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Accessible Summary: What is known on the subject: Comfort as a conceptual and lived experience is essential in psychiatric hospital contexts and for overall mental health wellbeing.Comfort is a valuable aspect when designing hospitals and built environments for psychiatric care. What the paper adds to existing knowledge: This article presents the results from a Design Anthropology study at four Psychiatric Units co‐located in a newly built regional hospital based on 126 ethnographic interviews with staff, within which 63 participants mentioned the importance of comfort in generating environments conducive to wellbeing.An in‐depth qualitative understanding of comforting practices, as emergent forms of everyday care. These may receive less attention within more established interventions from organisational models of care (e.g., Safewards) and might appear to be implicit gestures of courtesy. However, they contribute to meaningful encounters and contribute to individual and organisational wellbeing in psychiatric care. What are the implications for practice: This paper builds on comfort theories and demonstrates implications for practice through ethnographic examples. Comfort, often unnoticed until it is absent, needs to be maintained through continuous "small" but intentional acts of care. These constitute a finely tuned repertoire of everyday comforting practices of care at psychiatric contexts.Corridors and doors are presented as spaces where people have brief interactions that can contribute to everyday comforting experiences.Comfort is discussed in dialogue with existing literatures from psychiatric nursing, healthcare building design and design anthropology. Implicit and improvised practices of care that foster comforting environments have vital potential to support institutionally endorsed models of care (e.g., Safewards).The article proposes that design has a dual role for comforting environments in psychiatric care; (a) through the practice of architectural design and (b) through the practices of staff when creating everyday comforting interactions for wellbeing. Introduction: Creating a comforting environment is essential for delivering psychiatric care. While healthcare organisations explicitly implement care models and adapt the physical environment, attention to staff's implicit everyday practice is limited. Aim: Developing a design anthropology approach tailored specifically to the research site, we examine the social and physical environment to unpack how staff integrate both—implicit comforting interventions, and the explicit measures taken by the organisation—into their everyday practices of psychiatric care. Method: Design and sensory ethnography, using extended observations and "walking tours" were undertaken with 126 staff members. A thematic analysis was conducted on all visual and audio material. Results: Staff's everyday implicit care practices and situated design decisions provide a comforting environment for patients, visitors and staff. Discussion: Implicit practices combine with an explicit organisational model of care to achieve a comforting environment. The value of design anthropology to uncover these dynamics is emphasized. Comforting practice involving implicit gestures of courtesy, which are infrequently addressed within organisational models of care (e.g., Safewards), are foregrounded. Implications for practice: Explicit models of care have clear value in generating comfort; however, psychiatric hospital care also benefits from less visible modes of delivering comfort through everyday practices. By acknowledging both explicit and implicit modes of comfort, we can better understand how care models and psychiatric cultures of care are nurtured. Continuous "small" but intentional acts of care (e.g., brief interactions in corridors and at doors) constitute a finely tuned repertoire of everyday comforting practices. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Many parents find out that their unborn baby has a difference in their health, development, or genetics.This news is often unexpected and can be distressing and traumatic, which can lead to anxiety. There is a gap in support for parents. What the paper adds to existing knowledge: This paper offers a story of the lived experience of the first‐author, a mental health nurse who was told that her baby had a difference late in pregnancy.The narrative moves through the anxiety and difficulties faced when falling between gaps in the systems. What are the implications for practice: This paper identifies the need for more support for parents who receive a prenatal diagnosis.This support is within the mental health nurse scope of practice across a range of settings and services.People who have been given a psychiatric diagnosis have been excluded from other studies that explore the experience of the unexpected news of a congenital anomaly.Research in this area is indicated. Relevance to mental health nursing: Mental health nurses are well‐positioned to address the gap in psychosocial support for parents who have received a prenatal diagnosis.As clinicians who are recognized to deliver federally funded pregnancy support counselling, psychosocial support is within the mental health nurse scope of practice.Some parents will require a higher level of support, assessment and intervention when they experience reactive mental illness or pre‐existing mental illness is exacerbated.Furthermore, people who have received a psychiatric diagnosis have been excluded from studies that explore the experience of receiving a prenatal diagnosis.This exclusion has resulted in a gap in knowledge. Introduction: Expectant parents who receive a prenatal diagnosis of a congenital anomaly often experience shock, distress and a heightened risk of mental illness. Aim: This paper aimed to highlight the gap in psychosocial support for parents who receive a prenatal diagnosis through the personal narrative of a mental health nurse who received a third‐trimester diagnosis. Method: The first‐author reviewed her medical records and photos to recall moments of the experience and prompt reflection. Findings: The narrative moved through the shock, guilt and subsequent pathological anxiety that followed a prenatal diagnosis at 32‐week gestation and the option to terminate. Discussion: The gap in psychosocial supports for parents who receive a prenatal congenital anomaly diagnosis raises the risk to parental mental health and potentially confounds the risk to the baby. Mental health nurses are well‐positioned as service providers to fill this gap. Implications for Practice: The provision of psychosocial support after a prenatal diagnosis is within the mental health nurse scope of practice. This support may be provided through pregnancy support counselling, innovative nurse‐led perinatal mental health services or as additional support to a parent with the lived experience of mental illness who receives a prenatal diagnosis of a congenital anomaly. [ABSTRACT FROM AUTHOR]

Aim: This paper explores the personal, social and structural factors that influence patients' experiences of acute deterioration and medical emergency team (MET) encounter. Background: Patient experience is recognized as a means of assessing healthcare delivery with a positive experience being linked to high‐quality healthcare, improved patient safety and reduced length of stay. The experience of acute deterioration is unique, extensive and complex. However, little is known about this experience from the patient's perspective. Design: Constructivist grounded theory, informed by Kathy Charmaz, was used to explore the personal, social and structural factors that influence patients' experiences of acute deterioration and MET encounter. Methods: Using a semi‐structured interview guide, in‐depth individual interviews were conducted with 27 patients from three healthcare services in Victoria, Australia. Data were collected over a 12‐month period from 2018 to 2019. Interview data were analysed using grounded theory processes. Findings Contextual factors exert a powerful influence on patients' experiences of acute deterioration and MET encounter. The most significant factors identified include patients' expectations and illness perception, relationship with healthcare professionals during MET call and past experiences of acute illness. The expectations and perceptions patients had about their disease can condition their overall experience. Healthcare professional–patient interactions can significantly impact quality of care, patient experience and recovery. Patients' experiences of illness and healthcare can impact a person's future health‐seeking behaviour and health status. Conclusion: Patients' actions and processes about their experiences of acute deterioration and MET encounter are the result of the complex interface of contextual factors. Impact The findings from this study have highlighted the need for revised protocols for screening and management of patients who experience acute deterioration. [ABSTRACT FROM AUTHOR]

Aim: To develop a working definition of the concept of "clinical credibility" in nursing science. Background: In both academic and clinical settings, the phrase "clinical credibility" is used when discussing the education of health professionals. No clear definition for the concept is evident in the academic literature. To date, there has not been a study undertaken to develop a working definition of clinical credibility in nursing science. Methods: This protocol is stage 1 of a registered report. We will use concept mapping to compare and organise views of three stakeholder groups: nursing students (n = 20) from years 2 or 3 of a three‐year Bachelor of Nursing Programme, nurses and other health professionals (n = 20) still practising within a clinical setting, and people who have recently been inpatients in hospital (n = 20). First, participants will take part in separate stakeholder focus groups to generate statements about "What is clinical credibility?". Second, the same participants will complete two tasks: (1) rank the importance of each statement (prioritising) and (2) put the statements that appear to go together into groups (clustering). The data will then be analysed using a specialised software program called Ariadne. A visual "concept map" will be produced showing the importance and relationship of each statement as viewed by the participants. The projected timeline for the study is one year. The paper complies with the SPIRIT 2013 guidelines for study protocols adapted for mixed methods research. Conclusion: The findings of this study will provide a working definition of the concept of "clinical credibility" in nursing science. Relevance to clinical practice: The findings can be used to develop a measure of clinical credibility to predict student satisfaction and patient safety outcomes. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Existing literature provides insight into the general experience of carers of people with a mental illness. Previous studies have found that carers experience a range of emotions when looking after their relatives with a mental illness. However, experiences of carers as they engage with the healthcare system is largely absent from the literature., What this paper adds to existing knowledge? This paper identified the experiences of carers when their relatives are experiencing a crisis or acutely unwell. Carers found themselves in the middle between mental health services and their relatives., Strategies employed by carers to ensure their relatives receive adequate care were identified from this study. This paper identified how carers needed to become more assertive in order to receive adequate care for their relatives, and this finding has implications for any future carer education., What are the implications for practice? The participants identified the need to work more collaboratively with carers of people with a mental illness as they seek treatment for their relatives in order to achieve better health outcomes for the patients. Improved health service engagement of carers was seen by participants to assist them to better care for their relative., The study also found that there needs to be a clearer definition as to what constitutes mental health crisis and how carers are able to intervene during this period. Services could provide clear information concerning crisis services and in particular triage., Abstract Aim The literature reporting experiences of relatives of people with mental illness regarding their interactions with mental health services identifies many commonalities. However, the actual experience of carers engaging the services and understanding healthcare systems remains a gap in the literature. The aim of this study was to explore the experiences of carers (of people with a severe mental illness) in a major area mental health service in Victoria Australia as they fulfil their caring role while negotiating support for their relative. A carer is defined as a family member or significant other who is the primary individual who provides informal care for a person with severe mental illness and may or may not be in receipt of income supplement for such a role. Specifically this study has a focus on the experience of the carer when negotiating care needs or admission with a mental health service. Method A qualitative descriptive approach was used with five focus groups as a means of data collection. Ethical approval for the study was obtained from both the hospital and universities ethics committees. Results Key themes identified using thematic analysis are presented in the words of the carers and include: 'Juggling' between services; We became assertive and If only they would listen. Often carers were advocating for their relative and needing to negotiate between services (police and crisis assessment teams) to gain any form of assessment or intervention. Carers often spent a great deal of time on the phone to services only to be told that their relative was 'not sick enough' to access care or that no response would occur without another service also being involved. Discussion Our research highlights the importance of working collaboratively with informal carers and acknowledging their valuable contribution to the care of their relatives with a severe mental illness. It is very important that adequate support is given to carers especially during the period when their relatives are experiencing a crisis. An understanding of their experiences ensures a more family focused approach towards care. The study findings should enable the healthcare team to focus attention on the issues which are most pertinent to carers. Nurses are advocates not only for the patient but also for their families. Relevance statement Carers supporting a person who experiences mental illness can often find themselves in difficult and emotionally challenging situations such as at times of crisis and admission to mental health services. The fourth and latest Australian National Mental Health Plan (2009-2014) acknowledged these concerns and highlighted the need to recognize the role of carers in promoting well-being and recovery of the relative with a mental illness. The plan acknowledges that families are often best placed to recognize signs of relapse in their family members with a mental illness and discharge planning should include the involvement of family members (Commonwealth of Australia, ). To achieve best care outcomes for consumers, mental health nurses need to recognize the role of the carer and collaborate in care planning. [ABSTRACT FROM AUTHOR]

