadness, a loss of interest in usual activities, sleep problems or problems with a partner or children were all significantly associated with increased levels of distress. Conclusions: Caregivers of people with cancer reporting emotional or familial problems may be at greater risk of moderate and severe distress. Relevance to Clinical Practice: Awareness and recognition of caregiver distress are vital, and referral pathways for caregivers are the important area of development. [ABSTRACT FROM AUTHOR]

Aim: To describe Australian registered nurses' awareness, and implementation of reasonable adjustments within their practice when caring for people with intellectual disability and/or autism. Additionally, the association between key demographic, workforce, and respondent variables and familiarity of the term and regularity of use was explored. Design Cross‐sectional survey. Methods: Survey data were collected between August and October 2020 using an online survey tool. Data were analysed using descriptive and inferential statistics. Results: Familiarity of the concept of reasonable adjustments was relatively low, compared to respondents who report applying adjustments when caring for people with intellectual disability and/or autism. Higher levels of confidence, comfort, and knowledge when caring for this cohort were associated with greater awareness and application of reasonable adjustments. Conclusion: A higher volume, and diversity in type of, nursing education related to care for people with intellectual disability and/or autism is indicated. [ABSTRACT FROM AUTHOR]

The article presents the exploratory statistical analysis of antipsychotic medication use by people with dementia who are residing in residential aged care facilities. It discusses how the study was conducted at a major urban centre in southeastern Australia. The results reportedly revealed that only a small percentage of participants were suffering from psychotic comorbidity.

Aims: To compare levels of nurse burnout across eastern and western cultures, as well as examine the influence of burnout on patient safety cross‐culturally. Design: Comparative cross‐sectional study. Methods: Survey data were collected from nurses between August and October 2017 in Australia (n = 730) and between April and October 2019 in China (n = 1107). Variables included burnout (emotional exhaustion, depersonalization, personal accomplishment), nurse leadership and support, staffing and resource adequacy, and perceived patient safety. Data were analysed separately for each jurisdiction using bootstrapped hierarchical regressions, which tested the relationships between burnout indicators and patient safety, controlling for support resources. Results: Emotional exhaustion and depersonalization scores were significantly higher in the Australian sample compared with the Chinese sample. Australian participants reported significantly lower patient safety grades than Chinese participants and were less likely to agree that support resources were present in their current job. Separate regressions indicated that patient safety was significantly associated with staffing and resource adequacy, nurse leadership and support, and depersonalization among Australian participants (30% of variance explained in the final regression model), while staffing and resource adequacy, nurse leadership and support, personal accomplishment and emotional exhaustion predicted patient safety for Chinese participants (22% of variance explained in the final model). Conclusion: Australian nurses are at greater risk of burnout than Chinese nurses. Burnout dimensions are differentially associated with patient safety across cultures. Culturally relevant interventions may be more optimal than universal approaches for improving burnout and patient safety in nursing. Impact: This study increased understanding of cross‐cultural differences in nurse burnout and the relationship with patient safety. Australian nurses were at greater risk of burnout than Chinese nurses. Emotional exhaustion, depersonalization and personal accomplishment influenced patient safety distinctively across the countries. These findings inform interventions designed to reduce nurse burnout and improve patient safety internationally. [ABSTRACT FROM AUTHOR]

Aims and objectives: To (i) characterise prevalence of distress amongst people diagnosed with cancer, (ii) determine factors associated with increasing distress, (iii) describe reported problems for those with clinically significant distress and (iv) investigate the factors associated with referral to support services. Background: International studies report a high prevalence of clinically significant distress in people with cancer. Australian studies are notably lacking. Additionally, clinicians still do not fully understand the factors associated with cancer‐related distress. Design: Period prevalence study. Methods: Distress screening data were analysed for 1,071 people accessing the Cancer Council Western Australia information and support line between 01/01/2016–31/12/2018. These data included people's demographics, cancer diagnoses, level of distress, reported problems and the service to which they were referred. Distress and reported problems were measured using the National Comprehensive Cancer Network Distress Thermometer and Problem List. A partial proportional logistic regression model was constructed to determine which factors were associated with increasing levels of distress. Standard binary logistic regression models were used to investigate factors associated with referral to support services. The STROBE checklist was followed. Results: Prevalence of clinically significant distress was high. Self‐reported depression, sadness, worry and a lack of control over treatment decisions were significantly associated with increasing distress. Emotional problems were the most prevalent problems for people with clinically significant distress. Most people were referred to emotional health services, with depression, fatigue, living regionally and higher socioeconomic status associated with referral. Conclusions: Emotional problems such as depression, sadness and worry are associated with increasing levels of distress. Relevance to clinical practice: Not all factors associated with referral to support services were those associated with increasing levels of distress. This suggests that other factors may be more influential to referral decisions. [ABSTRACT FROM AUTHOR]

