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Aim To further develop and validate a new model of the early career transition pathway in the speciality of community nursing. Design Delphi policy approach, guided by a previous systematic review and semi‐structured interviews. Methods Four rounds of an expert panel (N = 19). Rounds one, two and four were questionnaires consisting of a combination of closed (Likert response) and open‐ended questions. Round three comprised of a focus group conducted using virtual meeting technology. Results The final model demonstrated reliable and valid measures. There were deficiencies in “pre‐entry”—where the marketing of community nursing was negligible and the support around orientation informal and minimal, mainly due to tight budgetary concerns. Community practice holds a whole new dimension for nurses transitioning from acute care as the concept of “knowing your community” took time and support—time to be accepted reciprocally and develop a sense of belonging to the community.

Background Delays in reperfusion therapy for myocardial infarction (MI) are associated with increased mortality and morbidity, and most of this delay is due to delay in patients initiating contact with emergency services. This study assesses the impact of the Australian National Heart Foundation media campaign and identifies patient characteristics and presenting symptoms that may contribute to delay. Methods This prospective cohort study identified patients with a diagnosis of MI admitted to a single tertiary metropolitan hospital in Perth, Western Australia from July 2013 to January 2014. Patients were interviewed and responses were categorised to determine their reasons for delaying treatment and the impact of mass media campaigns. Delay times were analysed using multivariable linear regression models for the Whole Cohort (all patients admitted to the tertiary hospital, including patients from rural and peripheral hospitals) and the Direct Admission Cohort (patients admitted directly to the tertiary hospital). Results Of 376 patients, 255 patients provided consent, and symptom onset-time was available for 175 patients. While almost two thirds of the cohort was aware of media campaigns, awareness was not associated with decreased prehospital delay. Median delay was 3.9 hours for the Whole Cohort and 3.5 hours for the Direct Admission Cohort. Delay was associated with being widowed, symptom onset on a weekday compared with weekend, past medical history of MI and coronary artery bypass graft, private compared with ambulance transport to hospital, and lack of symptoms of sweating and weakness. In addition, for the Direct Admission Cohort, age and income were also associated with delay. Conclusions This study did not find an association between awareness of media campaigns and delay. This study identified important characteristics and presenting symptoms that are associated with delay, and possibly relevant to future media campaigns.

Objective Burnout is a significant problem affecting the nursing workforce and is associated with significant personal suffering and high rates of nurse turnover. Efforts to further understand the variables that explain burnout are needed. The aim of this cross-sectional study was to examine both environmental and individual factors that may explain burnout among nurses. Method We recruited 1848 Australian nurses to complete several online questionnaires measuring the practice environment (Practice Environment Scale of the Nursing Work Index), burnout (Professional Quality of Life Scale), trait negative affect ( Spielberger State-Trait Anxiety Inventory form Y2) and resilience (Connor Davidson Resilience Scale). Correlational analysis as well as hierarchical regression was used to determine the relative importance of variables in explaining burnout scores. Results All of the practice environment scales were significantly related to burnout in the negative direction, and these relationships were above .3 for all except the relationship scale ( r = –.256) and the participation in hospital affairs scale ( r = –.285). Overall, the regression model accounted for 62% of the variance in nurse burnout scores. Trait negative affect, resilience and two aspects of practice environment (Manager sub-scale and Staffing sub-scale) all explained significant variance in burnout scores. The largest contribution came from the two individual variables (resilience and trait negative affect) that together explained 55% of the variance in burnout scores. Conclusions Findings suggest that health service administrators should provide nursing staff with education and support to build individual resilience. Workplaces that attend to staffing and resource issues and have managers who provide high levels of support to their staff appear to be essential strategies to help prevent nurse burnout.

