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Background Pregnant women in Australia seldom seek dental care and are unaware of its importance. To address these gaps the midwifery‐initiated oral health dental service (MIOH ‐DS ) program was comprehensive trialled and found effective. The aim of this study was to undertake a process evaluation of the MIOH ‐DS using the perspectives of pregnant women who participated in the trial. Methods A qualitative research design was utilized, whereby content analysis was undertaken on data from 11 semi‐structured interviews with women who participated in the program. Results All participants were receptive of the MIOH ‐DS intervention, and found it to be an acceptable intervention that met their needs, and encouraged future positive oral health practices and health‐seeking behaviours. They expressed that midwives were an appropriate professional to conduct oral health assessments, education and referrals to affordable dental services. Although some participants were initially apprehensive towards receiving treatment during pregnancy, dental staff members were able to appropriately educate and reassure them during treatment. Conclusions The MIOH ‐DS represents a promising and acceptable intervention strategy for pregnant women to promote their oral health. Findings merit further investigation on whether positive outcomes achieved can be sustained when implemented in other national or international settings similar to the study setting.

Introduction A continuing shift of healthcare delivery from hospital to the community has increased the acuity and complexity of care provided in the home. Global financial crises and nursing shortages have prompted policies supporting two tiers of nursing and expansion of the licensed practical nurse, second level or enrolled nurse role and evoked debate surrounding roles traditionally undertaken by registered nurses. Community nursing offers unique challenges for enrolled nurses wanting to enact their full scope of practice. Aim To compare and describe registered and enrolled nurse opinions of their current and potential enrolled nurse scope of practice in the community health setting. Methods A cross-sectional survey of 136 nurses (115 registered and 21 enrolled nurses) was undertaken within a large community nursing team in Australia. Participants reported their opinions of enrolled nurse scope of practice based on 27 core community nursing skills. Results Although substantial agreement was evident, there were statistically significant differences between registered nurse and enrolled nurse opinions in core skill areas; ‘Patient Education’ and ‘Clinical Observation’. Registered nurses identified some specialized skills—catheter and gastrostomy care—that could be undertaken by enrolled nurses with further education. Conclusion We confirm that registered nurses do agree with extending the skills of enrolled nurses. Education approaches that build shared confidence in enrolled nurse advanced skills are recommended. Implications for nursing and health policy The future supply of nurses is at risk. There are limited resources and increasing demand for quality health care where people live and work. While there may be opportunities internationally to improve productivity through advanced nursing roles, these policies should prioritize efficiency by firstly promoting the full enactment of nursing skills in these settings.

Aims and objectives To describe the implementation, practice and sustainability of Intentional Rounding (IR) within two diverse settings (aged care and maternity). Background The profile of patients in hospitals has changed over time, generally being more severe, placing heavy demands on nurses' time. Routine non-urgent care is often provided only when there is time. IR has been found to increase both patient and staff satisfaction, also resulting in improved patient outcomes such as reduced falls and call bell use. IR is also used as a time management tool for safe and reliable provision of routine care. Methods This descriptive qualitative research study comprised of three focus groups in a metropolitan hospital. Results Fifteen nurses participated in three focus groups. Seven main themes emerged from the thematic analysis of the verbatim transcripts: implementation and maintenance, how IR works, roles and responsibilities, context and environment, benefits, barriers and legal issues. Conclusion IR was quickly incorporated into normal practice, with clinicians being able to describe the main concepts and practices. IR was seen as a management tool, facilitating accountability and continuity of management support being essential for sustainability. Clinicians reported increases in patient and staff satisfaction, and the opportunity to provide patient education. While patient type and acuity, ward layout and staff experience affected the practice of IR, the principles of IR are robust enough to allow for differences in the ward specialty and patient type. However, care must be taken when implementing IR to reduce the risk of alienating experienced staff. Incorporation of IR charts into the patient health care record is recommended. Relevance to clinical practice Engaging all staff, encouraging ownership and stability of management are key factors in the successful implementation and maintenance of IR. IR is flexible and robust enough to accommodate different patient types and acuity.