Aim: To use expert consensus to develop guidance for nurse leaders implementing e‐health tools to support nursing work in hospitals. Background: Nurse leaders are increasingly required to make decisions about the selection, development, implementation and optimisation of e‐health tools for nursing work in hospitals. Guidance in this rapidly evolving and complex space is limited. Design: A two‐phase modified Delphi study. Methods: Phase one involved in‐depth interviews with five nursing informatics experts. Analysis used the qualitative framework method, informed by the Theoretical Domains Framework (TDF), to develop statements for an anonymous online Delphi scoring survey. This was distributed using snowball sampling methods to Australian nurse informatics leaders and experts. Final analysis involved synthesis of qualitative and quantitative data. The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) checklist. Results: Ten guidance statements to support nurse leaders to implement e‐health tools in hospitals were developed from the synthesis of qualitative interview data and 29 experts' responses to the 55‐item Delphi response survey. Conclusion: Implementation of e‐health tools for nursing work is complex in health settings and requires careful examination of multiple factors and interactions between clinicians, tools, service users and the health organisation. This research proposes ten statements to support nurse leaders with decisions about implementing e‐health tools to support nursing work in hospitals. Relevance to clinical practice: The ten statements developed by this research provide a resource to assist policy and practice decisions about e‐tools to ensure they are suited to supporting nursing work. Nurse leaders can use the ten statements for guidance in the selection, development, implementation and optimisation of e‐health tools to ensure suitability and adaptation for nursing work in hospitals. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to describe the demographic characteristics and to measure annual changes in composition of the paediatric population attending a specialist tertiary hospital in Sydney, Australia, between 2015 and 2017. Background: Australia has experienced steady growth in the number of people born overseas in the last fifty years thereby building a culturally and linguistically rich country. Such dynamic population changes pose a challenge to the nursing workforce, in particular how the needs of migrant families from non‐English‐speaking countries are accommodated. Design: Retrospective review of medical records. Methods: De‐identified paediatric inpatient data were imported from a hospital database into Statistical Package for the Social Sciences (version 21) database for cleaning and analysis. Strengthening the reporting of observational studies in epidemiology checklist was completed. Results: Paediatric inpatients born in a country other than Australia (8762, 5.7%) emigrated from 155 countries or were "born at Sea" (n = 13, 0.1%) and spoke an array of primary languages (n = 139), other than English. Whilst inpatient health service rates remained constant during the study period, an increased rate of service utilisation was reported for children born in Asia (IRR 1.3, p ≤ 0.001, 95% CI: 1.2–1.4) and in the Middle East (IRR 1.4, p ≤ 0.001, 95% CI: 1.2–1.6). Families who reported that they preferred to speak Chinese Languages, Middle Eastern languages (not Arabic) and languages of India reported increased rates. Conclusion: Significant annual changes in composition of the paediatric population were reported. Regular analysis of local inpatient data will inform health care that is responsive to change and addresses the unique needs of diverse families. Relevance to clinical practice: Diversity poses a potential challenge to the nursing workforce on a daily basis and more broadly. To meet the changing needs of diverse inpatient populations, nurses will need to plan, implement and evaluate cultural competency, linguistic access, workforce diversity and the quality of care to diverse populations. [ABSTRACT FROM AUTHOR]

Aims and objectives: To assess primary healthcare professionals' priority for managing diabetic foot disease (DFD) over the progressive course of the condition compared to other aspects of diabetes care. Background: DFD affects up to 60 million people globally. Evidence suggests that comprehensive preventative footcare may reduce serious complications of DFD, such as amputation. Design: A cross‐sectional quantitative study reported according to STROBE statement. Methods: General Practitioners (GPs) and Credentialled Diabetes Educators (CDEs) working within Australian primary care were invited to complete an online survey, to obtain information about preventative and early intervention footcare priorities and practices. Ten GPs and 84 CDEs completed the survey. Results: On diagnosis of type 2 diabetes, haemoglobin A1c (HbA1c) review was identified to be one of the top three priorities of care by 57 (61%) of participants whilst at 20‐year history of diabetes 73 (78%) participants indicated its priority. Foot assessments became a priority for 78% (n = 73) of participants and podiatry referrals a priority for 53% (n = 50) of participants only when a "foot concern" was raised. Referrals to specialist high‐risk foot podiatrists or services were a first priority for 56% (n = 53), when the person had significant amputation risk factors. Conclusion: Diabetes‐related preventative footcare assessments and management remain a low priority amongst primary healthcare professionals. Preventative care for asymptomatic complications, such as DFD, may be overlooked in favour of monitoring HbA1c or medication management. Limited prioritisation of footcare in primary care is concerning given the risks for amputation associated with DFD. Relevance to clinical practice: This study reveals the need for primary healthcare decision makers and clinicians to ensure preventative footcare is a focused priority earlier in the diabetes care continuum. Collaborative and widespread promotion of the importance of proactive rather than reactive footcare practices is required to support prevention of foot ulcers and amputation. [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]