Aim: To explore the benefits and challenges of a recently introduced Registered Undergraduate Student of Nursing workforce from the perspective of Nurses and Registered Undergraduate Students of Nursing, in a major metropolitan hospital in Australia in 2020. Design: A qualitative descriptive study was undertaken using individual interviews and focus groups. Methods: Purposively selected employed Registered Undergraduate Students of Nursing and nurses who worked with them were interviewed, using a semi‐structured format. Recordings were transcribed and coded using NVivo software. Reflexive thematic analysis using an inductive approach was undertaken. Results: Four major themes were revealed: (i) Navigating the programme, (ii) Belonging and integration; (iii) Patient care; and (iv) Continuing Development. Initial challenges were common, often related to clarifying the scope of practice for the new role. Ongoing issues were associated with gaps in understanding the role and lack of integration into the team. Mostly, nurses and Registered Undergraduate Students of Nursing built positive, professional relationships. Nurses valued the Registered Undergraduate Student of Nursing knowledge and skill level, reporting improved workload and work experiences when the Registered Undergraduate Student of Nursing was on shift. Nurses believed that the Registered Undergraduate Students of Nursing enhanced patient care. Registered Undergraduate Students of Nursing described positive, therapeutic relationships with patients. Registered Undergraduate Student of Nursing employment provided opportunities for new learning, leading to increased efficiency and confidence on clinical placement. Conclusions: This employment model benefited the Registered Undergraduate Students of Nursing and nurses who worked with them. In the absence of adequate training and support, challenges remained unresolved and negatively impacted the experience for nurses. In addition to university‐level education and clinical placement, the employment model can create a third space for student learning via on‐the‐job training. The study supports the ongoing employment of student nurses through the Registered Undergraduate Student of Nursing model. Implications for the Profession and/or Patient Care: Impact: This study contributes to the very small body of literature investigating Registered Undergraduate Student of Nursing workforces in Australian hospitals. It is the first to explore the experiences of both nurses and students working together in a major metropolitan setting and also the first in the context of the COVID‐19 pandemic.This study reflected a mostly positive experience for Registered Undergraduate Student of Nursing and the nurses who worked with them and highlighted the importance of adequate oversight and support in the implementation and maintenance of a Registered Undergraduate Student of Nursing workforce.Employed Registered Undergraduate Students of Nursing reported improved confidence, skills, and felt like they started clinical placement at an advantage, ready to step up and learn the Registered Nurse scope of practice.In addition to university‐level education and clinical placement, this employment model creates a third space for learning via on‐the‐job training. Reporting Method: COREQ guidelines were followed in the reporting of this study. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Strict patient isolation in hospital is associated with adverse health outcomes. However, there is a lack of high‐quality evidence for effective interventions to improve safety and quality of care for these patients. Aims: To identify patient reported areas for improvement in the care of patients in hospital isolation and to determine the feasibility of collecting patient reported outcomes using validated tools. Methods: Design: An exploratory mixed methods study. Setting: A major metropolitan teaching hospital in Melbourne, Australia. Participants: Patients in hospital isolation for transmissible infections. Data collection: Data were collected by (1) phone interviews with patients in isolation and (2) seven validated measurement tools to assess cognition, loneliness, nutritional status, quality of life, anxiety and depression and physical activity. Data were collected between September and December 2021. Data analysis: Interviews were transcribed and analysed using thematic analysis. Quantitative data were analysed descriptively including participant characteristics and outcome data. Results: Participants identified areas for improvement including activities to decrease boredom, more contact with staff to mitigate loneliness and increase comfort care, and formalised communication about clinical treatment and discharge plan. Patients with gastrointestinal symptoms were happier to be alone. There were operational challenges within the health service including delays and miscommunication. Only 70% of the participants completed all questionnaires. Conclusion: This study identified areas for improvement in care of patients in isolation and demonstrated that collecting patient reported outcomes using validated tools was feasible. The results of this research will inform development of an intervention to manage adverse effects. Implications for the Profession and/or Patient Care: Patients in hospital isolation require additional consideration to ensure that their needs are met to avoid adverse outcomes. The patient experience and comfort can be negatively affected when fundamental care is lacking. Reporting Method (EQUATOR): EQUATOR guidelines for Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR‐RHS). Patient or Public Contribution: Thirteen patients in hospital isolation agreed to participate in this study, sharing their experiences through interviews and assessment. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop a communication app to support nursing staff during the provision of standard care of patients from non‐English‐speaking backgrounds (NESBs), when an interpreter is not available. This paper reports on the user needs analysis phase that informed the development, content and functionality of the app. Background: In 2014 we developed CALD Assist, a communication app to support patient interactions with allied health clinicians when interpreters are not present. It includes 95 commonly used phrases professionally interpreted into 10 languages and grouped by discipline. This work expands upon our previous app to meet the needs of the nursing workforce. Design: Qualitative through focus groups, observations and interviews, with a quantitative component from observational data and staff surveys. Methods: Four focus groups with hospital staff, ten interviews with patients from NESBs and 85 observation sessions of everyday patient–staff interactions followed by staff surveys (n = 85) were held between January and June 2017. Results: Baseline data prior to app development revealed that staff confidence of the patients’ level of understanding and the success of the interaction were significantly greater for English‐speaking (ES) patients, than for non‐English‐speaking patients. A total of 143 phrases were identified and subdivided into 16 categories for inclusion in the new app. Conclusion: Staff participants highlighted that patients from NESBs are a challenging patient group to interact with. Patient and staff participants identified a range of areas where the nursing app could benefit, including pain management, mobility, hygiene and nutrition. Relevance to clinical practice: The proposed app can be used to reduce variances in practice and provide a timely and positive patient experience for patients from NESBs who are unable to communicate in English during hospital admissions. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Mental health nurses are affected by interpersonal, practice‐related and organizational factors that can increase workplace stress and reduce their physical and mental health and well‐being. Resilience programmes are a strength‐based preventative approach to supporting individuals to overcome workplace adversities. What the paper adds to existing knowledge?: This qualitative inquiry is the first study to report mental health nurses' perspectives and experiences on a workplace resilience programme. Strengthening mental health nurses' resilience through a resilience programme involved a process of understanding resilience, and applying resilience strategies such as positive self‐talk, managing negative self‐talk, detaching from stressful situations, being aware of and managing emotions, and showing more empathy, to address workplace challenges. To address the range of resources needed to support mental health nurses' resilience, a social–ecological approach to workplace resilience can be used to promote resource provision at individual, work unit, organizational and professional levels. What are the implications for practice?: Resilience programmes are one resource for addressing the impacts of workplace stressors on mental health nurses. Organizational barriers and risks to staff well‐being need to also be addressed to build a resilient workforce. Incorporating resilience strategies into clinical supervision or reflective practice models may help sustain beneficial outcomes following a resilience programme and support resilient practice. Abstract: Introduction: Mental health settings are potentially high‐stress workplaces that can lead to nurses' poorer health and well‐being. Resilience programmes are a strengths‐based preventative approach for promoting mental health and well‐being in the face of adversity; however, there is no prior research on mental health nurses' perspectives on resilience programmes. Aim: To explore the perspectives of mental health nurses participating in a mental health service‐initiated resilience programme (Promoting Adult Resilience). Method: An exploratory qualitative inquiry was undertaken. Multiple qualitative data: open‐ended responses and semi‐structured interviews and focus groups, were thematically analysed. Results: Twenty‐nine registered nurses from a metropolitan mental health service participated. Four main themes were as follows: being confronted by adversity; reinforcing understandings of resilience; strengthening resilience; and applying resilience skills at work. Discussion: This is the first study to report mental health nurses' perspectives on a resilience programme. Resilience programmes can help improve nurses' self‐efficacy and ability to realistically appraise stressful situations and to moderate their emotional responses to others. Implications for practice: It is recommended resilience programmes are provided to promote nurses' well‐being and resilient practices. To build a resilient workforce, the wider barriers and risks to staff well‐being need to be addressed at a unit, organizational and professional level. [ABSTRACT FROM AUTHOR]

