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When it comes to determining what constitutes nursing workload, there are a number of approaches that represent and characterise the work of nursing across the three traditional shift patterns (morning/day, afternoon/ evening and night). These are observational, self-reporting and work-sampling techniques. A review of the quantitative and qualitative literature to examine workload distributions between the three nursing shifts was undertaken. Using data sourced from the CINAHL, Scopus and Medline databases, the findings suggest that there is an inadequacy in establishing nursing productivity that is perhaps representative of the methods used to decipher nursing workload. This may contribute to poor quality care, and the high cost of excess nursing time contributes to the increasingly high costs of care. Linked to this is the nurse's job satisfaction. Quality of care and job satisfaction are important factors for the sustainability of the nursing workforce. There are few high-quality nursing articles that detail the workload distributions across the three nursing shifts and this is a potential area for further research.

Presentations to the emergency department with a diagnosis of hypocalcaemia-induced tetany secondary to total thyroidectomy are rare. A patient presented to the emergency department of a regional Australian hospital with hypocalcaemia-induced tetany. A case study was employed to reflect on the care provided and identify knowledge practice deficits within this unusual patient presentation. Calcium plays a central role within the nervous system and is vital for both cardiac and muscular contraction. The clinical manifestations of electrolyte disturbances such as hypocalcaemia can be life threatening, and therefore, appropriate assessment, monitoring and management are essential to ensure positive patient outcomes. Understanding the importance of calcium imbalance for the emergency and critical care nurse is paramount in preventing complications associated with cardiac conduction and muscle tone, especially the potential for airway compromise. Education is central to this and may include clinical case reviews, the application of pathophysiological presentations of electrolyte imbalance and a review of electrolyte administration guidelines. Understanding the role of calcium within the body will assist emergency and critical care nurses to assess, monitor and intervene appropriately, thereby preventing the life-threatening manifestations of hypocalcaemia.

Graduate transition programmes have been developed to recruit new nursing staff and facilitate an effective transition from nursing student to Registered Nurse within the clinical environment. Therefore the aim of this paper was to explore the various elements included in nursing graduate transition programmes. An integrative review was undertaken incorporating a strict inclusion criterion, critical appraisal, and thematic analysis of 30 studies. There are numerous transition programmes available yet there remains a lack of transparency regarding their aims/objectives, course content, support timeframe and the type of support provided. This inconsistency has resulted in a lack of clarity regarding efficacy or superiority of any one programme over another. Innovative multifaceted programs may assist in supporting the graduate registered nurse to transition effectively into the clinical environment. Providing these support programmes may allow nurse managers to recruit new graduates and therefore decrease the staff budget expenditure. Implications for nursing management No graduate programme was shown to be superior to others yet graduate programmes appear to positively influence the experience of the graduate and increase staff recruitment. Comparative research is needed to ascertain the integral components of these programmes.

Intra-abdominal hypertension can be classified as either primary or secondary. Primary intra-abdominal hypertension is often associated through trauma or diseases of the abdominopelvic region such as pancreatitis or abdominal surgery, while secondary intra-abdominal hypertension is the result of extra-abdominal causes such as sepsis or burns. The critically ill patient offers some challenges in monitoring in particular secondaryintra-abdominal hypertension because of the effects of fluid resuscitation, the use of inotropes and positive pressure ventilation. Recent work suggests that intensive care unit nurses are often unaware of the secondary effects of intra-abdominal pressure and therefore this is not monitored effectively. Therefore being aware of the cardio-respiratory effects may alert theintensive care nurse nurse to the development of intra-abdominal hypertension. The aim of this paper is to discuss the pathophysiology associated with the cardio-respiratory effects seen with intra-abdominal hypertension in the critically ill. In particular it will discuss how intra-abdominal hypertension can inadvertently be overlooked because of the low flow states that it produces which could be misconstrued as something else. It will also discuss how intra-abdominal hypertension impedes ventilation and respiratory mechanics which can often result in a non-cardiogenic pulmonary oedema. To close, the paper will offer some implications for critical care nursing practice.