Risk factors for poor perinatal mental health are well known. Psychosocial assessment and depression screening during the perinatal period aim to identify women at risk for poor perinatal outcomes. Early intervention programmes are known to improve the mental health outcomes of women and infants. Key to any intervention is initial and ongoing engagement in the therapeutic process. This mixed-methods study reports the proportion of women who engage/do not engage with services and their characteristics, as well as the strategies clinicians use to engage women. Data were collected by reviewing medical records, interviewing perinatal and infant mental health (PIMH) clinicians, their managers, key stakeholders, and women service users. Analyses identified that most (71.3%) women referred engaged with the PIMH service. Themes related to non-engagement are 'time to rethink' and 'stigma'. Themes reflecting the engagement strategies used by PIMH clinicians are initial engagement: 'back to basics' and 'building trust', therapeutic engagement: 'making myself useful', engagement at discharge: 'woman or clinician led', and models that facilitate engagement.

Aim This study aimed to gain undergraduate nursing students' perceptions of the essential qualities of the professional nurse. Background An essential component of undergraduate nursing programmes is to educate the student to become qualified as a professional/registered nurse. These characteristics will determine curricula and students' perceptions. No qualitative studies of the essential qualities of nurses are evident in recent literature. Methods A descriptive survey method was used to gather participants' perceptions of the qualities of a registered nurse over each year of their bachelor of nursing course at the largest programme in Australia. Findings Six concepts occurred most frequently in the students' responses. Caring was the most common followed by knowledge/understanding, empathy, work, communication and skills. Discussion A montage was developed with an interlacing of the qualities rather than any one concept predominating any year. Each quality was seen as essential and used to varying degrees as the nurse becomes a professional. These qualities form part of the education of nurses and have implications for nursing and/or health policy. This study has implications in the development of nursing curricula, which should include both the science and art of nursing with an emphasis on technical and communication skills. Conclusion This study has shown that students in Australia hold similar perceptions to their contemporaries in other international western countries. Implications for Nursing and Health Policy Caring is emphasized as a critical component of nursing delivery; however, opportunities must be presented to students to integrate skills such as caring, knowledge/understanding, empathy and communication.

Hospital malnutrition is a worldwide problem. A nutritional care policy was evaluated to determine whether nutrition was enhanced by improving patients' access and nurses' supervision of meals. Fourteen pre-audit wards (435 patients) and 20 postaudit wards (422 patients) across three hospitals participated in a pre-post audit and observation study with an examination of documentation. A food satisfaction survey was completed by 226 patients (pre) and 240 patients (post). A modest increase in the proportion of patients receiving supervision with meals (83% pre, 88% post, P = 0.058) was not associated with an increase in consumption (50% or more of meal). Patients report poor appetite in the presence of good to fair food quality. The nurse's role in nutritional care was defined. Protected mealtimes supported by nurse managers reorganizing staff mealtimes with assistance from carers, volunteers and other health professionals were endorsed. Nurses must ensure that patient's meal trays are accessible.

Aim The aim of this study was to explore the potential for one set of patient information for nursing handover and documentation. Background Communication of patient information requires two processes in nursing: a verbal summary of the patients' care and another report within the nursing notes, creating duplication. Introduction Advances in speech recognition technology have provided an opportunity to consider the practicality of one set of information at the nursing end-of-shift. Methods We used content analysis to compare transcripts from 162 digitally recorded handovers and written nursing notes for similar patients within general medical-surgical wards from two metropolitan hospitals in Sydney Australia. Findings Using the Nursing Handover Minimum Dataset analysis framework similar content [n = 2109 (handover) n = 1902 (nursing notes)] was found within the handovers and notes at the end-of-shift (7:00 am and 2:00 pm). Analysis of the overarching categories demonstrated the emphasis within the differing data sources as: patient identification (31%), care planning or interventions (25%), clinical history (13%), and clinical status (13%) for handover, vs. care planning (47%), clinical status (24%), and outcomes or goals of care (12%) for nursing notes. Discussion This study has demonstrated that similar patient information is presented at handover and within documentation. Major categories are consistent with international nursing minimum datasets in use. Conclusion We can use one set of patient information (within some limitations) for two purposes with system design, practice change and education. Experiments are currently being conducted trialling speech recognition within laboratory and clinical settings. Implications for Nursing and Health Policy One set of patient information, verbally generated at handover delivering electronic documentation within one process, will transform international nursing policy for nursing handover and documentation.