Accessible summary This paper reports on a study that was conducted in an acute psychiatric unit investigating how and what information is communicated at nursing handovers that relates to a patients risk status., Nursing handovers are conducted in an ad hoc manner and may not effectively communicate information required for management of patient risks., A consistent and evidenced-based approach to mental health nursing handovers is required, in order to promote best nursing practice., Abstract Mental health inpatient units are dynamic, complex environments that provide care for patients with heterogeneous ages, diagnoses and levels of acuity. These environments commonly expose clinicians and patients to many potential risks. Despite extensive research into risk assessment, prediction and management, no study has investigated how risk information is communicated at handover in acute mental health settings. Given the pivotal role handover plays in informing risk management, this evidence gap is significant. This paper reports on a study that investigated the practices of communicating risk at handover in an Australian acute mental health inpatient unit. The aim of this research was to identify the frequency and type of risk information communicated between nursing shifts, and the methods by which this communication was performed. A secondary aim was to identify effective and ineffective risk communication practices. This study involved an observational design method using a 14-item Clinical Audit Tool derived from handover principles outlined by World Health Organization. Five hundred occasions of patient handover were observed. Few risk information items were observed to be communicated in any method. Risk communication practice was inconsistent, and a key recommendation from the study is the use of standardized handover tools that ensures risk information is adequately reported. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the effects of introducing an electronic medication management system on reported medication errors. Background Computerised medication management systems have been found to improve medication safety; however, introducing medication management system into healthcare environments can create unanticipated or new problems and opportunities for medication error. Design Descriptive analysis of medication error reports. Methods This was a retrospective analysis of 359 incident reports drawn from the period of 1 May 2005-30 April 2006 across two hospital sites of a single not-for-profit private health service located in metropolitan Melbourne. Site A used a conventional pen and paper system for medication management, and Site B had introduced a computerised medication management system. Results Most medication errors occurred at the nurse administration (71·5%) and prescribing (16·4%) stages of delivery. The most common medication error type reported at Site A was omission (33%), and at Site B was wrong documentation (24·2%). A higher proportion of errors at the prescribing phase, and less nurse administration errors, were detected at Site B where the medication management system was in use. The incidence of other, less frequent errors was similar across the two hospital sites. Conclusions This examination of medication error reports suggests there are differences in the types of medication errors that are reported in association with the introduction of electronic medication management system compared to pen and paper system systems. The findings provide a new insight into the effects of introducing an electronic medication management system on the types of medication errors reported. Relevance to clinical practice The findings provide a new insight into the types of medication errors that are reported during implementation of an electronic medication management system. Extra support for physicians prescribing practices should be considered. [ABSTRACT FROM AUTHOR]

McKenna L, Boyle M, Brown T, Williams B, Molloy A, Lewis B, Molloy L. International Journal of Nursing Practice 2012; 18: 246-251 Levels of empathy in undergraduate nursing students Empathy and absence of prejudice and stigma are instrumental in facilitating effective nurse-patient relations. This study assessed empathy levels and regard for specific medical conditions in undergraduate nursing students. A cross-sectional study was undertaken using paper-based versions of the Jefferson Scale of Physician Empathy (JSPE) and Medical Condition Regard Scale (MCRS), along with a brief set of demographic questions. Participants reported good empathy levels on JSPE. Attitudes towards intellectual disability, chronic pain, acute mental illness and terminal illness rated well on MCRS. Attitudes towards substance abuse, however, were lower. There were no significant differences between age groups, gender or year level of study. Overall results of this study were positive. Nursing students demonstrated acceptable empathy levels. Attitudes towards patients who abuse substances highlight an area that needs both further exploration and addressing. Attitudes towards mental health diagnoses were particularly favourable given that these often attract stigma and negative attitudes. [ABSTRACT FROM AUTHOR]

Sullivan E, Hegney DG, Francis K. International Journal of Nursing Practice 2012; 18: 226-232 Victorian rural emergency care-a case for advancing nursing practice The aim of this paper is to profile the emergency care patients seen by a selection of rural health services in Victoria, and show how advancing nursing practice could contribute to a more sustainable model of care. Quantitative patient data extracted from five rural health services across Victoria ranging in size, were analysed using descriptive statistic techniques. Most patients who attended for emergency care did not require urgent or immediate medical attention (70%), many had minor injuries (over 30%) and did not need medicines (57%) but were attended by a doctor either directly or via telephone (over 74%). If emergency care services in rural Victoria are to be sustained in the face of severe medical workforce shortages, registered nurses will need to be enabled through professional development, legislation and organisation policy to manage autonomously a larger proportion of the non-urgent, less complex patients who present to these emergency services. [ABSTRACT FROM AUTHOR]

Amir LH, James JP, Kelso G, Moorhead AM. International Journal of Nursing Practice 2011; 17: 541-547 Accreditation of midwife lactation consultants to perform infant tongue-tie release Infants with a tongue-tie or ankyloglossia have a short lingual frenulum, which can lead to problems with breastfeeding: attachment difficulties, nipple pain and damage, poor weight gain and eventually a reduction in milk supply. Trained clinicians can release the frenulum (frenotomy) in infants having difficulty with breastfeeding. Although traditionally performed by medical practitioners, we argue that this simple procedure is within the scope of practice of other clinicians. This paper outlines the process of setting up and maintaining credentialing for midwife lactation consultants (International Board Certified Lactation Consultants (IBCLCs)) to assess infant tongue-ties and perform frenotomy when appropriate at a tertiary maternity hospital. Since 2005, 11 midwives/IBCLCs have been credentialed to perform frenotomies at The Breastfeeding Education and Support Services at The Royal Women's Hospital in Melbourne, Australia. We believe that nurses/midwives/lactation consultants working in other settings could be trained to perform frenotomies, thus enabling faster resolution of breastfeeding problems. [ABSTRACT FROM AUTHOR]

Mills J, Field J, Cant R. International Journal of Nursing Practice 2011; 17: 455-463 Factors affecting evidence translation for general practice nurses This paper explores the domains of influence affecting practice nurses' ability to find, evaluate and use clinical evidence. A cross-sectional survey of general practice nurses ( n = 590) in Victoria, Australia in 2008 provided data for a principal components analysis. The research replicates a study undertaken in the UK using the Developing Evidence-Based Practice Questionnaire. Five domains of influence on nurses' translation of evidence were identified: skills in finding/reviewing evidence; barriers to finding/reviewing evidence; knowledge from published sources; knowledge from other sources; and barriers or facilitators to change. Each domain was interpreted as underlying the relationship of nurses with evidence-based practice and was comparable to the original study's findings when subjected to factor analysis. Findings from this study show that the Developing Evidence-Based Practice Questionnaire-Au is a valid and useful instrument in determining the influences on practice nurses' ability to effect knowledge translation and conduct practice based on evidence. Given these findings, a new model is proposed that explains the influence of a number of domains on Australian general practice nurses' translation of knowledge into practice. [ABSTRACT FROM AUTHOR]

McKenna L, McCall L, Wray N. International Journal of Nursing Practice 2010; 16: 176–182 Clinical placements and nursing students' career planning: A qualitative exploration Many nursing students enter undergraduate programmes with preconceived ideas about their future nursing careers, and intend to practice in particular areas such as midwifery or paediatrics. Through clinical placements, students are exposed to different clinical areas and professional socialization is facilitated. However, little is known about the influence of clinical placements on students' career intentions. This paper reports nursing findings drawn from a large qualitative study conducted in Victoria, Australia that sought to explore the influence of health professional students' clinical placements on their future career intentions. Participants were invited to be involved in either face-to-face or focus group interviews depending upon their own preference. Thematic data analysis revealed three main themes: ‘re-affirming career choice’, ‘working in a particular area’ and ‘work location’. Findings from the study add to our understanding of factors influencing nursing students' planning for their future careers including the impact of clinical placements. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Mental health service users with medical co-morbidity frequently experience difficulties accessing and receiving appropriate treatment in emergency departments., Service users frequently experience fragmented care planning and coordinating between tertiary medical and primary care services., Little is known about mental health nurses' perspectives about how to address these problems., What this paper adds to existing knowledge? Emergency department clinicians' poor communication and negative attitudes have adverse effects on service users and the quality of care they receive., The findings contribute to the international evidence about mental health nurses' perspectives of service users feeling confused and frustrated in this situation, and improving coordination and continuity of care, facilitating transitions and increasing family and caregiver participation., Intervention studies are needed to evaluate if adoption of these measures leads to sustainable improvements in care planning and coordination, and how service users with medical co-morbidity are treated in emergency departments in particular., What are the implications for practice? Effective planning and coordination of care are essential to enable smooth transitions between tertiary medical (emergency departments in particular) and primary care services for service users with medical co-morbidity., Ongoing professional development education and support is needed for emergency department clinicians. There is also a need to develop an organized and systemic approach to improving service users' experience in emergency departments., Abstract Introduction Mental health service users with medical co-morbidity frequently experience difficulties accessing appropriate treatment in medical hospitals, and often there is poor collaboration within and between services. Little is known about mental health nurses' perspectives on how to address these problems. Aim To explore mental health nurses' perspectives of the experience of service users with medical co-morbidity in tertiary medical services, and to identify how to improve care planning and coordination for service users transitioning between tertiary medical and primary care services. Method Embedded within an experience-based co-design study, focus group discussions were conducted with 17 emergency department nurses and other clinicians, in Melbourne, Australia. Results Three main themes were abstracted from the data: feeling confused and frustrated, enhancing service users' transition and experience and involving families and caregivers. Participants perceived the service user experience to be characterized by fear, confusion and a sense of not being listened to. They highlighted that service users' transition and experience could be enhanced by facilitating transitions and improving coordination and continuity of care. They also emphasized the need to increase family and caregiver participation. Conclusion Our findings contribute to knowledge about improving the way service users are treated in emergency departments and improving care planning and coordination; in particular, facilitating transitions, improving coordination and continuity of care and increasing family and caregiver participation. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. Background Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. Design A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. Methods A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. Findings Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. Conclusions The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication management in an acute hospital setting. Language discourses shaped and were shaped by complex power relations between patients and clinicians and among clinicians themselves. Relevance to clinical practice Clinicians need to be encouraged to have regular conversations to talk about and challenge each other's practices. More emphasis should be placed on ensuring that patients are given opportunities to voice their concerns about how their medications are managed. [ABSTRACT FROM AUTHOR]