Intra-abdominal hypertension is classified as either primary or secondary – primary occurs due to intra-abdominal or retro-peritoneal pathophysiology, whereas secondary results in alterations in capillary fluid dynamics due to factors, such as massive fluid resuscitation and generalised inflammation. The renal and gastro-intestinal effects occur early in the progression of intra-abdominal hypertension, and may lead to poor patient outcomes if not identified. As a direct response to intra-abdominal hypertension, renal function is reduced with remarkable impairment from pressures of around 10 mmHg, oliguria developing at 15 mmHg and anuria developing at 30 mmHg. Intestinal micro-circulation is significantly reduced by up to 50% with intra-abdominal pressures as low as 15 mmHg. Mucosal and submucosal tissue hypo-perfusion causes considerable damage to the intestinal cells, potentially resulting in bacterial translocation, endotoxin release, sepsis and multiple organ failure. The critical care nurse plays an important role in the early identification of intra-abdominal hypertension however, without this essential knowledge base and comprehension of intra-abdominal hypertension, clinical signs and symptoms may go unnoticed or be misinterpreted as signs of other critical illnesses.

Background Nursing students find bioscience subjects challenging. Bioscience exams pose particular concerns for these students, which may lead to students adopting a surface-approach to learning. Objectives To promote student collective understanding of bioscience, improve their confidence for the final exam, and improve deeper understanding of bioscience. Design In order to address exam anxiety, and improve student understanding of content, this student engagement project involved nursing students collaborating in small groups to develop multiple-choice questions and answers, which became available to the entire student cohort. Settings This study was conducted at two campuses of an Australian university, within a first year bioscience subject as part of the undergraduate nursing programme. Participants All students enrolled in the subject were encouraged to attend face-to-face workshops, and collaborate in revision question writing. Online anonymous questionnaires were used to invite student feedback on this initiative; 79 respondents completed this feedback. Methods Students collaborated in groups to write revision questions as part of in-class activities. These questions were made available on the student online learning site for revision. An online feedback survey was deployed at the conclusion of all workshops for this subject, with questions rated using a Likert scale. Results Participants indicated that they enjoyed the opportunity to collaborate in this activity, and almost all of these respondents used these questions in their exam preparation. There was strong agreement that this activity improved their confidence for the final exam. Importantly, almost two-thirds of respondents agreed that writing questions improved their understanding of content, and assisted in their active reflection of content. Conclusions Overall, this initiative revealed various potential benefits for the students, including promoting bioscience understanding and confidence. This m

Aim - To explore the different handover models and processes available and their efficacy in improving handover communication within nursing practice. Background - The handover of information is a key nursing responsibility that ensures patient outcomes through continuity of care. This process is widely recognised as an opening for error that may comprise patient safety. Design - This paper is an integrative literature review that employed an inductive exploratory design. Data sources - A computerised database search was employed including CINAHL, PubMed and Science Direct and a manual citation search with included papers limited to papers published 2005-2016, in English with full text freely available. Review Methods - This included a systematic search strategy, a critical appraisal of the papers utilising the Critical Appraisal Skills Programme, an inductive data extraction and thematic analysis. Results - Sixteen papers were included in this review. The results detailed that there are various handover models in use yet there is no evidence that any one model displays superior efficacy. The iSoBAR model and its adaptations remain the only model employed across various specialties. Conclusions - More research is warranted to determine if any handover model displays superior efficacy or transferability.

There is a great deal of literature surrounding the needs of regional Australia. This integrative review of the literature focuses on the experience of the nurse academic educating on a satellite campus many of which are located in regional Australia. There were four themes identified including: - 1) challenges specific to regional satellite campuses, - 2) student characteristics, - 3) student experiences and - 4) the academics’ experiences. These themes delineated significant benefits but also considerable challenges to the provision of higher education on regional university campuses. The experience of nursing academics and indeed their students is remarkably different to their metropolitan counterparts and therefore the local context needs to be considered in regional education provision. Australian regional nursing academics need to be multi-skilled to address the workload and social inequity in support service provision.