Issues addressed: Oral health during pregnancy is important, yet is often neglected by women. A program is currently being developed for midwives in Australia to promote maternal oral health. The aim of this study was to record the views of pregnant women in Australia towards dental care and midwives promoting oral health. Methods: Using convenience sampling, a cross-sectional survey was undertaken of 241 pregnant women attending a metropolitan hospital in South Western Sydney in 2010. Results: Only 10% of women received oral-health promotional material during pregnancy. More than 50% reported dental problems, yet only 17% had discussed this with their midwives and less than half (44.6%) had sought dental treatment. The main barriers to obtaining dental care were: lack of awareness, safety concerns about dental treatment and dental costs. Pregnantwomen were more likely (P 90%) were receptive to midwives providing oral-health education, assessments and referrals to affordable dental services. Conclusion: This study has shown that pregnant women are receiving limited dental advice and are concerned about dental costs. It has also confirmed for the first time in Australia that women are very positive about receiving oral-health advice from midwives during their pregnancy. So what? Oral-health promotion programs during pregnancy should consider using midwives to increase dental awareness among women and provide pathways to affordable dental services.

Background: Current evidence highlights the importance of oral health during pregnancy. However, little is known about the oral health of pregnant women in Australia. The aim of this study was to report the oral health status, knowledge and practices of pregnant women in south-western Sydney. Methods: A cross-sectional survey of 241 pregnant women attending a large hospital in south-western Sydney. Results: More than half (59.3%) reported dental problems during pregnancy, less than a third (30.5%) saw a dentist in the last six months, only 10% had received any information about perinatal oral health and many (>50%) were unaware of the potential impact of poor maternal oral health on pregnancy and infant outcomes. Analysis revealed a significant difference (

Clinical handover is the primary source of patient information for nurses; however, inadequate information transfer compromises patient safety. We investigated the content and organization of information conveyed at 81 handovers. A structure that captures and presents the information transferred at handover emerged: identification of the patient and clinical risks, clinical history/presentation, clinical status, care plan and outcomes/goals of care (ICCCO). This approach covers essential information while allowing for prioritization of information when required. Further research into the impact of ICCCO on patient safety is in progress.

JOHNSON M., COWIN L.S., WILSON I. & YOUNG H. (2012) Professional identity and nursing: contemporary theoretical developments and future research challenges. International Nursing Review Aim: We propose that the conceptual orientation of professional identity is a logical consequence of self-concept development by focusing on career and its meaning and presents a measurable set of concepts that can be manipulated to improve retention of student and registered nurses within health service. Background: Although professional identity is a term that is commonly written of in nursing literature, its theoretical origins remain unclear, and available empirical evidence of its presence or ability to change is omitted from nursing research. Sources of evidence: We present a professional identity pathway and explore the factors that influence professional identity throughout a career in nursing. Discussion: Nurses' professional identities develop throughout their lifetimes, from before entering nursing education, throughout their years of study and clinical experience, and continue to evolve during their careers. Education is, however, a key period as it is during this time students gain the knowledge and skills that separate nurses as professional healthcare workers from lay people. Conclusion: Finally, a call for longitudinal studies of students to graduates, using conceptually derived and psychometrically proven instruments capable of detecting the subtle changes in the construct over time, is recommended. Further empirical research into the theoretical concepts that underline professional identity, and the factors that influence changes in this important construct in nursing, is required. Ultimately, the practical relevance of such research will lie in the potential it provides for enhanced nursing career support and improved workforce policies.