Aims and objectives To redefine the practice of rural nurses and describe a model that conceptualises the capabilities and characteristics required in the rural environment. Background The way in which the practice of rural nurses has been conceptualised is problematic. Definitions of rural nursing have been identified primarily through the functional context of rural health service delivery. The expert generalist term has provided a foundation theory for rural nurses with understandings informed by the scope of practice needed to meet service delivery requirements. However, authors exploring intrinsic characteristics of rural nurses have challenged this definition, as it does not adequately address the deeper, intangible complexities of practice required in the rural context. Despite this discourse, an alternative way to articulate the distinctive nature of rural nursing practice has eluded authors in Australia and internationally. Design A theoretical paper based on primary research. Methods The development of the model was informed by the findings of a study that explored the nursing practice of managing telephone presentations in rural health services in Victoria, Australia. The study involved policy review from State and Federal governments, nursing and medical professional bodies, and five rural health services; semi-structured interviews with eight Directors of Nursing, seven registered nurses and focus group interviews with eight registered nurses. Results An ambiguity tolerance model drawn from corporate global entrepreneurship theory was adapted to explain the findings of the study. The adapted model presents capabilities and characteristics used by nurses to successfully manage the ambiguity of providing care in the rural context. Conclusions Redefining the practice of rural nurses, through an adapted theory of ambiguity tolerance, highlights nursing characteristics and capabilities required in the rural context. This perspective offers new ways of thinking about the work of rural nurses, rural nurse policy, education, recruitment, retention and clinical governance. Relevance to clinical practice A greater understanding of rural nurse practice will assist in achieving positive care outcomes in an environment with competing stakeholder needs, and limited resources and options for care. [ABSTRACT FROM AUTHOR]

Aims and objectives The purpose of our paper was to explore primary caregivers' experience of the way public mental health nurses and other mental health clinicians responded to them as primary carers of older adults with mental illness. Background As populations age, the prevalence of mental illness in older adults will increase and the burden of care placed on family carers will intensify. While family carers are essential to the well-being and quality of life of older adults with mental illness, they frequently experience marginalisation from clinicians. Design An interpretative phenomenological analysis approach was used to inform data collection and analysis. Method Individual, semistructured, audio-recorded qualitative interviews were conducted with a purposive sample of 30 primary carers. Results Two themes were abstracted from the data highlighting carers' contrasting satisfaction with, and delivery of culturally competent care by, clinicians. A third theme, strategies for enhancing carers' experience of care, incorporated carers' suggestions about ways to strengthen their experience of caring. Conclusion Although some primary carers had favourable experiences with clinicians, most were dissatisfied and this, in turn, clouded their overall experience of caring. Relevance to clinical practice Our findings have implications for the provision of education, ongoing support for, and building the cultural competence of, clinicians about working with carers. They also highlight the need for a change in organisational and practice culture to encompass mutual respect and partnership with carers within the context of the providing person-centred care for carers and older adults with mental illness. [ABSTRACT FROM AUTHOR]

Aim To describe the design, development and evaluation of a consumer-centred video, which was underpinned by the Theory of Planned Behaviour and it was created to educate newly transplanted kidney recipients about the importance of medication adherence. Background Kidney transplantation is a treatment whereby medication adherence is critical to ensure long-term kidney graft success. To date, many interventions aimed to improve medication adherence in kidney transplantation have been conducted but consumers remain largely uninvolved in the interventional design. Design Qualitative sequential design. Methods Twenty-two participants who had maintained their kidney transplant for at least 8 months and three participants who had experienced a kidney graft loss due to non-adherence were interviewed from March-May 2014 in Victoria, Australia. These interviews were independently reviewed by two researchers and were used to guide the design of the story plot and to identify storytellers for the video. The first draft of the video was evaluated by a panel of seven experts in the field, one independent educational expert and two consumers using Lynn's content validity questionnaire. The content of the video was regarded as highly relevant and comprehensive, which achieved a score of >3·7 out of a possible 4. Results/findings The final 18-minute video comprised 15 sections. Topics included medication management, the factors affecting medication adherence and the absolute necessity of adherence to immunosuppressive medications for graft survival. Conclusion This paper has demonstrated the feasibility of creating a consumer-driven video that supports medication adherence in an engaging way. [ABSTRACT FROM AUTHOR]

Accessible summary Clinical leadership is important for the strength of mental health nursing as a profession, particularly in utilizing clinical-based opportunities for the professional development of new graduates and nursing students., To date, there has been limited research examining the attributes of nurses considered by their colleagues to be clinical leaders. This study presents the views and experiences of mental health nurses who deliver care, about what they identify as important for effective clinical leadership., Clinical teaching and role modelling are two fundamental roles of effective clinical leaders; they are underpinned by the attributes of professionalism, honesty, willingness to share knowledge and approachability., Additional research is needed to consider the applicability of these roles and attributes across larger samples of nurses in mental health settings., Abstract Clinical leadership is acknowledged as important to the nursing profession. While studies continue to identify its significance in contributing to positive outcomes for consumers, the role that clinical leadership has in enabling and supporting professional development in mental health nursing is poorly understood. This study utilized a grounded theory methodology to explore the characteristics clinicians consider important for clinical leadership and its significance for mental health nursing in day-to-day clinical practice. Individual face-to-face, semi-structured interviews were conducted with nurses working in mental health settings. Participants described the important role that clinical leaders play in enabling professional development of others through role modelling and clinical teaching. They describe how nurses, whom they perceive as clinical leaders, use role modelling and clinical teaching to influence the professional development of nursing staff and undergraduate nursing students. Attributes such as professionalism and honesty were seen, by participants, as enablers for clinical leaders in effectively and positively supporting the professional development of junior staff and undergraduate nurses in mental health nursing. This paper examines clinical leadership from the perspective of mental health nurses delivering care, and highlights the important role of clinical leaders in supporting professional development in mental health nursing. [ABSTRACT FROM AUTHOR]

Evidence-based practice ( EBP) in the clinical setting is recognized as an approach that leads to improved patient outcomes. Nurse educators ( NEs), clinical coaches ( CCs) and nurse specialists are in key positions to promote and facilitate EBP within clinical settings and have opportunities to advance practice. Therefore, it is important to understand their perceptions of factors promoting EBP and perceived barriers in facilitating EBP in clinical settings, before developing educational programmes. This paper reports findings from a study that aimed to explore NEs' , CCs' and nurse specialists' knowledge, skills and attitudes associated with EBP. This study used a questionnaire containing quantitative and a small number of qualitative questions to capture data collected from NEs, CCs and nurse specialists working at a tertiary health-care facility in Victoria, Australia. The questionnaire was distributed to a total of 435 people, of whom 135 responded (31%). Findings revealed that the three senior nurse groups relied heavily on personal experience, organizational policies and protocols as formal sources of knowledge. Furthermore, they had positive attitudes towards EBP. However, participants demonstrated lack of knowledge and skills in appraising and utilizing evidence into practice. They indicated a desire to seek educational opportunities to upskill themselves in the process of EBP. [ABSTRACT FROM AUTHOR]

In Australia, people experiencing personality disorder have featured little in policing studies and policy or mental health policy and legislation, and in the absence of specific guidance their behaviours represent an ongoing challenge for police. This paper presents police officers' accounts from a qualitative research project that explored police encounters with people experiencing mental illness. The officers singled out people with personality disorder and expressed frustration, anger, powerlessness and resignation with their referrals of this group to health services. Officers reported that emergency departments were reluctant to assess people with personality disorder and when they did assess them stated that the person did not meet criteria for admission to mental health services, or if admitted, they were quickly discharged. People with personality disorder were reported to take up considerable police resources. When police were told by mental health professionals that there was nothing they could do about people experiencing personality disorder, then the question from police was what was to be done with them. While pockets of collaborative practice exist between police and mental health services, much change is required to demonstrate that the needs of the person with personality disorder are being met. [ABSTRACT FROM AUTHOR]