OBJECTIVE: The objective of this review is to identify and map the literature that describes the individual and environmental factors that influence nurses and midwives to stay in or leave their discipline within the first three years of practice. INTRODUCTION: The turnover rate of newcomers within their first three years of nursing and midwifery is higher than in later years and is contributing to a worldwide shortage. Both individual and environmental factors, often in combination, contribute to this attrition. Many studies demonstrate the associations of factors with turnover or intention to stay; however, the scope of factors has not been documented. INCLUSION CRITERIA: Newcomers are defined as registered nurses and registered midwives within the first three years of entering their discipline. Quantitative and qualitative studies and systematic reviews that explore individual or environmental factors that influence the decision to leave or to remain in nursing and midwifery in any context will be considered. Factors may include coping, anxiety, mindfulness, practice environment, or combinations such as resilience, satisfaction, and burnout. Articles must have been peer reviewed. Literature published since 1974 in English will be considered. Newcomers who have completed skills-based training will be excluded. METHODS: The JBI method for scoping reviews will be followed. An extensive search of multiple databases and gray literature will be undertaken. Retrieval of full-text studies and data extraction will be performed independently by two reviewers. Data extracted will be synthesized and results reported using a mind map, tables, and narrative form.

Background Hospitals and other health care providers frequently experience difficulties contacting patients and their carers who live remotely from the town where the health service is located. In 2016 Nurse Navigator positions were introduced into the health services by Queensland Health, to support and navigate the care of people with chronic and complex conditions. One hospital in Far North Queensland initiated an additional free telephone service to provide another means of communication for patients and carers with the NNs and for off-campus health professionals to obtain details about a patient utilising the service. Calls made between 7am and 10pm, seven days per week are answered by a nurse navigator. Aim To report utilisation of the service by navigated clients and remotely located clinicians compared to use of navigators’ individual work numbers and direct health service numbers. We report the reason for calls to the free number and examine features of these calls. Methods Statistical analysis examined the call reason, duration of calls, setting from where calls originated and stream of calls. Interactions between the reasons for calls and the features of calls, such as contact method, were examined. Results The major reason for calls was clinical issues and the source of calls was primarily patients and carers. Clinical calls were longer in duration. Shorter calls were mainly non-clinical, made by a health professional. Setting for calls was not related to the reason. The most frequent number used was the individual mobile number of the NN, followed by the hospital landline. Although the free number was utilised by patients and carers, it was not the preferred option. Conclusion As patients and carers preferred to access their NN directly than via the 1800 number, further research should explore options best suited to this group of patients outside normal business hours.

Nursing is recognized as a stressful occupation where the incidence of negative outcomes such as burnout and high attrition has been well documented. Studies have consistently found that a higher level of resilience is related to retention in the nursing workforce. Mindfulness has been shown to lower levels of burnout and may play an important role in resilience to vicarious trauma. A brief mindful self-care and resiliency (MSCR) program aimed specifically at reducing compassion fatigue, and enhancing nurses’ resilience was piloted in a tertiary acute care hospital in Australia. This paper reports findings from the qualitative component of a mixed methods study which aimed to explore nurses’ responses to the MSCR program including its perceived feasibility, acceptability, and applicability. A sample of 20 nurses completed the MSCR program, of which 16 nurses (80% response) participated in individual unstructured interviews. Verbatim transcripts of the audio recorded interviews were subjected to thematic analysis. Five themes emerged that described participants’ perceptions of how the program benefitted nurses and its applicability in routine practice: Gaining perspective and insight; developing feelings of inner calm; taking time to care for self; feasibility and acceptability of the MSCR program; and using self-care strategies. The MSCR program was found to be feasible and acceptable from the perspective of nurse participants working in this acute care hospital. Fifteen nurses (94%) reported using mindful awareness and self-regulation after completing the program indicating that the strategies offered were practicable in this work setting.

Introduction The objectives of this research were to: (1) determine the extent of Australian radiation therapists (RTs) research participation; (2) evaluate the impact of research involvement on career perceptions (3) explore which research topics require investigation and (4) identify benefits and barriers to research participation. Methods This study used mixed methods to collect qualitative and quantitative data using an online survey from a larger workforce study of RTs and radiation oncology medical physicists. Participants practising in Australia completed questions about their research involvement. Chi‐square tests and logistic regression were used to analyse quantitative data and content analysis was used to explore qualitative data. Results Two hundred and ninety‐six RTs answered the research questions. Forty‐six percent had been involved in research. Of these, 91% had been involved in departmental, 28% in national, 14% in international and 29% in informal or self‐directed research studies. Eleven RTs (8%) had received funding as a chief/principal investigator. Involvement in research was associated with a desire to make a career change. However, it also appeared to be associated with greater satisfaction with career progression and staying in the career. Respondents identified a range of potential research topics, benefits of participating in research and barriers which included lack of time, support and cost. Conclusion Almost half of the RT participants identified that they were participating in research. Our data suggest that continued involvement in research, and opportunities to participate, improve RT job satisfaction. RTs' research activities are likely to be extended through provision of additional time and support.