Background - Nursing students’ ability to learn, integrate and apply bioscience knowledge to their clinical practice remains a concern. Objectives - To evaluate the implementation, influence, and student perspective of a team-teaching workshop to integrate bioscience theory with clinical nursing practice. Design - The team-teaching workshop was offered prior to commencement of the university semester as a refresher course at an Australian university. This study employed a sequential explanatory mixed methods design incorporating both quantitative and qualitative items. Methods - An evaluation survey with quantitative and qualitative items and a focus group were employed. The qualitative data were analysed using a thematic approach. The quantitative data was combined with the emergent themes in the qualitative data. Participants - Participants were final year nursing students. Nine students attended the workshop. All students completed the evaluation (N=9) and 44.4% (N=4) attended the focus group. Results - The results revealed six themes: (1) lectures are an inadequate teaching strategy for bioscience; (2) teaching strategies which incorporate active learning engage students; (3) the team-teaching workshop provides an effective learning environment; (4) the workshop content should be expanded; (5) pharmacology should relate to bioscience, and bioscience should relate to nursing, and; (6) team-teaching was effective in integrating pharmacology with bioscience, and then translating this into nursing practice. Students had felt there was disjointedness between pharmacology and bioscience, and between bioscience and nursing care within their undergraduate studies. The workshop that was based on team-teaching bridged those gaps, utilised active learning strategies and provided an effective learning environment. Conclusion - Team-teaching that employs active learning strategies is an effective approach to assist nursing stu

Nursing students have reported bioscience to be challenging and difficult to understand. This may have a negative impact upon their ability to understand patients’ clinical condition and nursing practice. We sought information about students’ experiences with bioscience. One hundred and twenty six final-year nursing students completed a questionnaire. The findings showed that the majority of participants considered bioscience subjects to require more work compared to nursing subjects (65.9%), would like a better understanding of bioscience (73.8%) but understood that bioscience forms the foundation nursing practice (76.2%). Younger participants without secondary school science rated bioscience harder than nursing subjects (p=0.024) and spent more time studying bioscience compared to older participants (>30 years; p=0.006). Participants without any secondary school science lacked an ability to apply bioscience concepts to patient conditions (p=0.005). These results show that nursing students, especially those without secondary school science, would benefit from improved bioscience integration with nursing practice. Nursing and bioscience educators should consider greater alignment of bioscience with nursing practice subjects, especially earlier in the curriculum.

Aims and objectives To explore new graduate registered nurses’ reflections of bioscience courses during their nursing program, and the relationship between bioscience content and their clinical practice. Background Undergraduate nursing students internationally find bioscience courses challenging, which may be due to the volume of content and level of difficulty of these courses. Such challenges may be exacerbated by insufficient integration between bioscience theory and nursing clinical practice. Design A descriptive, cross-sectional mixed methods study was conducted. Methods A 30-item questionnaire with five written response questions which explored recently registered nurses’ reflections on bioscience courses during their nursing degree was employed. Descriptive analyses were reported for individual items. Thematic analysis of qualitative responses were grouped to reveal emerging themes. Results Registered nurses’ (n=22) reflections revealed that bioscience courses were a significant challenge during their undergraduate program, and they lacked confidence explaining the biological basis of nursing. Participants would like improved knowledge of the relevant bioscience for nursing, and agreed that bioscience courses should be extended into the undergraduate final year. The importance of relating bioscience content to nursing practice was elaborated extensively throughout written responses. Conclusions Although registered nurses reflected that bioscience courses were difficult with large volumes of content, having more bioscience with greater relevance to nursing applications was considered important in their current clinical practice. It is suggested that bioscience academics develop greater contextual links between bioscience content and clinical practice relevant to nursing.