JEFFERIES D., JOHNSON M., NICHOLLS D., LANGDON R. & LAD S. Evaluating an intensive ward-based writing coach programme to improve nursing documentation: lessons learned. International Nursing Review59, 394–401 Aim: This study aimed to develop a ward-based writing coach programme to improve the quality of patient information in nursing documentation. Background: Omissions in the patient information make nursing notes an unreliable source for care planning. Strategies to improve the quality of nursing documentation have been unsuccessful. An education programme, with one-to-one coaching in the clinical environment, was tested. Method: A concurrent mixed methods approach including a pre–post test intervention and control design for the quantitative component combined with a qualitative approach using a focus group (eight nurses) was used. Healthcare records for 87 patients (intervention) (46 pre and 41 post) and 88 patients (control) (51 pre and 37 post) were reviewed using the Nursing and Midwifery Content Audit Tool for quality nursing documentation. Sixteen nurses from two intervention wards participated in an introductory workshop with 2 weeks of coaching. No intervention was given to the control ward. Results: No significant differences were found between the wards across the 14 criteria representing quality documentation; most criteria were present in 75% or more of the records. Improvements were demonstrated in both the intervention and comparison units. Themes identified from the focus groups included the impact these changes had on nurses and patients, perceived difficulties with nursing documentation, medicolegal aspects and the attributes of an effective writing coach. Conclusion: Writing coaching is a supportive approach to improving nursing documentation. Also, regular auditing prompts nurses to improve nursing documentation. Further research using larger sample sizes can further confirm or refute these findings.

Background: An integrative review was undertaken to synthesise the research related to professionals’ perceptions and experiences of working in collaborative and integrated models of perinatal care for women with mental health problems. Method: A search of the databases CINAHL, Medline, PubMed, Psychinfo and Scopus was conducted. Studies were limited to English language papers published from 2000 to 2010. Fourteen papers were included in the review. Results: The overarching theme identified in the review related to the process of ‘making it happen’. Eight key elements were identified as central components of this process: funding and resources for collaboration; shared vision, aims and goals; pathways and guidelines; continuity of care; building relationships and trust; role clarity; training and education of staff and support to work in new ways. Conclusion: Perinatal mental health is an emerging field that is particularly challenging as it requires professionals to work across disciplines and timeframes, where there is a risk of dichotomising care, compounding existing barriers to service uptake. Professionals need resources and to feel supported to change clinical practice and work in more collaborative ways. The voices of women and families are missing in the literature.

Johnson M, Tran DT, Young H. International Journal of Nursing Practice 2011; 17: 548–555 Developing risk management behaviours for nurses through medication incident analysis The aim of this study was to define risk management behaviours related to medication safety. Mixed methods were used to analyze 318 nursing related medication incidents reported in an Australian metropolitan hospital. Most incidents did not result in patient harm (93%). Omission of medications was the most frequent often related to patient absences from the unit or nurses failing to sign for medications. Thematic analysis resulted in the Medication Safety Subscales including 29 behavioural statements within three domains—administering medications, storage and management of medications, managing adverse events related to medications. The Medication Safety Subscales can be used by managers, educators and clinicians to reinforce the importance of medication safety. Early action by nurses may reduce patient injury.

Aims and objectives. This study presents a minimum data set designed for an electronic system to complement verbal nursing handover. Background. Poor communication of patient information at handover has been implicated in adverse events with changes to clinical handover being proposed as a solution. This study developed a minimum data set for an electronic patient summary tool. Design. Using an observational design the scope of information being presented by nurses at handover was identified in relation to a generic Nursing Handover Minimum Data Set. Method. Patient handovers (n = 195) were observed and digitally recorded across diverse specialties. Results. Content analysis confirmed the frequent use of the Nursing Handover Minimum Data Set items across all specialties. The use of the items was affected by the patient context and the clinical setting. Aged care patients often had several clinical alerts reported (pressure areas, falls risk). Rapid changes in patient condition in emergency emphasised the need for a focus on observations and presenting problems. Mental health and maternity required further refinement of the items. Conclusion. The generic Nursing Handover Minimum Data Set can direct nurses to give a comprehensive account of their patient’s condition and care. The data set needs to be flexible and adaptable to the patient context and setting and complements structured content verbal handover. This minimum data set provides an excellent framework for system development by clinicians, managers and information technologists. Educators can use this tool to teach student nurses, new graduates and experienced staff, about the patient information to be presented at handover. Relevance to clinical practice. The Nursing Handover Minimum Data Set for electronic nursing handover complements verbal handover and provides a tool to give clinicians access to comprehensive information about all patients within the ward area.