Aim To synthesize existing research to determine if nurses who work shifts have poorer psychological functioning and resilience than nurses who do not work shifts. Background Research exploring the impact of shift work on the psychological functioning and resilience of nurses is limited compared with research investigating the impact of shifts on physical outcomes. Design Integrative literature review. Data Sources Relevant databases were searched from January 1995–August 2016 using the combination of keywords: nurse, shift work; rotating roster; night shift; resilient; hardiness; coping; well-being; burnout; mental health; occupational stress; compassion fatigue; compassion satisfaction; stress; anxiety; depression. Review Methods Two authors independently performed the integrative review processes proposed by Whittemore and Knafl and a quality assessment using the mixed-methods appraisal tool by Pluye et al. Results A total of 37 articles were included in the review (32 quantitative, 4 qualitative and 1 mixed-methods). Approximately half of the studies directly compared nurse shift workers with non-shift workers. Findings were grouped according to the following main outcomes: (1) general psychological well-being/quality of life; (2) Job satisfaction/burnout; (3) Depression, anxiety and stress; and (4) Resilience/coping. We did not find definitive evidence that shift work is associated with poorer psychological functioning in nurses. Overall, the findings suggest that the impact of shift work on nurse psychological functioning is dependent on several contextual and individual factors. Conclusion More studies are required which directly compare the psychological outcomes and resilience of nurse shift workers with non-shift workers.

Purpose To explore the self-perceived role of the Aboriginal peer support worker working with families with young children. This study was a component of a larger participatory action research study undertaken in a Western Australian metropolitan setting to develop and evaluate the suitability, feasibility and effectiveness of an Aboriginal peer-led home visiting program. Methods Focus group interviews were carried out with peer support workers using unstructured and semi-structured interviews within Action Learning Sets. Data were analysed using thematic analysis. Results The overarching theme on the self-perceived role of the Aboriginal peer support worker was Giving Parent Support, with subsidiary themes relating to development and ongoing sustainability of the support. Discussion The peer support workers viewed their role as providing parent support through enabling strategies which developed client acceptance and trust, delivered culturally relevant support, advocated for families, developed therapeutic engagement and communication strategies, and created safe home visiting practices. They recognised the importance of linking families with community support such as community child health nurses which was important for improving long term physical and psychosocial health outcomes for children. Conclusion Aboriginal Peer Support Workers identified their emerging integral role in the development of this unique culturally acceptable home visitingsupport for Aboriginal parents. Innovative approaches towards client engagement demonstrated their value in developing creative ways of working in partnership with families, community support services and child health nurses across a range of challenging psychosocial environments.

ObjectivesThis study aimed to test and further develop the ‘Early Career and Rapid Transition to a Nursing Specialty’ (TRANSPEC) model to a nursing specialty developed from a systematic review. Semi-structured interviews of specialist clinically based nurses and a consensus Delphi study with an expert panel were used to expand and achieve consensus, agreement, reliability and stability of the model.DesignA modified Delphi, two rounds (64 and 52 Likert items) of reiterative online questionnaires and one round as a nominal group technique, was informed by qualitative thematic analysis of semi-structured interviews.Setting and participantsInterviews with 14 specialists clinical practicing registered nurses and a panel of 25 national experts participated in the Delphi study.ResultsThe interview participants experienced 14 rapid transitions and three were early career transition. The overarching themes from the preliminary model were confirmed and further expanded. These were the self (personal and professional); the transition processes (final and informal); a sense of belonging; and the overarching context of practice over a time continuum. In the Delphi, the highest rating item was ‘Specialty work colleagues respect, include, support, and accept specialist nurse on completion of transition processes’. Pre-entry was highlighted as an important time point prior to transition. All items reaching consensus were included in the final model. Cronbach α increased from 0.725 to 0.875 for the final model.ConclusionsThe TRANSPEC model is a valid and reliable evidence-based tool for use in the career pathway and development of nursing specialists. Using the Benner model ‘Novice to Expert’ after the novice incomer phase is achieved, further lifelong learning development will transform the novice specialist over time continuum.