Background: As frontline healthcare workers, there is a growing expectation that nurses should be able to respond to disclosures of family violence. However, the profession and hospital systems have been slow to respond with clear skills, knowledge and confidence deficits identified in existing research. There is limited research which has robustly evaluated the effectiveness of in‐depth, multifaceted training on readiness to respond among nurses. Aim: To longitudinally evaluate the effectiveness of an in‐depth family violence training intervention on confidence, knowledge and clinical skills of nurses working in a large tertiary adult hospital. Design: Single‐centre, longitudinal intervention study. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross‐sectional guidelines were used. Methods: One hundred and ten nursing clinicians participated in this study to complete a comprehensive evidence‐based model of healthcare workers response for assisting patients experiencing family violence. A mixed methods survey was used to assess change in knowledge, confidence and clinical skills among participants. Outcome assessment was electronically undertaken at baseline, 6–9 months and 12–15 months following intervention. Results: Statistically significant improvement was seen in self‐reported knowledge, confidence and frequency of screening for family violence. Relative to baseline estimates, these improvements were identified 6–9 months and 12–15 months following intervention; albeit with consideration to the visually observed trend of skill reversion at follow‐up. Quantitative findings were paralleled by qualitatively identified improvements in the recognition of the intersectional nature of violence, need for patient collaboration in screening and depth in considerations around how family violence is screened for. Conclusions: Findings provide tentative support for the utility of a multidimensional training approach to improving nurses' readiness to respond to disclosures of family violence. Relevance to clinical practice: This study provides preliminary support for multidimensional, evidence‐based training to effectively improve nurses' confidence, knowledge and clinical skills required for responding to family violence. Reporting Method: The study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (SQUIRE) Statement: guidelines for reporting observational studies (see Table S1). Patient Contribution: Patients were involved in the initial design of the survey tool. This involvement came through the Allied Health Consumer panel and included input on the design and question wording of the survey items. [ABSTRACT FROM AUTHOR]

Aims: To explore clinical supervision practice by Victorian Maternal and Child Health nurses, identify the self‐reported supervision needs of nurses and the facilitators and barriers to meeting those needs. Background: Community‐based Maternal and Child Health nurses have responsibilities for the safety and wellbeing of children and specific clinical support needs. Clinical supervision has the potential to support nurses' clinical practice and reflective skills; however, little is known internationally about child and family health nurses' supervision practices. Design: Qualitative descriptive study. Methods: Twenty‐three semi‐structured interviews were conducted between October and December 2021 with nurses, managers and supervisors across metropolitan, regional/rural areas of Victoria, Australia. Inductive thematic analysis was applied to the data. The Consolidated Criteria for Reporting Qualitative Research guided this study. Results: Three main themes, with subthemes were generated; 'Understand what we do', 'It's the gathering of the nurses' and 'Bringing a case'. A lack of agreed purpose, aims and varied understandings of clinical supervision contributed to suboptimal clinical supervision. Although participants agreed about the importance of clinical supervision, the perceived benefits were inconsistently realized. Conclusions: This study points to a need for greater organizational awareness of the conditions and leadership needed to build reflective skills and culture in community‐based child and family nursing. Reporting Method: The Consolidated Criteria for Reporting Qualitative Research has guided this study. No Patient or Public Contribution: There was no patient or public contribution in the conduct of this study. Impact: A stronger focus is needed to build reflective culture and skill in child and family nursing.Areas for improving child and family nurses' use of clinical supervision have been identified.This study can inform nurse education, policy and service leaders, to strengthen clinical supervision in child and family nursing contexts. [ABSTRACT FROM AUTHOR]

Aims To investigate the extent to which emotional labour and emotional intelligence are associated with well-being and job-stress among a group of Australian community nurses. The moderating role of emotional intelligence was evaluated as a key factor in the rescue of healthcare workers from job-stress, thus increasing job retention. Background Although emotional labour has been broadly investigated in the literature, the contribution of emotional labour and emotional intelligence to the well-being and experience of job-stress in a community nursing setting requires further exploration. Design This study used a cross-sectional quantitative research design with data collected from Australian community nurses. Methods Australian community nurses ( n = 312) reported on their perceived emotional labour, emotional intelligence and their levels of well-being and job-stress using a paper and pencil survey in 2010. Results/Findings Results from structural equation modelling support the hypothesis that both emotional labour and emotional intelligence have significant effects on nurses' well-being and perceived job-stress. Emotional intelligence plays a moderating role in the experience of job-stress. Conclusion These findings provide additional evidence for the important effects that emotional labour and emotional intelligence can have on well-being and job-stress among community nurses. The potential benefits of emotional intelligence in the nurses' emotional work have been explored. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to describe the implementation of a depression screening and referral tool in two cardiac wards of a major metropolitan public hospital. The tool consisted of two sections: (1) screening for depression risk (Cardiac Depression Scale-5) and (2) consequential referral actions. Background. Prior research has shown that depression in patients with heart disease is associated with significantly impaired quality of life, decreased medication adherence, increased morbidity and increased use of healthcare services. Design. A prospective in-patient study design. Method. A consecutive sample of 202 patients admitted to either the cardiac medical ( n = 145) or surgical ( n = 57) wards of a major Melbourne metropolitan hospital were recruited into the study over an 18-week period. Results. Just over half (54%) of the patients were identified as 'at risk' of depression. Of these, 19% were assessed as moderate risk and 35% high risk. Of those patients, 91% had the risk score documented in their medical history, 90% had engaged in discussions with clinicians regarding their risk score, 85% had their risk score communicated formally to the medical team and 25% were formally referred for appropriate follow-up - significantly more than prior to implementation of the screening and referral tool. Conclusions. By providing a formalised mechanism for detecting depression, documented screening and referral rates improved for those with comorbid depression and heart disease affording an opportunity for early intervention. These findings support a move towards integrated approaches to screening of depression to become standard practice in the acute cardiac setting. Relevance to clinical practice. Such mechanisms also have the potential to initiate the development of new models of care that acknowledge the complexity of comorbid depression and heart disease and provide pathways from speciality to primary care which integrate the physical and psychosocial domains inclusive of screening, referral, systematic monitoring and streamlined behavioural and physical care. [ABSTRACT FROM AUTHOR]

A person-centred health promotion model of care to improve self-care and lifestyle changes for older people with chronic illnesses is conceptualized in this paper. The model supports effective interpersonal communication with nurses and health-care consumers and is developed to concept stage. Older people with chronic illnesses who experience stress, anxiety or social isolation are more likely to be admitted and re-admitted to acute hospitals. Interventions to decrease the risk factors are frequently unsuccessful in this patient group. Programmes, led by nurses, aimed at reducing stress, anxiety and social isolation while supporting older people postdischarge from hospital might be successful. The model integrates research from synthesized case studies and a critical literature review. The practices of interrelating four key elements-'construct', 'context', 'process' and 'outcome'-are proposed for nurses to assist patients advancing self-care and lifestyle change. The model is designed for implementation in outpatient, clinic or community settings. [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]

Aim: To understand how the COVID‐19 pandemic impacted nurse educators' and novice nurses' experience with the perioperative transition to specialty practice program. Design: A qualitative descriptive study. Methods: Semi‐structured interviews were conducted with five perioperative nurse educators and five perioperative transition to specialty practice program participants from a major metropolitan health service in Melbourne. Data were collected between April and July 2021. Interviews were audio‐recorded and transcribed verbatim, and data were analysed using reflexive thematic analysis. Results: Five themes were identified. The value of the perioperative transition to specialty practice program in supporting novice nurses was recognized in the theme 'Nurturing our novices'. Widespread changes to clinical practice were demonstrated in the theme 'Every day is different', including changes to elective surgery, redeployment of staff and the transmission risk of COVID‐19. 'The perils and joys of online learning' revealed both challenges and benefits of transitioning theoretical education from face‐to‐face to online delivery. 'Roller coaster of emotions' represented the heightened emotions participants experienced due to the COVID‐19 pandemic. 'Looking back to move forward' encompassed participants' reflections on the year, considering the challenges, adaptive strategies and the future of perioperative nursing education. Conclusion: The perioperative transition to specialty practice program was significantly impacted by the COVID‐19 pandemic. Participants needed to adapt to rapid and frequent changes, which contributed to feelings of emotional distress, affected consolidation of clinical learning and reduced engagement with theoretical education. Impact Perioperative nurses should acknowledge that opportunities for learning were decreased for transition to specialty practice program participants during the pandemic. Ongoing support and education should be provided, to nurture the future generation of perioperative nurses. [ABSTRACT FROM AUTHOR]