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Aim: The aim of this study was to investigate stories of recovery through the lens of intensive care unit (ICU) survivors. Background: Survival from ICUs is increasing, as are associated physical and psychological complications. Despite the significant impact on survivors, there is inadequate support provision in Australia and world-wide for this population. Design: An interpretive biographical approach of intensive care survivors' experiences of recovery. Methods: Data were collected during 2014-2015 from diaries, face to face interviews, memos and field notes. Six participants diarized for 3 months commencing 2 months after hospital discharge. At 5 months, participants were interviewed about the content of their diaries and symbols and signifiers in them to create a shared meaning. Analysis of diaries and interviews were undertaken using two frameworks to identify themes throughout participants' stories and provides a unique portrait of recovery through their individual lens. Findings: Participants considered their lives had irreparably changed and yet felt unsupported by a healthcare system that had "saved" them. This view through their lens identified turmoil, which existed between their surface and inner worlds as they struggled to conform to what recovery "should be". Conclusion: The novel biographical methods provided a safe and creative way to reveal survivors' inner thoughts and feelings. Participants' considered creating their stories supported their recovery process and in particular enabled them to reflect on their progress. Findings from this study may lead to increased awareness among health care providers about problems survivors face and improved support services more broadly, based on frameworks appropriate for this population. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the nature of relatives’ involvement in the care of patients in acute medical settings in Australia and Saudi Arabia and to explore the perceptions, attitudes and experiences of nurses. Background: There is little known about how relatives respond to being involved in patient care and the impact this has on the quality of care. Equally, little is known about how nurses enable such involvement. Previous studies have focused on settings such as critical care and paediatrics where relatives’ involvement as advocates is mostly acknowledged and accepted. Design: The study used a qualitative ethnographic approach based on an interpretive paradigm. Methods: Data collection was carried out in medical settings in two major hospitals: one in Australia and another in Saudi Arabia. Data were collected by observations and interviews over a 6‐month period, with 3 months spent in each setting. Results: In both fields, relatives and nurses faced ongoing ambiguity about the role relatives should play in the hospital environment. Nurses were challenged by the unpredictability of relatives’ participation in patient care. The nurses’ fear of taking responsibility and uncertainty about the relatives’ role led them to take varied and individualised approaches to the involvement of relatives in patient care. Relatives were unclear about how to behave in the role; what the needs of patients were; and whether they were contributing positively to care and this resulted in frustration. Conclusion: The results show that ambiguity regarding the role of relatives led to problems in patient care such as safety concerns and conflict with nurses. Relevance to clinical practice: This study identified the need for patients’ relatives and nursing staff to more actively engage in negotiating and managing their respective roles in acute medical areas. This could be supported by the development and use of a set of principles or guidelines for nurses, relatives and patients regarding relatives’ involvement in hospital care settings to reduce ambiguity for all involved. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to achieve profession-wide consensus on an Australian nurse practitioner specialty framework. Background Since its introduction in 1998, the Australian nurse practitioner profession has grown to over 1300 endorsed practitioners, representing over 50 different specialties. To complement better a generalist learning and teaching framework with specialist clinical education, prior research proposed a broad framework of Australian nurse practitioner specialty areas termed metaspecialties. Design This study employed an online three-round modified Delphi method. Method Recruitment using purposive sampling and snowballing techniques identified an eligible sample from a population of nurse practitioners with at least 12 months' postendorsement experience ( n = 966). Data were collected using online survey software from September 2014-January 2015 and analysed using descriptive statistics and content analysis. The Content Validity Index and McNemar's Test for Change were used to determine consensus on the nurse practitioner metaspecialties. Results One-fifth of the total eligible population completed the study. Participants achieved high consensus on four metaspecialties, including: Emergency and acute care, primary health care, child and family health care and mental health care. Two metaspecialties did not achieve consensus and require further investigation. Conclusion A large sample of nurse practitioners achieved consensus on an Australian metaspecialty framework, increasing the likelihood of widespread acceptance across the profession. This technique may be appropriate for use in jurisdictions with smaller populations of nurse practitioners. Ongoing research is needed to re-evaluate the metaspecialties as the profession grows. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to explore the extent to which Australian child and family health nurses work with families with complex needs and how their practice responds to the needs of these families. Background Many families with young children face challenges to their parenting capacity, potentially placing their children at risk of poorer developmental outcomes. Nurses increasingly work with families with mental health problems, trauma histories and/or substance dependence. Universal child health services must respond effectively to these challenges, to address health inequalities and to promote the best outcomes for all children and families. Design The descriptive study used cross-sectional data from the first national survey of child and family health nurses in Australia, conducted during 2011. Methods Survey data reported how often, where and how child and family health nurses worked with families with complex needs and their confidence in nursing tasks. Findings Many, but not all, of the 679 respondents saw families with complex needs in their regular weekly caseload. Child and family health nurses with diverse and complex caseloads reported using varied approaches to support their clients. They often undertook additional professional development and leadership roles compared with nurses who reported less complex caseloads. Most respondents reported high levels of professional confidence. Conclusion For health services providing universal support and early intervention for families at risk, the findings underscore the importance of appropriate education, training and support for child and family health professionals. The findings can inform the organization and delivery of services for families in Australia and internationally. [ABSTRACT FROM AUTHOR]