Objective: Rural doctors are difficult to recruit and retain. Burnout and stress in the medical workforce fluctuates according to location. Overall, doctors have an elevated risk of depression and suicide compared to the general population and other professionals. Higher levels of occupational stress also effect patient care, levels of work satisfaction and relationships with others. This study evaluated the effectiveness, acceptability, feasibility and sustainability of the Mindful Self-Care and Resiliency Program. Design: This was a sequential mixed-method study involving the collection of both quantitative and qualitative data. Setting: The study was conducted in Emerald, Queensland. Participants: Thirteen doctors took part in the program with seven providing pre and post survey responses. Qualitative data were collected via semi-structured telephone interviews with an additional four rural doctors. Intervention The Mindful Self-Care and Resiliency program consisted of a 4-hour face-to-face session and three 1-hour video-conference follow up sessions. Main outcome measures Burnout, negative affect, well-being and psychological strain were assessed using self-report measures before and after taking part in the program. Results The majority (six out of seven) of the doctors showed reductions in burnout, psychological strain and negative affect following participation in the program. The qualitative data indicated that all doctors gained new skills: self-awareness, reflection and self-care. They also reported improved interaction with colleagues and patients, to whom they passed on their new learning. Conclusion This preliminary investigation of the effectiveness and feasibility of Mindful Self-Care and Resiliency for rural doctors indicates that the program has promise in improving the emotional well-being of this occupational group. Although this study captured approximately one-third of the Emerald workforce, further research with a larger sample is required to confirm these findings.

Aim To understand the impact and causes of ‘Failure to Attend’ (FTA) labelling, of patients with chronic conditions. Background Nurse navigators are registered nurses employed by public hospitals in Queensland, Australia, to coordinate the care of patients with multiple chronic conditions, who frequently miss hospital appointments. The role of the nurse navigator is to improve care management of these patients. Evidence for this is measured through improvement in patient self-management of their conditions, a reduction in preventable hospital admissions and compliance with attendance at outpatient clinics. Failure to attend (FTA) is one measure of hospital utilisation, identifying outpatient appointments that are cancelled or not attended. Method The cohort for this study was patients with multiple chronic conditions, and nurse navigators coordinating their care. Data describing the concept of FTA were thematically analysed twelve months into this three year evaluation. Results Although the patient is blamed for failing to attend appointments, the reasons appear to be a mixture of systems error/miscommunication between the patient and the health services or social reasons impacting on patient’s capacity to attend. Themes emerging from the data were: access barriers; failure to recognise personal stigma of FTA; and bridging the gap. Conclusion The nurse navigators demonstrate their pivotal role in engaging with outpatient services to reduce FTAs whilst helping patients to become confident in dealing with multiple appointments. There are many reasons why a patient is unable to attend a scheduled appointment. The phrase ‘Failure to Attend’ has distinctly negative connotations and can lead to a sense of blame and shame for those with complex chronic needs. We propose the use of the neutral phrase “appointment did not proceed” to replace FTA. Implications for Nursing management This article advocates for further consideration of collaborative models that engage the patient in their care journey and for consideration of the language used within the outpatient acute hospital setting, proposing the term ‘appointment did not proceed.’

As part of a study of the radiation oncology workforce, radiation oncology medical physicists (ROMPs) who had worked in Australia were surveyed regarding their attitudes to participating in research. Responses from 88 ROMPs were available for analysis, representing a broad mix of employment situations and research experience. Greater than 70% of ROMPs described their involvement in research as "liking it" or "loving it", with associated identified benefits including skills development, job satisfaction and career progression. Over half of respondents agreed that involvement in research inspired them to stay in their profession. However, lack of time, support and motivation were all identified as barriers to participation in research. Areas of research interest were identified. This study highlights the importance of a research culture for job satisfaction and staff retention.