COWIN L.S. & JOHNSON M. (2011) Many paths lead to nursing: factors influencing students' perceptions of nursing. International Nursing Review58, 413–419 Background: A diverse group of students is being recruited to nursing programmes worldwide, although little research has identified the effect of this diversity. Contemporary knowledge of the qualities of nurses and how they vary with demographic and other factors may assist in the retention of nursing students. Aim: The aim of this study is to explore student nurses' perceptions of the qualities of nurses and how these differ with age, country of birth, gender, healthcare experience and mode of entry to the nursing programme. Methods: Using a descriptive comparative design, 676 nursing students in their first week of a Bachelor of Nursing programme participated (77% response). Participants completed a survey noting demographic data such as age, gender, healthcare experience, country of birth, nursing programme entry method and attributes of nurses from the valid and reliable Qualities of Nursing Scale (QoN). Results: Overall, the students confirmed their agreement with the 12 items of the QoN and rated good listening skills as the most important quality for a nurse rather than Caring or Helping. Male participants and participants born overseas demonstrated the lowest mean scores on most qualities, suggesting less agreement with the qualities. Discussion: The recruitment of students to university needs to continue to support disparate entry pathways. Students with more life experience (older students) or health experience may be more likely to complete nursing courses and to be retained within health services. Qualities of nurses may be changing to reflect modern perceptions of nurses with a shift away from the focus on caring.

Aims and objective. This study sought to explore the perceptions of pregnant women in Australia towards oral health care during pregnancy and their views regarding midwives providing oral health education, assessment and referrals as part of antenatal care. Background. Maintaining oral health during pregnancy is important. Yet, many pregnant women do not access dental services during this time. Antenatal care providers are now recommended to promote maternal oral health, and various countries have adopted this strategy. However, in Australia, a lack of emphasis is placed on maternal oral health especially by antenatal care providers. Currently, a preventive programme is being developed to promote maternal oral health with the help of midwives in Australia. Very little is known about the perceptions of such an approach from pregnant women. Design. Qualitative approach. Method. Data were collected via semi-structured telephone interviews with 10 pregnant women residing in south-western Sydney. Results. Thematic analyses of the data suggest a high prevalence of poor oral health among pregnant women, especially those socioeconomically disadvantaged. The findings also highlight various barriers deterring these women from seeking dental care the most significant being lack of dental awareness, high treatment costs and misconceptions about dental treatment during pregnancy. The absence of affordable dental care remains a major barrier in Australia. The proposed preventive programme was well received by women although issues such as education for midwives and referral pathways were highlighted. Conclusions. The findings suggest that a tailored midwifery-initiated oral health programme has potential in Australia, especially for low-income families as it addresses many existing barriers to dental care. Relevance to clinical practice. Antenatal care providers in Australia should provide more information about oral health. These health professionals should be adequately educated to promote oral health. Health services should also consider offering pregnant women affordable and accessible dental services.

Aims. To describe Irish nurses’ views of clinical leadership and to describe their clinical leadership development needs. Background. Nurses are often unclear about the precise nature of clinical leadership and its impact on the processes and outcomes of care and little is known about their self-perceived clinical leadership development needs. Design. Seventeen focus group interviews were conducted with a purposive sample of 144 nurses from 13 practice settings. A conceptual lens was provided by the work of Bernstein and Young who emphasise the epistemological, practical and relational significance of boundaries and how they relate in fundamental ways to professionals’ sense of their distinctive disciplinary identities and membership of specialised communities of practice. Methods. Focus group data were collected using semi-structured topic guides. Analysis was facilitated by NVivo 7� and interpretation was informed by a conceptual framework arising from the interplay of emerging themes and the literature review. Results. The implications for clinical leadership development of two critical concepts, ‘representing nursing’ and ‘compensatory action’, are discussed in detail. Conclusions. Clinical leadership development should emphasise the development of all nurses as clinical leaders in the context of the delineation, clarification and articulation of their distinctive contribution in multidisciplinary care settings. Relevance to clinical practice. Clinical leaders are recognised as practice experts and as leaders in their particular fields. Recognition and influence in and beyond the immediate context of care depends greatly on their ability to articulate the distinct nursing contribution to patient care. This ability provides an essential resource to resist the ongoing blurring, effacement and dilution of nurses’ roles.