Aims and objectives Investigate effects of teamwork on missed nursing care across a healthcare network in Australia. Background Missed care is universally used as an indicator of quality nursing care, however, little is known about mitigating effects of teamwork on these events. Design A descriptive exploratory study. Methods Missed Care and Team Work surveys were completed by 334 nurses. Using Stata software, nursing staff demographic information and components of missed care and teamwork were compared across the healthcare network. Statistical tests were performed to identify predicting factors for missed care. Results The most commonly reported components of missed care were as follows: ambulation three times per day (43·3%), turning patient every two hours (29%) and mouth care (27·7%). The commonest reasons mentioned for missed care were as follows: inadequate labour resources (range 69·8-52·7%), followed by material resources (range 59·3-33·3%) and communication (range 39·3-27·2%). There were significant differences in missed care scores across units. Using the mean scores in regression correlation matrix, the negative relationship of missed care and teamwork was supported ( r = −0·34, p < 0·001). Controlling for occupation of the staff member and staff characteristics in multiple regression models, teamwork alone accounted for about 9% of missed nursing care. Conclusion Similar to previous international research findings, our results showed nursing teamwork significantly impacted on missed nursing care. Teamwork may be a mitigating factor to address missed care and future research is needed. Relevance to clinical practice These results may provide administrators, educators and clinicians with information to develop practices and policies to improve patient care internationally. [ABSTRACT FROM AUTHOR]

The aim of this research is to describe the experiences of Australian and New Zealand nursing and midwifery students looking for employment after graduation. This qualitative study draws from 2008, 2009 and 2010 responses provided by 197 recently graduated Australian and New Zealand nurses and midwives to, Describe your experiences gaining employment as a nurse or midwife after graduation. Two themes were inductively derived, Taking what you can get and I had a job lined up. Within the taking what you can get theme, respondents efforts to gain employment as a nurse or midwife after graduation were challenged by limited choices round the type of clinical practice available and/or job insecurity. In contrast, for respondents in the I had a job lined up theme, employment after graduation was linked to job offers during student's clinical placements and/or hospitals where they completed their final practicum. Understanding and better facilitating the transition of new nurse/midwife graduates to healthcare institutions are vitally important to sustaining the nursing workforce. [ABSTRACT FROM AUTHOR]

Aims. This article reports on the quantitative findings from a large mixed method study that determined the extent to which the provision of alternatives to an Emergency Department and Index of Relative Social Disadvantage score influenced non-urgent paediatric Emergency Department use. Background. In Australia, there is an increasing use of Emergency Departments for the provision of non-urgent care that may be better serviced in the community. Further, despite the plethora of literature describing the characteristics of non-urgent users of Emergency Departments the link to social and community characteristics remains under explored. Design. This 2010 retrospective analysis of the Hospital Admission Status data from the paediatric Emergency Department provided the information on attendance types and numbers along with postcode details. The postcodes in conjunction with Australia Bureau of Statistics data provided the levels of deprivation from the Index of Relative Social Deprivation scores. Method. A logistic regression analysis determined the levels of influence of deprivation and General Practitioner or Nurse Practitioner provision on the use of Emergency Departments for non-urgent care. Findings. Rates of use for non-urgent care is higher for populations who come from areas of deprivation and have limited primary care services, such as low levels of General Practitioners. Children from areas of high deprivation and limited access to primary care were up to six times more likely to use Emergency Department for non-urgent care. Conclusions. Deprivation impacts on the use of paediatric Emergency Departments for non-urgent care even in countries like Australia where there is government subsidized health care. [ABSTRACT FROM AUTHOR]