Enrolled nurses who undertake the Bachelor of Nursing to qualify as registered nurses are usually offered advanced standing, awarding them credit for approximately one year of study. Bioscience subjects form an integral component of undergraduate nursing studies, yet being provided with credit means that these students study less bioscience than a standard-entry pathway. In this study, we examined the bioscience perceptions from enrolled nurses commencing at second year (n=49), using a mixed methods approach. Quantitative data were analysed to determine between and within group differences with age and studies of science in secondary school. Qualitative data were organised into emerging themes, and integrated with quantitative results during analysis. Participants who had studied biology and other science in secondary school had significantly greater agreement with the importance of studying science prior to the Bachelor of Nursing. Main challenges anticipated by these students included bioscience terminology and insufficient prior science knowledge, and the volume and depth of bioscience, particularly in comparison with nursing subjects. Insufficient skills in concentrating and retaining information were also identified as concerns. Nonetheless, most participants were confident that they would learn sufficient bioscience to work as a registered nurse. Prior experience working as an enrolled nurse did not appear to confer an understanding of the importance of bioscience for the future role of the registered nurse. It is paramount that the undergraduate bioscience component is tailored towards the specific needs of this cohort in preparation for their role as registered nurses.

Background - The transition shock sometimes associated with moving from student to registered nurse can lead to feelings of self-doubt and insecurity especially with the increased expectations and responsibilities that registration brings. Known as Imposter Phenomena, individuals often express a lack of self-confidence, uncertainty in their abilities or that others have an over inflated opinion of them. Aim - The aim of this study is to examine the extent at which imposter phenomenon is evident in four final year nursing student cohorts in Australia, New Zealand and the United Kingdom. Design - A survey design. Settings - The study took place at 4 higher education institutes – two metropolitan campuses and two regional campuses between October 2014 and February 2015 in Australia, New Zealand and the United Kingdom. A sample of 223 final year nursing students undertaking nationally accredited nursing programmes were approached. Results - Each cohort exhibited mild to moderate feelings of Imposter Phenomena. A positive weak correlation between imposter phenomena and preparedness for practice was found. The New Zealand cohort scored higher than both the Australian and United Kingdom cohorts on both feelings of imposterism and preparedness for practice. Conclusions - Nursing students possess internalised feelings which suggest their performance and competence once qualified could be compromised. There is some speculation that the respective curriculums may have some bearing on preparing students for registration and beyond. It is recommended that educational programmes designed for this student cohort should be mindful of this internal conflict and potential external hostility.

Background - This study explores the concept of learning styles and discusses the importance of pedagogical strategies that may influence the academic achievement of nursing students in their learning of bioscience and pathophysiology concepts. Bioscience and pathophysiology concepts are arguably a cornerstone of nursing practice (smales, 2010). Consequently knowledge comprehension presents a challenge when nursing students’ report experiencing difficulties in the amalgamation and integration of bioscience education with clinical situations (Smales, 2010). These difficulties include the academics teaching perspective, the learning environment, pre-existing knowledge, content delivery style and curriculum time. Miller et al., (2008), suggest that educational research in nursing should focus not on the volume of bioscience content learnt but should instead detail the mechanisms through which the student learnt the bioscience content. Therefore nursing educators may need to focus on the learning style and study strategies that nursing students employ and evaluate if these learning styles influence the students unit success. Aim(s) and research questions - To review the interaction between learning style as an indicator of nursing student study methodology and correlate if learning style and associated strategy influence academic success in the bioscience units. Research methodology - The literature review utilised an inductive approach allow themes from the literature to emerge. The search process utilised several databases, namely CINAHL, ERIC, Science Direct, Web of science, and ProQuest for various types of research papers related to the field of nursing bioscience education. After the duplicates were removed the citations of the included papers were also manually reviewed to ascertain literature relevant to the study. These papers were subjected to a critical appraisal utilising the Critical Appraisal Skills Programme (CASP) checklist which res