Aims and objectives: To understand how the pandemic environment impacted the delivery of FCC of children and families from a nursing perspective in a major tertiary paediatric hospital. Background: Family‐centred care (FCC) is a well‐established framework to promote parental involvement in every aspect of a child's hospitalization, however, rules and restrictions in place during the COVID‐19 pandemic affected the ways in which Family‐centred Care could be delivered in practice. Design: This is a qualitative exploratory descriptive study to elicit the perspective of paediatric nurses delivering care to children in a hospital during the COVID‐19 pandemic in Victoria, Australia. Methods: Nurses from all subspecialties in a tertiary paediatric hospital were invited to participate in virtual focus groups to discuss their experience of delivering FCC during the COVID‐19 pandemic. Focus groups were recorded and transcribed, then analysed using Framework Analysis. Results: Nineteen nurses participated across seven focus groups during June and July 2020. The four themes—Advocating with empathy, Enabling communication, Responding with flexibility, and Balancing competing considerations—and the eight subthemes that were generated, outline how nurses deliver FCC, and how these FCC actions were impacted by the COVID‐19 environment and the related hospital restrictions. Conclusion: This study documents the experiences, resilience and resourcefulness of paediatric nurses in Australia during the COVID‐19 pandemic as well as moving Family‐centred Care from a theoretical framework into a practical reality. Impact The findings from this study should inform consideration of the impacts of public health policies during infectious disease outbreaks moving forward. In addition by describing the core actions of Family‐centred Care, this study has implications for educational interventions on how to translate FCC theory into practice. No public or patient contribution as this study explored nursing perceptions only. [ABSTRACT FROM AUTHOR]

Background: Preventable harms during hospitalization pose a major challenge for health systems globally. Nurse‐led strategies provide comprehensive harm prevention to keep the most vulnerable patients safe in hospital, but gaps in care are common. Nursing roles and activities to prevent harm to patients during acute hospitalization are poorly understood. Aim: The aim of this study was to identify nurses' perceived enablers and barriers to the implementation of comprehensive harm prevention for older people admitted to an acute hospital setting. Design: Anonymous, online, cross‐sectional survey. Methods: The adapted Influences on Patient Safety Behaviours Questionnaire (IPSBQ) was used to collect data from nurses working on five general medicine wards across three hospitals of a single tertiary health service in Australia in 2019. Participants also rated their perceptions of overall quality of care, missed care and awareness of strategies for an eight‐factor framework for comprehensive harm prevention. The STROBE reporting checklist was used. Results: Ward response rates between 35% and 58% resulted in 132 complete questionnaires for analyses. High mean scores for behavioural regulation (3.28), beliefs about capabilities (2.96) and environmental context and resources (2.73) indicated these domains were perceived by nurses as enablers. Low mean scores for the domains of intentions (1.65), beliefs about consequences (1.69), optimism (1.72) and professional role and identity (1.85) indicated these were barriers to comprehensive harm prevention by nurses. High perceived quality of care (scored 9–10/10) (p =.024), and awareness of strategies for the eight‐factor framework (p =.019) were significant enablers of comprehensive harm prevention. Conclusion: Targeted evidence‐based strategies that include education, persuasion, incentivization, coercion and modelling would be most useful for promoting comprehensive harm prevention by nurses. However, to be most effective the harm prevention strategy may need to be tailored for each ward. [ABSTRACT FROM AUTHOR]

Aim: To assess the prevalence of modifiable health‐risk behaviours among Indigenous Australian adults with diabetes attending a regional Victorian Indigenous primary‐care clinic. Design: A cross‐sectional observational single‐site study. Methods: As part of a multi‐study project we administered the Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional wellbeing (SNAPE) survey tool during the study baseline visit to methodically capture health‐related behavioural data in the nurse‐led integrated Diabetes Education and Eye Screening (iDEES) project in a regional Indigenous primary healthcare setting between January 2018 and March 2020. This descriptive SNAPE study helps address the lack of health behaviour data for Indigenous people with diabetes. Results: Of 172 eligible adults, 135 (79%) were recruited to the iDEES study, 50 (37%) male. All participated in at least one survey. Median (range) age was 56 (46–67) years; 130 (96%) had Type 2 diabetes of median [IQR] duration 6 (2–12) years. All 135 provided smoking data; 88 (65%) completed all surveys. Forty‐nine (36%) and 29 (22%) were current or former smokers, respectively; 5 (6%) met vegetable intake guidelines, 22 (25%) met fruit intake guidelines; 38 [43%] drank alcohol in the past year. On average, participants walked for ≥10 min at a time 4 days/week and sat for an average of 8 h on weekdays; 35 (40%) had minimal‐mild, and 30 (34%) had moderate‐severe depressive symptoms. Conclusion: Suboptimal modifiable health‐risk behaviours and depressive symptoms are common in Indigenous Australian adults with diabetes. Impact: Orderly assessment and reporting of health‐risk behaviours using a single multi‐component survey instrument (SNAPE tool) during a nurse‐led diabetes education clinical visit is feasible and efficient. Such data may facilitate personalised interventions and improve diabetes management at both individual and health service levels. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore: i) the frequency and nature of patient participation in nursing handover and ii) patients' and nurses' perceived strategies to enhance patient involvement in nursing handover. Background: Patient participation in nursing handover is important for patient‐centred care, shared decision‐making, patient safety and a positive healthcare experience Design: A multi‐site prospective study using a mixed methods design. Methods: Between September and December 2019, nursing handovers were observed on ten randomly selected wards, followed by semi‐structured interviews with patients (n = 33), and nurses (n = 20) from the observed handovers. Data were analysed using descriptive statistics for structured observations and thematic analysis of interviews, and triangulated to develop a greater understanding of patient participation in nursing handover. This study is reported using the Good Reporting of Mixed Methods Study guidelines. Results: The median patient age was 77 years and 47% (n = 55) patients were female. Of the 117 handovers, 76.9% (n = 90) were conducted in the patient's presence. Patients were active participants in 33.3% (n = 30) and passive participants in 46.7% (n = 42) of handovers; in 20% of handovers (n = 18), the patient had no input at all. Active participation was more likely in women (vs. men), surgical patients (vs. medical patients) and when nurses displayed engagement behaviours (eye contact, opportunity to ask questions, explanations). Three major themes were identified from the interviews: 'Being Involved', 'Layers of Influence' and 'Information Exchange'. Conclusions: The main finding was that patient participation in handover was low and strongly influenced by a complex interplay of factors including patient and nurse preferences and perceptions. Relevance to Clinical Practice: Handover is an essential tool in the provision of safe patient care. Patients were able to actively participate in nursing handover when they understood the purpose and timing of handover and had rapport with nurses. [ABSTRACT FROM AUTHOR]

Aims: To understand why some nursing homes use hospital avoidance programs more frequently than others. Design: Two hospital avoidance programs, called residential‐in‐reach services in Victoria, Australia, were evaluated using a qualitative descriptive design. Methods: Between 2014 and 2018, 127 semi‐structured interviews were conducted with staff from nursing homes, general practitioners and staff from the residential‐in reach services. The interviews took an average of 45 min and transcripts were thematically analysed. Results: Nursing home reliance on residential‐in‐reach services to manage deteriorating residents was evident in both evaluations. Irrespective of the model of service provision, reliance was associated with: the increased care needs of residents; difficulties accessing timely and appropriate medical care; and the reduced numbers of skilled registered nurses to assess and manage deteriorating residents. Conclusion: The residential‐in‐reach services are highly regarded by nursing homes. However, some are reliant on these services to provide nursing assessment and management. Using residential‐in‐reach services to substitute for nursing care, deskills nurses and shifts the cost of providing care from the service provider to other agencies. To provide residents with quality nursing care, the number of skilled registered nurses able to work within their scope of practice needs to be increased in Australian nursing homes. Impact: The findings highlight the challenges of providing care in older people living in aged care. Increasing the number of skilled registered nurses in Australian nursing homes, would support deteriorating residents to stay in familiar surroundings and reduce reliance on external services to provide nursing care. [ABSTRACT FROM AUTHOR]

Street M, Eustace P, Livingston PM, Craike MJ, Kent B, Patterson D. International Journal of Nursing Practice 2011; : 133-140 Strategies to support continuity of care and improve patient safety during clinical handover have been developed. The aims of this study were to identify the strengths and limitations in current practice of nursing clinical handover and implement a new bedside handover process. A total of 259 nurses completed a cross-sectional survey at change of shift on 1 day, which was followed by an audit of the pilot implementation of bedside handover. The survey results showed great variation in the duration, location and method of handover with significant differences in the experience of nurses employed part-time compared with full-time. Following implementation of standardized bedside handover on two wards, the audit revealed significant improvement in the involvement of patients, use of Situation-Background-Assessment-Recommendation, active patient checks and checking of documentation. These findings suggest the use of standardized protocols and communication tools for bedside handover improve continuity of patient care. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of the study was to enhance understanding about dignified care from older peoples' and their carers' perspectives. The information will contribute to the development of a tool to measure older peoples' dignity during hospitalisation. Background: Older people are a vulnerable cohort at risk of loss of dignity during acute hospitalisation arising from environmental, behavioural and patient factors. It is not clear how older people and their relatives define dignified care in acute care settings. Design: An interpretative descriptive method was used. Methods: A purposive sample of older people (at least 65 years) who had been hospitalised in acute care and subsequently transferred to sub‐acute care, and their relatives, were invited to participate. The study was undertaken in one sub‐acute ward in a regional healthcare organisation in Victoria, Australia. Individual interviews were audio‐recorded then transcribed. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. Results: Individual interviews were conducted: 24 patients and 12 relatives. Three main themes were identified: "Involve me in decisions about my care and treatment," "Keep me safe when I am vulnerable" and "Treat me as an individual and with respect." Older people want to be involved in decisions about their care and treatment and to receive adequate, suitable information. They feel vulnerable during hospitalisation and want to feel safe when speaking up about concerns. Individual acknowledgement is an important aspect of dignity. Conclusions: Older people and their relatives identified specific elements of care that uphold or threaten dignity during acute hospitalisation. Nurses play a major role in upholding dignity for older people in hospital. Relevance to clinical practice: Clinicians may benefit from systematic dignity‐related training. Specific strategies to enhance older persons' dignity, including communication skills training and continence management need to be developed, implemented and evaluated. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. Background: Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. Design: Delphi Method. Method: A three‐round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. Results: High patient acuity or complexity, as well as inadequate bed space on wards, are "very high" risks that occur "often" and "very often," respectively. The pressure to admit patients, delayed medical review and patient boarding are all "high" risks that occur "often." Though only occurring "sometimes," inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a "very high" risk to patient care. Conclusion: The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system‐wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. Relevance to clinical practice: This study provides a description of the challenges that face acute care nursing in the provision of safe and high‐quality care. [ABSTRACT FROM AUTHOR]