The purpose of the study was to inform policy for reform in nursing. A survey mailed to members of the Queensland Nurses' Union four times between 2001 and 2010 elicited views on their employment and working conditions, professional development and career opportunities. Results across years and sectors of nursing consistently showed dissatisfaction in many aspects of employment, particularly by nurses working in aged care. However, views on staffing numbers, skill mix, workload, work stress, pay and staff morale all showed significant improvements over the decade. For example in 2001, 48.8% of nurses believed that their pay was poor, whereas in 2010, this had reduced to 35.2%. Furthermore, there was a significant rise throughout the decade in the opinion of the value of nursing as a good career. In light of the need to address nurse workforce shortages, the trends are encouraging; however, more improvements are required in order to support recruitment and retention. [ABSTRACT FROM AUTHOR]

The aim of this review is to explore the literature relating to the delivery of cervical screening by practice nurses ( PNs) in the United Kingdom and Australia. Research relating to PNs began in earnest approximately 15 years ago in the UK context, and more recently, c.2005, in Australia. Although there is scant literature devoted specifically to the role of PNs in cervical screening, literature relating to the role of PNs provides evidence of the extent to which PNs in the United Kingdom and Australia are involved in the provision of cervical screening services. Findings from this review indicate that the role of PNs in the provision of cervical screening differs substantially between the United Kingdom and Australia. PNs in the United Kingdom provide a high percentage of cervical screening services, whereas in Australia general practitioners provide around 80% of all cervical smears, which account for only 0.6% of all procedures undertaken by PNs. Employment and funding models and inadequate multidisciplinary collaboration are contributing to the underutilization of PNs in Australia. [ABSTRACT FROM AUTHOR]

Aim To quantify the risk of death associated with Clostridium difficile infection, in an Australian tertiary hospital. Background Two reviews examining Clostridium difficile infection and mortality indicate that Clostridium difficile infection is associated with increased mortality in hospitalized patients. Studies investigating the mortality of Clostridium difficile infection in settings outside of Europe and North America are required, so that the epidemiology of Clostridium difficile infection in these regions can be understood and appropriate prevention strategies made. Design An observational non-concurrent cohort study design was used. Methods Data from all persons who had (exposed) and a matched sample of persons who did not have Clostridium difficile infection, for the calendar years 2007-2010, were analysed. The risk of dying within 30, 60, 90 and 180 days was compared using the two groups. Kaplan-Meier survival analysis and conditional logistic regression models were applied to the data to examine time to death and mortality risk adjusted for comorbidities using the Charlson Comorbidity Index. Results One hundred and fifty-eight cases of infection were identified. A statistically significant difference in all-cause mortality was identified between exposed and non-exposed groups at 60 and 180 days. In a conditional regression model, mortality in the exposed group was significantly higher at 180 days. Conclusion In this Australian study, Clostridium difficile infection was associated with increased mortality. In doing so, it highlights the need for nurses to immediately instigate contact precautions for persons suspected of having Clostridium difficile infection and to facilitate a timely faecal collection for testing. Our findings support ongoing surveillance of Clostridium difficile infection and associated prevention and control activities. [ABSTRACT FROM AUTHOR]

Aims and objectives. The main aim of this study is to develop a path model to examine the effect of administrative stressors on nursing work outcomes in a sample of Australian public and non-profit nurses. Background. The implementation of managerial reform initiatives has negative consequences on work outcomes. However, less is known about the effects of these stressors in public and non-profit health care organisations. Design. An online, self-completion questionnaire was sent to a random sample of nurses, employed in nursing-related occupations. Participants. Useable surveys were received from 251 nurses. Methods. The path model was analysed using SmartPLS software (SmartPLS, Hamburg, Germany). Results. Public and non-profit nurses experienced time and resource administrative-related stressors (such as resource shortage and pay not as good as other people doing similar work). They relied on work-related social support to reduce the negative consequences. Resource stressors led to job dissatisfaction while time stressors led to psychological strain. Nursing staff who reported better psychological health reported higher job satisfaction and higher level of commitment towards their organisations. Conclusions. Context-specific administrative stressors have a negative impact on the work outcomes of public and non-profit nurses. Work-related social support mechanisms were found to mediate the negative consequences of administrative resourcing stressors on nursing job satisfaction. Relevance to clinical practice. Nursing managers have to be sympathetic and care for the negative experiences of nursing staff, especially when there is an increasing level of administrative expectations during organisational change. Senior management should take note of the stressors caused by the lack of resources such as information, staffing and resources, as these were found to lead to an increase in nurses seeking work-related social support from their peers and supervisors. Effective implementation of these strategies would lead to a nursing workforce, which has higher level of psychological health, job satisfaction and organisational commitment. [ABSTRACT FROM AUTHOR]