Objectives To explore if active learning principles be applied to nursing bioscience assessments and will this influence student perception of confidence in applying theory to practice? - Design and Data Sources A review of the literature utilising searches of various databases including CINAHL, PUBMED, Google Scholar and Mosby's Journal Index. - Methods The literature search identified research from twenty-six original articles, two electronic books, one published book and one conference proceedings paper. - Results Bioscience has been identified as an area that nurses struggle to learn in tertiary institutions and then apply to clinical practice. A number of problems have been identified and explored that may contribute to this poor understanding and retention. University academics need to be knowledgeable of innovative teaching and assessing modalities that focus on enhancing student learning and address the integration issues associated with the theory practice gap. Increased bioscience education is associated with improved patient outcomes therefore by addressing this “bioscience problem” and improving the integration of bioscience in clinical practice there will subsequently be an improvement in health care outcomes. - Conclusion From the literature several themes were identified. First there are many problems with teaching nursing students bioscience education. These include class sizes, motivation, concentration, delivery mode, lecturer perspectives, student's previous knowledge, anxiety, and a lack of confidence. Among these influences the type of assessment employed by the educator has not been explored or identified as a contributor to student learning specifically in nursing bioscience instruction. Second that educating could be achieved more effectively if active learning principles were applied and the needs and expectations of the student were met. Lastly, assessment influences student retention and the student experience and as such assessment shou

Devising authentic assessments for subjects with large enrolments is a challenge. This study describes an electronic role-play assessment for approximately 600 first-year nursing students to learn and apply pathophysiology (bioscience) concepts to nursing practice. Students used Microsoft Office PowerPoint® to prepare electronic role-plays both between a nurse and patient, and between two nurses, thus simulating workplace scenarios. Student feedback demonstrated that respondents found this assessment useful for learning pathophysiology, and for applying pathophysiology to a nursing clinical setting. This electronic presentation circumvented issues associated with a traditional oral presentation such as embarrassment and logistics of scheduling groups, and rated well with students of non-English speaking background. The electronic role-play assessment initiative encouraged students to apply their bioscience knowledge to a clinical setting, and allowed students to conceptualise the importance of bioscience within both the nursing degree and the profession.

Bioscience content within undergraduate nursing degrees provides foundational knowledge of pathophysiology, anatomy, physiology, microbiology and pharmacology. However, nursing students often find studying the bioscience components of undergraduate nursing program daunting (Friedel & Treagust 2005, Craft et al. 2013). This is related to factors such as the volume of content, degree of difficulty and insufficient linkage between bioscience concepts and nurses' clinical practice. Students who are unable to conceptualise the relevance of bioscience with nursing subjects and subsequent nursing practice may not appreciate the broader importance of bioscience, and hence may adopt a surface approach to learning (Craft et al. 2013). The aim of this study was to develop a model within Nursing Practice in the Context theory subject, to include a bioscientist lecturing to complement the nursing lecturer, in order to explicitly demonstrate links between physiology, pathophysiology and nursing practice.

The International Council of Nurses (2009) acknowledges that the perception : New Graduates are not prepared for the realities of practice nor do they have the competencies needed by current health care services...

Transition to university can be a highly stressful time of change and adjustment for commencing students. Students entering university with limited prior academic success may be at more risk of failure than their peers (Palmer, Bexley & James, 2011). Under preparedness relates to unrealistic workload expectations, social isolation, and academic curriculum and assessment expectations (James et al, 2010). Bridging courses are a common response to addressing the needs of students with limited prior academic experience (Greenfield, Keup, & Gardner, 2013). In 2014, the Caboolture Campus of Queensland University of Technology (QUT) piloted a cross faculty bridging course designed to engage students in learning to become university ready. The goal of this transition program was to foster a sense of belonging and normalise help-seeking behaviour. Students who attended the series of workshops will be closely followed through their first year of university to ascertain the effectiveness of the pilot course.