Aims and objectives: The proposed study aimed to answer the following question: What communication issues do nurses find challenging when caring for people with life‐limiting illness? Background: Evidence suggests that attitudes, skills and knowledge about how nurses communicate effectively with patients and their families could be improved. However, the literature predominantly focuses on nurses working in oncology and the medical profession. Design: A qualitative descriptive design was used. Methods: Focus groups were conducted with 39 nurses from three wards within a regional healthcare organisation in Victoria, Australia. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. Results: In their view, nurses have the potential to develop a strong bond with patients and their families. Three key themes were identified: (a) feeling unskilled to have difficult conversations with patients who have life‐limiting illness; (b) interacting with family members adds complexity to care of patients who have life‐limiting illness; and (c) organisational factors impede nurses' capacity to have meaningful conversations with patients and their families. Conclusions: Caring for individuals with life‐limiting illness is complex and often occurs in an emotionally charged environment. However, nurses report being hampered by time restraints and lack of information about the patient's condition and goals of care. Limitations in conversation structure and a comprehensive range of core communication skills affect their ability to confidently engage in conversations, particularly when they are responding to prognostic questions. Relevance to clinical practice: Whilst nurses are responsible for performing technical skills, they can maximise care by developing a trusting relationship with patients and their relatives. Increased acuity limits the time nurses have to talk with patients. In addition, they lack confidence to deal with difficult questions. Specific training may increase nurses' confidence and efficiency when communicating with patients and their families. [ABSTRACT FROM AUTHOR]

Background: In the case of life‐threatening conditions such as respiratory or cardiac arrest, or the clinical deterioration of the patient, a Code Blue activation may be instigated. A Code Blue activation involves a team of advanced trained clinicians attending the emergency needs of the patient. Aims and objectives: The aim of the study was to explore the number of cases of Code Blue activations, looking at the timing, clinical ward, diagnosis and activation criteria while noting cases where escalation from a Medical Emergency Team (MET) call occurs in one Regional Healthcare Service in Victoria, Australia, over a six‐year period. Methods: A quantitative retrospective descriptive study of Code Blue emergencies over a six‐year period from June 2010 to June 2016 was conducted. Data collected from the RISKMAN program operating at a single site was imported into SPSS (V 22) for descriptive statistical analysis. A STROBE EQUATOR checklist was used for this study (see File S1). Findings: The majority of Code Blue activations were male (59%, n = 127) and aged between 70 and 89 years of age (43%, n = 93). A Code Blue activation was more likely to occur at 08:00 hr, 14:00 hr or 22:00 hr, corresponding to the nurses' change in shift, with the majority of Code Blues (27.8%, n = 60) occurring in the emergency department. Cardiac arrest was the main activation criterion with 54.6% (n = 118) cases followed by respiratory arrest (14%, n = 32). Interestingly, 20% (n = 45) of the Code Blue activations were upgraded from a Medical Emergency Team (MET) call. Conclusion: This project has produced several interesting findings surrounding Code Blue activations at one regional healthcare service which are not present in existing literature and is worthwhile for further investigation. Relevance to clinical practice: Understanding Code Blue activation criteria, common timings (month, time of day) and patient demographics ensures clinicians can remain vigilant in watching for the signs of patient deterioration and improve staff preparedness Code Blue events. [ABSTRACT FROM AUTHOR]

Aims and objectives: To understand the interprofessional and intraprofessional communication patterns of overseas qualified nurses as they coordinate care for patients in Australian hospitals. Background: Numerous studies have informed the transitioning experiences of overseas qualified nurses with non‐English‐speaking backgrounds working in English‐speaking workplaces. Only a few observational studies have involved examining the intercultural communication experiences of overseas qualified nurses, and none have considered their intra‐ and interprofessional communication patterns. Design: A qualitative design was adopted, using participant observation and discourse analysis. Methods: This study was from January 2017 to March 2017. Thirteen overseas qualified nurses working in acute, subacute and interventional cardiology settings in a Melbourne metropolitan hospital were shadowed over a period of 12 weeks to collect data that inform their communication patterns. The COREQ checklist was used. Results: This observational study informed by genre analysis revealed that intra‐ and interprofessional communication occurred more commonly under the clinical communication goals of coordinating care and less commonly under facilitating intervention. Communication strategies ranged from structured interactions with use of communication tools to unstructured ad hoc interactions. Analysis of the discourse patterns demonstrated that effectiveness of interactions was affected by hesitancy, lack of assertion and few strategies to manage inadequate or aggressive communication by other team members. Poor clinical communication with peers was not always caused by the nurses from non‐English‐speaking backgrounds. Positive interpersonal interactions with laughter, language‐switching and small talk were evident in interactions with nurses from similar cultural backgrounds but were rare with local colleagues. Conclusion: The linguistic evidence from this study shows variations in communication competency between participants, which emphasises the importance of not viewing overseas qualified nurses' communication training needs as homogenous. With the growing multicultural nature of healthcare teams, this study underscores the need for intercultural communication training for team integration and patient safety. Relevance to clinical practice: Continuous professional development should incorporate intercultural communication training to ensure team effectiveness within nursing teams as well as interprofessional teams. [ABSTRACT FROM AUTHOR]

Aims and objectives: To study the prevalence and determinants of undiagnosed delirium in a tertiary hospital. Background: Delirium is a common inpatient condition. It is frequently undiagnosed in a variety of settings, but determinants of undiagnosed delirium are largely unknown, and the frequency of undiagnosed delirium across all inpatient units is uncertain. The utility of hospital‐wide screening then is also uncertain. Methods: Hospital‐wide prevalence study conducted over 4 months, using a chart‐based method. Gender, age, admitting unit, history of dementia and comorbidity were used in univariate and multivariate analyses to search for differences in patients with no delirium, with undiagnosed delirium and with diagnosed delirium. Sensitivity, specificity and number needed to screen were calculated from proportions in each group. Study was conducted in concordance with STROBE guidelines. Results: Delirium was prevalent in 12.5% of all patients and undiagnosed in 24.1% of patients. Only age ≥65 years and a history of dementia predicted delirium, and undiagnosed delirium in both univariate and multivariate analyses. Age ≥65 years accounts for 92.3% sensitivity and 50.8% specificity for undiagnosed delirium in this group. History of dementia had a 23.0% sensitivity and 97.0% specificity. Twenty‐eight patients would need to be screened to detect a case of undiagnosed delirium. Discussion: There was a high rate of delirium and undiagnosed delirium in this cohort. Known risk factors for delirium also independently predict undiagnosed delirium; other factors were not found. Conclusion: Undiagnosed delirium is common and difficult to predict from patient baseline characteristics other than age. Relevance to clinical practice: Assessment of all inpatients for delirium is recommended. [ABSTRACT FROM AUTHOR]