Aim and objective. This study sought to explore the nature of bullying in the Australian nursing workplace. Background. While there is widespread concern about the extent and consequences of bullying among nurses, to date, there have been no published reports cataloguing the types of behaviours that constitute bullying. Design. Reported here are findings from the first stage of a three-stage sequential mixed methods study. Methods. The first, qualitative stage of this study employed in-depth, semi structured interviews with 26 nurses who had experienced bullying from two Australian area health services. Content analysis of the verbatim interview transcripts was performed using thenvivo 7 software program. Results. The analysis identified six major categories and constituent sub-categories. The typology of bullying behaviours reported here is one of these major categories. Conclusion. The typology of behaviours developed from the study provides detailed insights into the complexity of bullying experienced by nurses. The behaviours were labelled: personal attack, erosion of professional competence and reputation, and attack through work roles and tasks. These themes provide insight into the construct of bullying by providing a detailed catalogue of bullying behaviours that show that bullying is frequently masked in work tasks or work processes and focused on damaging the reputation and status of targets. Relevance to clinical practice. The detailed catalogue of bullying behaviours draws attention to the breadth of the bullying experience. It is anticipated the typology will be of use to nurses, managers and other professionals who are interested in responding to the problem of bullying in nursing. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore first-time mothers’ experiences of birth at home and in hospital in Australia. Background. The first birth has unique physical and psychological impacts on women. With the first birth, women become mothers. Design. A grounded theory methodology was used. Data were generated from in-depth interviews with women in their own homes. Methods. Nineteen women were interviewed in Sydney, Australia. The experiences of seven women who gave birth for the first time in a public hospital and seven women who gave birth for the first time at home were contrasted with two mothers who gave birth for the first time in birth centres, one mother who gave birth for the first time in a private hospital and two women who had given birth more than once. Results. Following the birth, women ‘processed the birth’ by ‘remembering’, ‘talking (storytelling)’ and ‘feeling’. This activity appeared to help most women resolve their feelings about the birth and understand what it actually means to be a new mother. ‘Personal and social integration’ occurred for most women as they entered ‘motherland’. Conclusion. First-time mothers appear to ‘process the birth’ to a greater extent than multiparous women because they are experiencing this for the first time. These women also have limited social networks in ‘motherland’, and these are facilitated through sharing the experiences of their labour or ‘processing the birth’. Relevance to clinical practice. Identifying the novice status of first-time mothers and understanding the way they process the birth can help health providers to be sensitive to the specific needs of primiparous women. In particular, their need to tell their birth stories following birth; understanding that these stories help women to process the birth and connect to other women. [ABSTRACT FROM AUTHOR]