It is known that bioscience is perceived to be difficult and causes anxiety within undergraduate nursing students; yet, commencing students' perceptions of bioscience is not known. Therefore, the aim of this study was to ascertain incoming students' perceptions, knowledge and approaches to learning bioscience. Incoming students to the Bachelor of Nursing completed a questionnaire prior to undertaking bioscience. Two hundred and seventy three students completed the questionnaire that explored their expectations, preconceptions of bioscience content, approaches to learning bioscience, and relationship to clinical practice in the context of biosciences. Participant ages ranged from 17 to 53 (mean 23 years), and 78% of students had completed at least one secondary school science subject, of which 60% had studied biology. Overall, students' preconceptions included anxiety about studying bioscience, bioscience being difficult and harder than nursing subjects, and that more content will be required for bioscience than nursing subjects. Analysis using ANOVA revealed the relationships for secondary school science and age on student responses. A significant effect of secondary school science was found for science in school being advantageous for bioscience (p = 0.010), understanding what bioscience entails (p = 0.002), needing to study science prior to the start of the semester (p = 0.009), and that bioscience is considered difficult (p = 0.029). A significant effect of age was found for exams being more difficult than other assessments (p = 0.000) and for being able to see the relevance of nursing when reaching the workplace (p = 0.011). The findings also indicated that perceptions and associated anxieties related to bioscience were present in commencing students, similar to those which have been reported previously in established student groups. This strongly suggests that the faculty should attempt to dispel preconceptions about bioscience and target improved supports to f

Nursing was one of the last health professions to be established in the higher education sector. A lingering challence is the integration of bioscience into nursing curriculum. Research suggests that students perceive bioscience teaching to be difficult thereby contributing to heightened anxiety. It has been proposed that high content volume, lack of secondary school science, and predominance of science lectureres without clinical practice experience, may lead to a bioscience disconnet with curricula. To ascertain the extent of this problem, we undertook a cross-sectional designed study of commencing, second and third year undergraduate nursing students (n=566). They were surveyed about perceptions, knowledge and approaches to bioscience learning. Preliminary analysis revealed similar findings between the three different cohorts. Generally, sudents perceived bioscience subjects to be difficult, more challenging and requiring more study hours than clinical nursing subjects. Interestingly, the perception of difficulty and associated anxieties were found in both commencing and existing students. Moreover, students with secondary school biology combined with another science subject perceived bioscience teaching more favourably compared to those who had studied one secondary school science subject. University coursework needs to embed strategies to minimise anxieties about learning bioscience by using innovative deliveries and scaffolded assessments that target the learner's needs.

Pathophysiology is a complex, though essential, component of all undergraduate nursing courses and there is an identified need for a text tailored specifically for the Australian and New Zealand student. The entrenched bio-medical terminology can often be difficult to relate to nursing practice. To overcome this, the authors have presented pathophysiology in an accessible manner appropriate to undergraduate students, providing a balance between science, clinical case material and pharmacology. This adaptation prioritises the diseases relevant to nursing students and presents them according to their prevalence and rate of incidence in Australia and New Zealand. This focused approach prepares students for the presentations they will experience in a clinical setting. Each body system is explored first by structure and function, then by alteration.This establishes the physiology prior to addressing the diseases relative to the system and allows the student to analyse and compare the normal versus altered state. A lifespan approach is incorporated in the Alterations chapters, as each chapter addresses childhood diseases through to the aged with respect to each body system. A new section on Contemporary Health Issues examines the effects of an aging population and lifestyle choices on the overall health of our society. These are explored through specific chapters on Stress; Genes and the Environment; Obesity and Diabetes; Cancer; Mental Illness and Indigenous health issues. Concept maps are used to assist students to understand the basic concepts of each chapter and are used as a foundation for more complex discussions. Clinical case studies are also included in each chapter to bring pathophysiology into practice. Each patient case study will highlight relevant symptoms of a given disease within a clinical setting. This is analysed with respect to the relevancy of each given symptom, their respective affect on body systems and the best course of pharmacological treatment.