Abstract: Aims and objectives: To establish the frequency of clinical deterioration in the early postoperative period in patients who have undergone general or orthopaedic surgery. Background: Worldwide, clinical deterioration is a significant problem in acute care settings. Early recognition and response to clinical deterioration is one of the ten National Safety and Quality Health Service Standards in Australia. However, there is limited understanding of the frequency of clinical deterioration in surgical patients. Methods: A point prevalence study was conducted from September–October 2014. The records of 100 consecutive in patients admitted for orthopaedic (n = 48) or general surgery (n = 52) to a health service in Melbourne, Australia, were audited. The frequency of clinical deterioration episodes was summarised using descriptive statistics. Results: Baseline characteristics of the two patient groups were equivalent except that orthopaedic patients were older than the general surgery patients (median age 71 [IQR 19] years vs. 62 [IQR 17] years). There were 17 medical emergency team calls and 23 calls for urgent clinical review in 28 patients. The main indications for emergency calls were hypotension (26%), fever (19%), hypoxia (15%), tachycardia (13%) and altered blood glucose level (11%). The majority of episodes were managed on the ward, and there were one ICU transfer and no cardiac arrest calls. Conclusion: One in four patients experienced early postoperative clinical deterioration. Hypotension was the most common trigger for escalation of care highlighting a need to optimise fluid and haemodynamic management of postoperative patients. Relevance to clinical practice: Haemodynamic instability leading to the activation of rapid response systems is very common in the immediate postoperative period. There is the need for locally tailored interventions to optimise fluid management and decrease incidence of further complications. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore service provision for Victorian regional refugee families from the perspective of maternal and child health nurses. Background: Increasingly, more families from a refugee background are resettling in regional Victoria. The refugee journey has significant effect on families. Refugee families with infants and young children can be provided with support by maternal and child health services; however, many families experience barriers to ongoing engagement with this service. Design: This descriptive study used focus group and questionnaire. A purposive sample of 26 maternal and child health nurses was drawn from six municipalities throughout regional Victoria, where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio‐recorded narratives were transcribed, prior to inductive thematic analysis. Methods: This descriptive study used focus group and questionnaire. A purposive sample of 26 Maternal and Child Health nurses was drawn from six municipalities throughout regional Victoria where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio‐recorded narratives were transcribed verbatim, prior to inductive thematic analysis. Results: Participating nurses were experienced nurses, averaging 12 years in the service. Four major themes emerged from thematic analysis: “How to identify women from a refugee background”; “The Maternal and Child Health nurse role when working with families from a refugee background”; “Interpreting issues”; and “Access to other referral agencies.” Nurses worked to develop a relationship with families, attending to a complex mix of issues which were complicated by language barriers. Nurses found their role in supporting refugee families required additional time and more home visits. Conclusions: To provide best practice, maternal and child health nurses need (i) ongoing professional development; (ii) time, flexibility and creativity to build relationships with refugee families and (iii) better access to services that enhance communication, such as interpreting services and translated resources. Relevance to clinical practice: Nurses require ongoing professional development to help them address the multifaceted needs of families of refugee background. With limited resources available in regional areas, accessing further education can be challenging. Distance education models and organisational support could provide nurses with educational opportunities aimed at improving service provision and clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify factors that influence the engagement of Chinese Australians with advance care planning. Background: Despite the benefits of advance care planning, there is a low prevalence of advance care planning in the Chinese Australian community. Reasons for this are often cited as cultural considerations and taboos surrounding future medical planning and death; however, other logistical factors may also be important. Design: This qualitative study used a thematic analysis grounded theory approach to explore facilitators and barriers to engagement in advance care planning. Methods: Semistructured interviews were conducted in‐language (Mandarin or Cantonese) exploring the views of a purposive sample of 30 community‐dwelling older Chinese Australians within Victoria, Australia. Results: Three key themes were identified: knowledge of, attitudes towards and needs for undertaking advance care planning amongst the Chinese Australians. There was a low awareness of advance care planning amongst the participants and some confusion regarding the concept. Most participants reported positive attitudes towards advance care planning but acknowledged that others may be uncomfortable discussing death‐related topics. Participants would want to know the true status of their health and plan ahead in consultation with family members to reduce the burden on the family and suffering for themselves. Language was identified as the largest barrier to overcome to increase advance care planning awareness. In‐language materials and key support networks including GPs, family and Chinese community groups were identified as ideal forums for the promotion of advance care planning. Conclusions: The participants of this study were open to conversations regarding future medical planning and end‐of‐life care, suggesting the low uptake of advance care planning amongst Chinese Australians is not culturally motivated but may be due a lack of knowledge relating to advance care planning. Relevance to clinical practice: The results highlight the need to provide access to appropriate in‐language advance care planning resources and promotion of advance care planning across the Chinese community. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify the issues surrounding medication error reporting in community nursing and improvement strategies related to medication safety. Background: Medication‐related problems have been identified from various sources in the literature. Examples of these include incident reporting by healthcare professionals, medico‐legal and patient complaints and systematic identification of organisational structure. Only a few studies report on the clinicians’ perceptions of medication safety in community nursing and the challenges they face within their workplace to implement medication safety initiatives. Design: Qualitative design, using conversation‐style interviews with experienced registered nurses in primary care roles. Methods: Using a general iterative approach of semantic analysis, our qualitative research study was guided by an essentialist paradigm. Our method for understanding included semi‐structured in‐depth interviews with 10 clinicians from a large community care organisation in rural Victoria in Australia. We developed an interview guide, which included open‐ended questions on clinicians’ experiences, perceived barriers and facilitators, and strategies to improve medication safety. Results: Several barriers have been identified by healthcare practitioners that hinder medication safety in primary care including culture differences between community and hospital setting, politics within the healthcare system, lack of clarity around the nurses’ roles and lack of error reporting. Other sources of errors cited by the participants were the lack of clarity or awareness of the processes and procedures of medication incidents reporting for staff within the organisation experience. Lack of education regarding medication safety, the dilemmas associated with reporting and documentation are also significant barriers. [ABSTRACT FROM AUTHOR]

Aims and objectives: To obtain an understanding of how Hospital in the Home (HITH) nurses recognise and respond to clinical deterioration in patients receiving care at home or in their usual place of residence. Background: Recognising and responding to clinical deterioration is an international safety priority and a key nursing responsibility. Despite an increase in care delivery in home environments, how HITH nurses recognise and respond to clinical deterioration is not yet fully understood. Design: A prospective, descriptive exploratory design was used. A survey containing questions related to participant characteristics and 10 patient scenarios was used to collect data from 47 nurses employed in the HITH units of three major health services in Melbourne, Australia. The 10 scenarios reflected typical HITH patients and included medical history and clinical assessment findings (respiratory rate, oxygen saturation, heart rate, blood pressure, temperature, conscious state and pain score). Results: The three major findings from this study were that: (i) nurse and patient characteristics influenced HITH nurses’ assessment decisions; (ii) the cues used by HITH nurses to recognise clinical deterioration varied according to the clinical context; and (iii) although HITH nurses work in an autonomous role, they engage in collaborative practice when responding to clinical deterioration. Conclusion: Hospital in the Home nurses play a fundamental role in patient assessment, and the context in which they recognise and respond to deterioration is markedly different to that of hospital nurses. Relevance to clinical practice: The assessment, measurement and interpretation of clinical data are a nursing responsibility that is crucial to early recognition and response to clinical deterioration. The capacity of HITH services to care for increasing numbers of patients in their home environment, and to promptly recognise and respond to clinical deterioration should it occur, is fundamental to safety within the healthcare system. Hospital in the Home nurses are integral to a sustainable healthcare system that is responsive to dynamic changes in public health policies, and meets the healthcare needs of the community. [ABSTRACT FROM AUTHOR]

Aim and objectives: To examine associations between risk of aggression and nursing interventions designed to prevent aggression. Background: There is scarce empirical research exploring the nature and effectiveness of interventions designed to prevent inpatient aggression. Some strategies may be effective when patients are escalating, whereas others may be effective when aggression is imminent. Research examining level of risk for aggression and selection and effectiveness of interventions and impact on aggression is necessary. Design: Archival case file. Methods: Data from clinical files of 30 male and 30 female patients across three forensic acute units for the first 60 days of hospitalisation were collected. Risk for imminent aggression as measured by the Dynamic Appraisal of Situational Aggression, documented nursing interventions following each assessment, and acts of aggression within the 24‐hours following assessment were collected. Generalised estimating equations were used to investigate whether intervention strategies were associated with reduction in aggression. Results: When a Dynamic Appraisal of Situational Aggression assessment was completed, nurses intervened more frequently compared to days when no Dynamic Appraisal of Situational Aggression assessment was completed. Higher Dynamic Appraisal of Situational Aggression assessments were associated with a greater number of interventions. The percentage of interventions selected for males differed from females; males received more pro re nata medication and observation, and females received more limit setting, one‐to‐one nursing and reassurance. Pro re nata medication was the most commonly documented intervention (35.9%) in this study. Pro re nata medication, limit setting and reassurance were associated with an increased likelihood of aggression in some risk bands. Conclusions: Structured risk assessment prompts intervention, and higher risk ratings result in more interventions. Patient gender influences the type of interventions. Some interventions are associated with increased aggression, although this depends upon gender and risk level. Relevance to clinical practice: When structured risk assessments are used, there is greater likelihood of intervention. Intervention should occur early using least restrictive interventions. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study was to investigate the effect of chronic wounds on the physical, emotional, social, lifestyle and financial domains of quality of life among people who self-treat their wounds. Background Patient-centred models of care have received increased attention over recent decades because of the potential to contribute positively to the patient's health and well-being. A contemporary understanding of the effect of chronic wounds on quality of life may assist care providers and healthcare systems to respond to patient needs and improve patient outcomes. Method A qualitative, exploratory study was conducted in Victoria, Australia. Participants were aged 18 years or older and had a chronic wound that was currently or previously self-treated. A sample of 25 participants was recruited from the community, and in-depth interviews were conducted in participants' homes. A thematic analysis was conducted to identify themes that represented the physical, emotional, social, lifestyle and financial domains of quality of life. Results Study participants ( n = 25) were 71 years of age (average), and the majority had a leg wound. Participants experienced a negative effect on quality of life. Physical limitations affected activity and compromised the management of other health conditions. Participants felt frustrated with and distrusting of healthcare professionals from whom they received advice and care. Daily lifestyle and workforce participation were disrupted when receiving professional care. Wound treatment and professional care expenses negatively affected personal finances. Conclusion Continued effort is required to develop relationships and treatment regimens that are conducive to healing and to optimise well-being. Additionally, healthcare systems should identify and address structural shortcomings of care services to create more patient-centred models of wound care in the community setting. [ABSTRACT FROM AUTHOR]