Background Designing child and family health services to meet the diverse needs of contemporary families is intended to minimize impacts of early disadvantage and subsequent lifelong health and social issues. Innovative programs to engage families with child and family support services have led to interest in the potential value of peer-led home visiting from parents in local communities. There is a range of benefits and challenges identified in a limited number of studies associated with home visiting peer support. Objectives The objective of the review is to identify: INCLUSION CRITERIA PARTICIPANTS: Families/parents with one or more children aged zero to four years, peer support workers and their supervisors. Intervention and phenomenon of interest Peer-led home visiting parenting support programs that use volunteer or paraprofessional home visitors from the local community compared to standard community maternal-child care. The phenomenon of interest will be the relationships between participants in the program. Types of studies Quantitative studies: randomized control trials (RCTs). Qualitative studies: grounded theory and qualitative descriptive studies. Outcomes Parental attitudes and beliefs, coping skills and confidence in parenting, parental stress, compliance with child health checks/links with primary healthcare services, satisfaction with peer support and services and the nature of the relationship between parents and home visitors. Search strategy The search strategy will include both published and unpublished studies. Seven journal databases and five other sources will be searched. Only studies published in the English language from 2000 to 2015 will be considered. Methodological quality Studies were assessed by two independent reviewers using standardized critical appraisal tools from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) as appropriate. Data extraction Both quantitative and qualitative data were independently extracted by two reviewers using standardized data extraction tools from the JBI-MAStARI and the JBI-QARI, respectively, including qualitative and quantitative details about setting of interventions, phenomena of interest, participants, study methods and outcomes or findings. Data synthesis For quantitative findings, statistical pooling was not possible due to differences in interventions and outcome measures. Findings were presented in narrative form. Qualitative findings were aggregated into categories based on similarity of meaning from which synthesized findings were generated. Results Quantitative results from two RCTs demonstrated positive impacts of peer-led home visiting parent support programs including more positive parenting attitudes and beliefs, and more child preventative health care visits.Fifteen qualitative findings from two studies were aggregated into five categories from which two synthesized findings emerged. Parents and home visitors identified similar components as contributing to their program's success, these being quality of relationships between parents and home visitors with elements being mutual respect, trust and being valued within the partnership. In addition, home visitors identified importance of enabling strategies to develop relationships. They also needed supportive working environments with clinical staff and management. Conclusion The current review indicates a positive impact of peer-led home visiting parent support programs, incorporating a framework of partnership between parents and home visitors, on mother-infant dyads. Positive changes in parenting attitudes and beliefs, and increased number of child preventative healthcare visits are supported by the quality of the relationship between parent and home visitor, and home visitors' working environments. Implications for practice The essential characteristics of an effective parent support program are strategies for relationship building between parents and home visitors; ongoing staff and home visitor education to enhance communication, collaboration and working in partnership; supervision by team leaders; and continuous quality improvement. Implications for research The focus of further research should be on confirmatory studies using an action research methodology and the cost-effectiveness of these models.

It is now well established that a significant number of nurses have less than optimal levels of wellness as a result of the stressful nature of their work. Identifying effective workplace strategies to help improve the resilience of nurses is therefore a high priority. In this study, we evaluated the feasibility of a mindfulness-based intervention aimed at reducing compassion fatigue and improving emotional well-being in nurses. A total of 21 nurses recruited from a large teaching hospital in Western Australia, participated in a mindful self-care and resiliency (MSCR) intervention. The intervention consisted of a 1-day compassion fatigue prevention educational workshop, followed by a series of weekly mindfulness training seminars conducted over 4 weeks (12 h total intervention time). Participants completed a number of standardized measures at pre, post, and 1-month follow-up. Significant improvements were observed following the intervention for compassion satisfaction, burnout, trait-negative affect, obsessive passion, and stress scores. At pre-intervention, 45 % of the sample had high burnout scores, but this reduced to just 15 % by post-intervention. No significant changes were observed for general resilience, anxiety, or secondary traumatic stress post-intervention or at follow-up. The results of this preliminary study indicate that MSCR may represent a feasible approach to improving resilience and well-being among nurses. Further research utilizing a control group is required to strengthen conclusions.