Aims and objectives. To describe self-reported barriers to clinical leadership development among nurses and midwives in Ireland. Background. Effective clinical leadership is essential for optimising care and improving patient outcomes. Clinical leadership development is concerned with intrapersonal and interpersonal capabilities and is context bound. Barriers to clinical leadership development among nurses and midwives are associated with interdisciplinary and organisational factors, such as lack of influence in interdisciplinary care planning and policy. Design. A national postal survey of nurses and midwives was administered to a simple random sample of 3000 nurses and midwives in Ireland. Method. The method of data collection was the Clinical Leadership Analysis of Need Questionnaire (CLAN-Q) Barriers Scale (CLAN-QBS©), a self-administered, self-report questionnaire developed to measure the barriers to clinical leadership development. Results. Mean scores for the CLAN-Q barriers subscales showed that barriers to clinical leadership development were perceived as lower in the dimension ‘quality care factors’, when compared with the dimensions ‘interdisciplinary relationships, recognition and influence’. Staff and other promotional grades differed significantly in self-perceived barriers related to interdisciplinary working, influence and recognition of the disciplinary contribution. Conclusions. Differential experiences of barriers among higher and lower grades suggest that grade level may influence ability to negotiate work-related and organisational barriers to clinical leadership development. Relevance to clinical practice. Overcoming the barriers to clinical leadership development requires attention to interdisciplinary relationships in the practicum and to the actual and perceived degree of relative influence that nurses and midwives have at wider departmental and organisational levels.

Nurses play an important role in preventing and managing falls in acute hospitals. We analysed 577 hospital falls incidents and found 77% unwitnessed and most resulted in no patient harm (85%). Further qualitative analysis of 40 incidents highlighted a high proportion of falls being related to transferring near the bed unit. Simple messages for nurses working in acute care settings are recommended including 'high risk activity (transferring, mobilizing) and high risk area (bed unit, toilet/bathroom) is a high risk situation'. A balanced approach emphasizing patient and family education and the use of alarm devices where supervision is not available are suggested. Postfall management by nurses might be contributing to the low occurrence of injury reported in these findings and requires further research.

Aims. Researchers collaborated with clinicians, consumers and dietitians to develop a policy defining how nurses could support their patients’ nutritional care. Background. A high prevalence of hospital malnutrition has been reported in Australia, Europe and the UK. A patient’s nutritional status can deteriorate during admission. Malnutrition can increase complications, length of stay, mortality rates and health care costs. As the nursing role has become increasingly complex, traditional nurturing activities such as serving the patients’ meals have devolved to other categories of staff leaving the role of nurses in their patients’ nutritional care ill-defined. Design. The research team systematically reviewed relevant research literature using the principles of qualitative metasynthesis to identify appropriate nursing strategies that would assist in reducing the prevalence of hospital malnutrition. Method. The policy was developed using a systematic review approach: devising a clinical question, searching the literature, appraising research evidence, analysing existing policy documents, synthesising evidence into dominant themes and once the policy was drafted, initiating a wide ranging consultation and ratification process. Results. A literature search located 147 articles. Forty articles were identified as being within the scope of the clinical question. Most were reports of audits or observation studies. The dominant themes were developed into standards that assisted nurses in supporting the oral nutrition of their patients. These included the following: a focussed mealtime, management of mealtime environments, management of staff mealtimes and a designated nutrition support nurse in each clinical area to monitor and evaluate the implementation of the policy. Conclusions. There is a distinct role for nurses that will assist in reducing the prevalence of hospital malnutrition but successful implementation can only occur with the support of the multidisciplinary team. Relevance to clinical practice. This policy provides a framework to define and invigorate nursing’s role in supporting the patient’s nutrition care.