Aim. This article argues that the current model of emergency practice in rural Victorian hospitals, which relies heavily on visiting medical officers, needs to be reconceptualised if emergency services are to be supplied to rural communities. Background. Medical workforce shortages are manifesting in Victoria as a reduction in emergency care services from rural hospitals. The suggested alternative model of emergency care involves advancing nursing practice to enable a redistribution of clinical capacity across the health care team. Clinicians will need to work collaboratively and continuously negotiate their roles to meet the patient’s and the clinical team’s needs. Design. Systematic review. Methods. This article is based on a review of the Victorian and Australian literature on the subject of Victorian health services and policy, emergency care, collaboration, communication and rural nurse scope of practice and roles. Emergency care activity was drawn from data held in the Victorian Emergency Management Dataset and personal communications between one of the authors and hospital executives in a small selection of rural hospitals in Victoria. Results. The evidence reviewed suggests that the current emergency practice profile of rural hospitals in Victoria does not reflect the reconceptualised model of rural emergency practice. Instead, only a small proportion of non-urgent presentations is managed by nurses without medical support, and the data suggest that metropolitan nurses are more likely to manage without medical support than rural nurses. Conclusion. Reconceptualising rural emergency care in Victoria will require significantly greater investment in rural nurses’ knowledge and skills to enable them to operate confidently at a more advanced level. Clinical teams that deliver emergency service in rural hospitals will be expected increasingly to work collaboratively and interprofessionally. Relevance to clinical practice. This article offers some directions for advancing nursing practice and strategies for improving interprofessional collaboration in the delivery of rural emergency care. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study set out to explore the relationship between emotional work, emotional well-being and professional practice of generalist community health nurses who provided palliative care to clients living at home. Background. Research suggests that palliative care practice is emotionally demanding and at times challenging. Whilst nurses find their palliative practice a source of job satisfaction the associated stresses can impact on nurses emotional well-being. Design. A qualitative emancipatory methodology informed this study. Methods. Semi-structured interviews/storytelling and reflective journaling were the two methods applied. Sixteen community health nurses including the researcher participated. Thematic analysis of the data was undertaken. Results. The concept of emotional well-being is associated with nurses’ feelings of being balanced or out of balance. There is a pervasive interconnectedness between emotional work, emotional well-being and professional practice that is influenced by factors such as organisational and workplace issues; communication with health professionals, professional boundaries; education and professional development. Three major interwoven themes emerged highlighting that palliative care provision was demanding and rewarding, yet dependent on the nurse’s comfortability within practice. Self-care is also important to the generalist nurses and strategies to enhance well-being include healthy lifestyle choices, debriefing, self-validation, assertiveness and emotional support. Conclusions. Emotional well-being is complex and multifaceted. The value of emotional well-being to professional practice is important. Palliative care provision is associated with demands, rewards and comfortability. It is essential that attention be given to the experiences of generalist community health nurses who engage in palliative care provision. Relevance to clinical practice. As the demand for community palliative care increases, the issues that limit and enhance the emotional well-being of generalist palliative care nurses’ become critical. The findings have international relevance to generalist and specialist palliative care nurses, academics and researchers alike. [ABSTRACT FROM AUTHOR]

Aims and objectives. To provide a contemporary description of the practice of nurses caring for older people in long term care. Background. The increasing size and morbidity of the population of older persons is driving the requirement for nurses who work in long term care to have appropriate educational qualifications and expertise. Design. A mixed method research design was used in this study. Method. The perceptions from clinical registered nurses ( n = 48) and nurse managers ( n = 16), working in six long term aged care facilities were elicited. Data were collected via purposive questionnaires, document analysis and semi-structured interviews. Results. There was considerable agreement among the data and from the two groups of nurses about registered nurses’ practice. The most frequently performed nursing activities revealed in the questionnaire were ‘Organising their own workload’ and ‘Devising an individualised plan of care’ whilst the lowest were ‘Developing policies in response to changes in legislation or clinical practice’ and ‘Introducing appropriate research findings into practice’. Categories from the interviews included, ‘It is a team effort’, ‘We manage’ and ‘Clinical skills and responsibilities’. Overall the data revealed a picture of nurses managing the care of older persons in a specialised context. Conclusion. The findings confirm that the practice of nurses working with older persons in long term care has expanded to the role of specialised care facilitator. Registered nurses’ practice in this study is consistent with current descriptions of gerontological nursing. However, some elements of practice require further development: person-centred care and evidence-based practice. Relevance to clinical practice. It remains a challenge for registered nurses working with older people to deliver person-centred care and to engage with evidence and integrate evidence into policy and practice. Strategies are required for registered nurses to develop these elements of practice. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of the study was to investigate the phenomenon of Advance Care Planning and the use of Advance Care Directives in residential aged care facilities in Australia. The objectives were to: • investigate the implementation process of Advance Care Planning and the use of Advance Care Directives; • investigate the outcomes of Advance Care Planning and experiences of people involved in Advance Care Planning and Advance Care Directives, including residents, families and nursing staff. Background. Benefits of Advance Care Planning for older residents are considerable given their degenerative health-breakdown and minimal chance of recovery. To date, the use of Advance Care Planning and Advance Care Directives is limited and models of service delivery and processes are needed to enhance best practice with Advance Care Planning and positive outcomes for older Australians. Design. Case study. Methods. The study conducted using multiple sources of evidence to enrich understanding of the phenomenon of Advance Care Planning. The researcher engaged in data collection over six months involving participant observation, field notes, semi-structured interviews and document analysis. The findings contribute to the limited knowledge of options currently available to older adults and their families in their decision-making about end-of-life care options. Permission to conduct the study. Prior to commencement of the data collection, ethics clearances from the University of Newcastle and the regional Area Health Service were achieved. Permission to access the residential aged care facilities to undertake the study was obtained from the relevant residential aged care facility ethics committees or designated authorities. The researcher undertook several strategies to ensure all the ethical principles were considered and adhered to while conducting the project. Results. The research identified the components and factors involved in the Advance Care Planning process and in attaining desired outcomes. The conceptual framework developed elaborates how Advance Care Planning should be implemented and what may constitute successful implementation of Advance Care Planning in residential aged care facilities. The four main elements (input, throughput, output, feedback), and 20 sub-elements were requisites for nurses to initiate and implement the Advance Care Planning. Conclusion. The essential components for end-of-life care are identified in the implementation processes of Advance Care Planning in residential aged care facilities. The study contributes to greater awareness of the processes needed for ‘dying well’ and highlights the need to explore experiences of ‘successful dying’ and the way nurses contribute to these events. Relevance to clinical practice. The case study identified four determinative requisites for successful implementation of Advance Care Planning in aged care facilities: the expert nurse, discussion, education and involvement of a multidisciplinary team. Nurses should take these factors into account and use person-centred approach in formalised processes to encourage participation in plans for end-of-life care. [ABSTRACT FROM AUTHOR]