Objective: This study aims to ascertain if differences exist in the perception of the professional practice environment and personal well-being of nurses across different geographical areas in Queensland. Design: This paper was performed on a prospective, self-report cross-sectional on-line survey. Setting: The study was conducted among the nurses employed in public and private health care settings: acute hospitals, community health and aged care in Queensland, Australia. Participants: Participants of this study were 1608 registered and enrolled nurses and assistants in nursing, current members of the Queensland Nurses Union in 2013 and who provided a workplace postcode. One thousand eight of these participants worked in major cities, while 382 in rural locations and 238 in remote areas. Interventions: None. Main outcome measures: Scores of well-being as determined by the following scales: the Depression, Anxiety and Stress Scale, the Professional Quality of Life Scale version 5, the Connor–Davidson Resilience Scale and of the Professional Practice Environment using the Practice Environment Scale – Nursing Work Index Revised. Results: Nurses employed in major cities perceived 'nursing foundations for quality care' more favourably than those from other settings. Remote area nurses had lower levels of secondary traumatic stress than nurses in major cities and rural areas. There was no difference between nurses across their geographical locations for stress, anxiety, depression, compassion satisfaction, burnout, resilience and the four other measures of the Practice Environment Scale. Conclusions: The study findings provide new data suggesting that, with the exception of secondary traumatic stress, the personal well-being of nurses does not differ across geographical settings. Similarly, with the exception of the subscale of 'nursing foundations for quality care' there was no difference in perceptions of the professional practice environment. As secondary traumatic stress is associated with burnout, this finding needs to be investigated further.

IntroductionThe management of patients who need chronic and complex care is a focus of attention internationally, brought about by an increase in chronic conditions, requiring significantly more care over longer periods of time. The increase in chronic conditions has placed pressure on health services, financially and physically, bringing about changes in the way care is delivered, with hospital avoidance and home-based care encouraged. In this environment, nurses play an important role in co-ordinating care across services. This review formed one part of a funded project that explored the nurse navigator role within a proposed 24-hour telephone-call service in one regional area that has a diverse population in terms of cultural identity and geographical location in relation to service access.AimThe review reports on the extant literature on the nurse's role in the provision of afterhours telephone services for patients with chronic and complex conditions. The specific aim was to explore the effectiveness of services for patients in geographically isolated locations.MethodsThe methodological approach to the review followed the Preferred Reporting System for Meta-Analyses (PRISMA) guidelines. A thematic analysis was used to identify themes with chronic care models underpinning analysis.ResultsThree themes were identified; nurse-led decision making; consumer profile; and program outcomes. Each theme was divided into two sub-themes. The two sub-themes for decision making were: the experience of the staff who provided the service and the tool or protocol used. The two sub-themes for consumers profile were; the geographic/demographic identity of the consumers, and consumer satisfaction. The final theme of outcomes describes how the effectiveness of the service is measured, broken into two sub-themes: the economic/workforce outcomes and the consumer outcomes.DiscussionThe provision of an after-hours telephone service, in whatever model used should align with a Chronic Care Model. In this way, after-hours telephone services provided by experienced nurses, supported by ongoing professional development and relevant protocols, form part of the ongoing improvement for chronic and complex care management as a health priority.

With increasing age and chronicity in populations, the need to reduce the costs of care while enhancing quality and hospital avoidance, is important. Nurse-led co-ordination is one such model of care that supports this approach. The aim of this research was to assess the impact that newly appointed Navigators have on service provision; social and economic impact; nurses' professional quality of life and compassion fatigue; and analysis of the change that has occurred to models of care and service delivery.A concurrent mixed-method approach was selected to address the research aims.The research project was funded in July 2018 and will conclude in December 2020. Several cohorts will be studied including; patients assigned to a navigator, patients not assigned to a navigator, family members of patients assigned a navigator; and a sample sized estimated at 140 navigators.This study provides a comprehensive international longitudinal and mixed method framework for evaluating the impact of nurse navigators on quality of care outcomes for patients with chronic conditions. IMPACT-WHAT PROBLEM WILL THE STUDY ADDRESS?: Even with specialty focused co-ordinated care, patients get lost in the system, increasing the incidence of non-compliance and exacerbation of condition. Navigators work with patients across service boundaries allowing for care that is patient responsive, and permitting variables in clinical, social and practical elements of care to be addressed in a timely manner. This novel nurse-led approach, supports hospital avoidance and patient self-management, while encouraging expansion and opportunity for the nursing and midwifery workforce.目的: 随着人口年龄和慢性化的增加,在提高质量和避免住院的同时降低护理成本的需求显得非常重要。护士引导型协调就是支持这种方法的护理模式之一。这项研究目的在于评估新任导航员对服务提供的影响;社会和经济影响;护士职业生活质量与同情心疲乏;以及对护理和服务提供模式所发生变化的分析。 设计: 选择了并行混合方法来解决研究目标。 方法: 研究项目于2018年7月获得资助,将于2020年12月结束。将研究几个队列,包括:分配给导航员的患者、未分配给导航员的患者、分配给导航员的患者家属;和估计为140个航海家的样本量。 讨论: 本研究为评估护士导航员对慢性病患者护理结果质量的影响提供了一个全面型国际纵向和混合方法框架。 影响--研究将解决什么问题?以下内容;: 即使有了专业专注型协调护理,患者也会迷失在身体系统中,从而增加不遵从和病情恶化的发生率。导航员跨越服务边界与患者合作,考虑患者响应型护理,并允许及时处理临床、社会和实际护理要素中的变量。这种新颖的护士主导型方法有助于避免住院和患者自我管理,同时鼓励护理和助产人员的壮大和机遇。.