Tran D.T. & Johnson M. (2010) Classifying nursing errors in clinical management within an Australian hospital. International Nursing Review57, 454–462 Background: Although many classification systems relating to patient safety exist, no taxonomy was identified that classified nursing errors in clinical management. Aims: To develop a classification system for nursing errors relating to clinical management (NECM taxonomy) and to describe contributing factors and patient consequences. Methods: We analysed 241 (11%) self-reported incidents relating to clinical management in nursing in a metropolitan hospital. Descriptive analysis of numeric data and content analysis of text data were undertaken to derive the NECM taxonomy, contributing factors and consequences for patients. Results: Clinical management incidents represented 1.63 incidents per 1000 occupied bed days. The four themes of the NECM taxonomy were nursing care process (67%), communication (22%), administrative process (5%), and knowledge and skill (6%). Half of the incidents did not cause any patient harm. Contributing factors (n = 111) included the following: patient clinical, social conditions and behaviours (27%); resources (22%); environment and workload (18%); other health professionals (15%); communication (13%); and nurse's knowledge and experience (5%). Conclusion: The NECM taxonomy provides direction to clinicians and managers on areas in clinical management that are most vulnerable to error, and therefore, priorities for system change management. Any nurses who wish to classify nursing errors relating to clinical management could use these types of errors. This study informs further research into risk management behaviour, and self-assessment tools for clinicians. Globally, nurses need to continue to monitor and act upon patient safety issues.

Aims and objectives The aim of this paper is to examine current evidence supporting the promotion of oral health during pregnancy and proffer aspects of a potential role for Australian midwives. Background Research continues to show that poor oral health during pregnancy can have an impact on the health outcomes of the mother and baby. Poor maternal oral health increases the chances of infants developing early caries and is strongly associated with adverse pregnancy outcomes such as preterm and low birth-weight babies. Unfortunately in Australia, no preventive strategies exist to maintain the oral health of pregnant women. Design Systematic review. Method This review examines all literature on oral health during pregnancy published to date in the English language and focuses on whether preventive oral health strategies during the prenatal period are warranted in Australia and if so, how they could be provided. Results Maintaining oral health is important during pregnancy and many developed countries have implemented preventive strategies to address this issue using non-dental professionals such as prenatal care providers. However, despite the positive international evidence, limited importance is being given to the oral health of pregnant women in Australia. It is also evident that the unique potential of prenatal care providers such as midwives to assess and improve maternal oral heath is not being thoroughly utilised. Compounding the issue in Australia, especially for pregnant women from socioeconomically disadvantaged backgrounds, is the limited access to public dental services and the high cost of private dental treatment. Conclusion Promoting and maintaining oral health during pregnancy is crucial, and preventive prenatal oral health services are needed in Australia to achieve this. Relevance to clinical practice Midwives have an excellent opportunity to offer preventive oral health services by providing oral health assessments, education and referrals for pregnant women attending antenatal clinics.

A three-stage process was undertaken to identify and modify a tool that was capable of measuring the many aspects of maternal satisfaction relevant to Australian women. First, the scope of maternal satisfaction to be measured was defined by summarizing available literature and surveys purporting to measure maternal satisfaction (including surveys used in maternity services in New South Wales). The multidimensional nature of maternal satisfaction was confirmed, with 16 core aspects (common to the literature and local surveys) and nine additional unique aspects of maternal satisfaction being identified. Second, these core and additional aspects were used to examine the comprehensiveness of the Mason Survey, a survey recommended by the National Health and Medical Research Council of Australia for use in maternity services. Eighty-eight per cent of the core and additional aspects (22/25) were found to be present in the Mason Survey. Third, an expert panel further modified the Mason Survey by removing items not applicable to the Australian context. The modified Mason Survey is a comprehensive measure of maternal satisfaction suitable for Australian women and capable of providing valuable information on the quality of services and future planning for maternity services.