Aims and objectives. To evaluate nurses’ knowledge of adolescent sleep and sleep disturbance and the strategies they employ to facilitate sleep in adolescent patients. Background. Sleep disturbance in adolescents is common and associated with potentially devastating outcomes and co-morbidities. Despite this, little literature exists that reports nursing interventions related to facilitating sleep, and no literature could be located that explored what Australian nurses know about adolescent sleep and sleep disturbance. Design. Qualitative. Method.  Eight nurses routinely involved in the care of adolescent patients were interviewed via email and instant messaging over a five month period. Explored was the formation and extent of knowledge held by these nurses about adolescent sleep and sleep disturbance and the strategies they used to facilitate sleep in adolescent patients. Data were analysed thematically. Results. Three main themes were identified: ‘A patchwork of experiences’, ‘Traditional remedies, personal beliefs and commonsense’ and ‘Drugs, doctors and disempowerment’. Conclusions. Despite a lack of formal education about adolescent sleep and sleep disturbance, through life and professional experience the nurses in this study had formulated effective strategies to assist the sleep of adolescent patients. Relevance to clinical practice. There is a need for nursing education regarding adolescent sleep issues. Providing rationales for nursing strategies would afford nurses greater confidence to strongly advocate for a more non-pharmacological approach to managing certain types of sleep disturbance. Initiating routine assessment of adolescent sleep in both hospital and community settings could be beneficial to detecting a range of difficulties adolescent patients may be experiencing. [ABSTRACT FROM AUTHOR]

Aims. The aim of this study was to improve the emergency nursing care of acute stroke by enhancing the use of evidence regarding prevention of early complications. Background. Preventing complications in the first 24–48 hours decreases stroke-related mortality. Many patients spend considerable part of the first 24 hours following stroke in the Emergency Department therefore emergency nurses play a key role in patient outcomes following stroke. Design. A pre-test/post-test design was used and the study intervention was a guideline for Emergency Department nursing management of acute stroke. Methods. The following outcomes were measured before and after guideline implementation: triage category, waiting time, Emergency Department length of stay, time to specialist assessment, assessment and monitoring of vital signs, temperature and blood glucose and venous-thromboembolism and pressure injury risk assessment and interventions. Results. There was significant improvement in triage decisions (21·4% increase in triage category 2, p = 0·009; 15·6% decrease in triage category 4, p = 0·048). Frequency of assessments of respiratory rate ( p = 0·009), heart rate ( p = 0·022), blood pressure ( p = 0·032) and oxygen saturation ( p = 0·001) increased. In terms of risk management, documentation of pressure area interventions increased by 28·8% ( p = 0·006), documentation of nil orally status increased by 13·8% (ns), swallow assessment prior to oral intake increased by 41·3% ( p = 0·003), speech pathology assessment in Emergency Department increased by 6·1% (ns) and there was 93·5 minute decrease in time to speech pathology assessment for admitted patients (ns). Relevance to clinical practice. An evidence-based guideline can improve emergency nursing care of acute stroke and optimise patient outcomes following stroke. As the continuum of stroke care begins in the Emergency Department, detailed recommendations for evidence-based emergency nursing care should be included in all multidisciplinary guidelines for the management of acute stroke. [ABSTRACT FROM AUTHOR]