To investigate the impact of shift work on the psychological functioning and resilience of nurses by comparing nurses who work shifts and nurses who work regular hours.A comparative descriptive design using an online self-report questionnaire.Data were collected from employed Registered and Enrolled Nurses (N = 1,369) who were members of the Queensland Nurses and Midwives Union (QNMU) in 2013. The survey included standardized measures of resilience, depression, anxiety, compassion satisfaction, compassion fatigue, and intention to leave the profession.Generalized Linear Mixed Model analysis revealed shift workers had significantly lower levels of compassion satisfaction. However, there were no significant differences between the groups on resilience, depression, anxiety, stress, compassion fatigue or intention to leave nursing.The findings suggest that shift work is not associated with worse psychological functioning or lower resilience in nurses. However, this study requires replication using a longitudinal design to confirm these findings.目的: 通过对轮班护士和定时上班的护士之间的比较,调查轮班制对护士心理功能和心理复原力的影响。 设计: 使用在线自我报告问卷的比较描述性设计。 方法: 数据来自2013年昆士兰护士和助产士联盟(QNMU)成员里的聘用注册护士和注册护士(人数为1369人)。这项调查包括复原力、抑郁、焦虑、同情心满意度、同情疲劳和离职打算的标准化措施。 结果: 广义线性混合模型分析显示,轮班员工的同情心满意度明显较低。但是,在复原力、抑郁、焦虑、压力、同情疲劳或离职意向等方面,两组之间没有明显差异。 结论: 调查结果表明,轮班工作与护士的心理功能变糟和复原力降低没有关系。然而,这项研究需要使用纵向设计来证实这些发现。.

Introduction The Mindful Self-Care and Resiliency (MSCR) programme is a brief psychosocial intervention designed to promote resilience among various occupational groups. The intervention is based on the principles of mindfulness and also incorporates an educational self-care component. The current paper presents the protocol for a pilot study that will evaluate the effectiveness of this programme among general practitioners working in rural Queensland, Australia. Methods and analysis We will measure the impact of the MSCR programme on levels of employee resilience (Connor-Davidson Resilience Scale; State-Trait Assessment of Resilience STARS), compassion satisfaction and compassion fatigue (Professional Quality of Life Scale), self-compassion (Self-Compassion Scale) and mood (Positive and Negative Affect Scale). We will also assess the impact of the programme on job satisfaction (The Abridged Job in General Scale), absenteeism/presenteeism (The WHO Health and Work Performance Questionnaire) and general well-being (WHO Five Well-being Index). Repeated measures analysis of variance will be used to analyse the impact of the intervention on the outcome measures taken at pre, post, 1-month, 3-month and 6-month follow-ups. We will conduct individual interviews with participants to gather data on the feasibility and acceptability of the programme. Finally, we will conduct an initial cost-effectiveness analysis of the programme. Ethics and dissemination Approval for this study was obtained from the Curtin University Human Research ethics committee and the study has been registered with the Australian Clinical Trials Registry. Results will be published and presented at national and international congresses. Trial registration number ACTRN12617001479392p; Pre-results.