Community nurses are often the health professionals with whom older Australians living at home have most contact. The home environment has been identified to have a number of hazards associated with falls in older people. The Home-screen scale was specifically designed as a nurse-administered instrument to identify environmental and behavioral risks that alert nurses to the need for action to reduce fall risks in the home. A 14-item scale was administered to 1,165 older people receiving community nursing services. Psychometric investigation confirmed a 10-item scale with construct validity and internal consistency (alpha = 0.86, n = 989), explaining 60% of the construct of home safety (safe home environment and safe home behaviors). In addition, differences in mean scores were found in clients able and unable to transfer independently (t = 4.5 [df = 323.1] p < 0.001 [Group 1: M = 82.14, SD = 15.56; Group 2: M = 75.54, SD = 20.83, n = 989]). Similarly, an association existed between clients with low scores on the Home-screen scale and the perceived need for home modification. A score of 74 on this scale has been identified as a critical point for potential client injury. The use of this scale, both as an initial screening instrument and as a monitoring tool for community nurses working with older people, is recommended.

Evidence-based care has heralded an advancement for health with extensive rhetoric and incentives encouraging clinicians to become active participants in practice change. This paper explores two mechanisms-research utilization and systematic reviews--as processes to develop empowerment in clinicians, and develop an ethos of basing practice on research. The intent of these approaches is to create an environment that enables clinicians to seek solutions to practice problems, inform practice decisions and develop practice policy using evidence from research. The goal is to develop evidence-based clinicians who remain active and interested in their practice and who are committed to promoting the application of research to practice. The strengths and weaknesses of these methods are explored within two case studies where they are applied to the management of hypothermia and the efficacy of postoperative observations. Key points of application for each of the methods are outlined in the conclusions.

This descriptive study examined the coping styles and specific strategies used by a group of pregnant adolescents attending an adolescent family support service. Seventy-one adolescents, with a mean age of 17 years, and a mean gestation of 25 weeks, completed the Revised Jalowiec Coping Scale (JCS-R). The findings demonstrated that the optimistic coping style (emotion-focused) was the most frequently used and most effective coping style for these young women. A confrontive coping style (problem-focused) was also used and found to be effective. A combination of problem-focused and emotion-focused styles is recommended, with an increased emphasis on problem-focused approaches. The focus by the adolescents on optimistic approaches is suggestive of a lack of understanding of the challenges that motherhood will place upon them, but is consistent with their age and developmental stage. A longitudinal study of coping styles and changes in style throughout pregnancy and early motherhood is recommended. Initial assessment and monitoring of coping styles of pregnant adolescents is proposed. This assessment would be the beginning point for a teaching program that highlights increased use of adaptive coping styles (problem-focused) with decreased use of maladaptive approaches, and includes emotion-focused styles. By expanding the repertoire of coping styles and strategies available to the adolescent, the public health nurse (PHN) prepares these vulnerable mothers for the challenges ahead.

Two interventions: a forced warm-air device (Bair-Hugger series 500, Augustine Medical Inc., Eden Prairie, MN, USA), group 1; and a standardized approach to the use of warmed blankets (group 2) are compared with the aim of enhancing thermoregulation in surgical patients with mild and moderate hypothermia in the immediate recovery period. One hundred and twenty patients in a post-anaesthetic care unit were systematically allocated to group 1 or group 2 so each group consisted of 110 participants. No significant differences were found between the groups in gender, age, time in surgery, use of warmed intravenous fluids or muscle relaxants, or type of surgery. After exclusion of orthopaedic patients, significant differences in the mean rewarming rates were found, with more rapid rewarming occurring within group 1 (the group rewarmed with a forced warm-air device, t = 2.15, df = 92, P = 0.03) compared with group 2. No significant differences were found in the mean rewarming time, or heat gain between groups, and subsequent power estimates were less than 0.80. This study supports improved rewarming rates in select surgical patients (with mild or moderate hypothermia) using the Bair-HuggerTM compared with a standardized blanket rewarming intervention and identifies the need for patient comfort and cost-benefit analysis to be considered in future studies.