This study aimed to determine and compare Radiation Therapists' (RTs') and Radiation Oncology Medical Physicists' (ROMPs') perspectives about their profession and workplace, satisfaction with career progression opportunities, and leaving the current workplace. RTs and ROMPs who were currently or had previously worked in Australia were invited to complete an online survey. Univariate and multivariate methods were used for analysis. Participants were 342 RTs and 112 ROMPs with estimated response rates of 14% and 26% respectively. Both professions rated workload poorly and identified the need for improvement in: communication between professions' members, support for junior staff/new graduates, staff morale, on-site training and multidisciplinary communication. RTs, more than ROMPs, perceived their profession was recognised and respected, but RTs were less likely to be satisfied with career progression/advancement, job promotion prospects and opportunities to specialise. At least 20% of RTs and ROMPs were thinking about leaving their workplace and 13% of RTs and 8% of ROMPs were thinking about leaving their profession. Different factors contributed to workforce satisfaction and retention within each profession. Staff satisfaction and career progression are critical to retain RTs and ROMPs. Further research is required to explore strategies to address workplace dissatisfaction, recruitment and retention.

Review question/objective What is the effectiveness and experience of families participating in peer led parenting support programs delivered as home visiting programs? The objective of this review is to identify the effectiveness and experience of families participating in peer led parenting support programs delivered as home visiting programs. The quantitative objective is to identify the effectiveness of peer led home visiting parent support for families. More specifically, the objectives are to identify: The types of peer led home visiting programs that are, or have been undertaken. The effectiveness of peer led home visiting parent support programs on families. The qualitative objectives are to identify the experiences and meanings of peer led parenting support programs for families. More specifically, the objectives are to identify the evidence on: The meaning that families place on peer led home visiting parent support programs. The experiences of families with regard to peer led home visiting parent support programs. The successful components of peer led home visiting parent support programs. The differences between peer led home visiting programs offered to Indigenous and non-Indigenous families. Inclusion criteria Types of participants The quantitative and qualitative components of this review will consider studies that include: 1. Families/parents (including Indigenous and non-Indigenous) with one or more children aged 0-4 years of age. Parents may be married, single or in defacto and/or same sex relationships. 2. Parent/Peer support workers. Exclusion Criteria All exclusion criteria are addressed in the relevant sections of the protocol. Types of intervention(s)/phenomena of interest Peer led parenting support programs delivered as home visiting programs include the use of volunteer or paraprofessional parents who have shared similar parenting experiences in the local community. The quantitative component of the review will consider studies that evaluate the effectiveness of peer led home visiting parent support programs for families/parents with children 0-4 years of age. Interventions delivered as non-home visiting support or delivered with non-peer support will not be included. The qualitative component of this review will consider studies that investigate the meaning and experiences of peer led parenting support programs for families with children 0-4 years of age. TRUNCATED AT 350 WORDS

ObjectiveShortages in the speciality nursing workforce, both nationally and internationally are driving the need for the development of an evidence-based model to inform recruitment and retention into speciality nursing practice. This study aimed to identify the factors influencing rapid and early career transition into speciality nursing practice.MethodsA comprehensive systematic review of the literature was undertaken using a convergent qualitative synthesis design where results from qualitative, quantitative and mixed methods studies were transformed into qualitative findings. Databases included CINAHL, Medline, Scopus and PsycINFO. Search terms were: nurse, early career, rapid career, transition, specialty, and Medical Subject Heading terms included: professional development and educational, nursing, and continuing. Using validated tools, papers were independently assessed by a minimum of two reviewers.ResultsTwenty-three research articles were included. There were no randomized control trials. Through thematic analysis and matrix mapping of the results, the TRANSPEC model was developed. The model outlines three phases of transition: pre-entry, incomer and insider. There has been little focus on pre-entry with programs being designed at the incomer and insider phases. Impacting on these phases are three concepts: the self (professional and personal), the transition processes (informal and formal) and a sense of belonging. The overarching theme influencing the phases and concepts is the context of practice. Enablers and inhibitors influence successful transition and therefore impact on recruitment and retention. Each nurse's transition is influenced by time.ConclusionsFor successful transition, the enablers and inhibitors impacting on the three concepts, phases and the context of practice need to be considered when developing any program. It is apparent that while previous studies have focused on the transition processes, such as curricula, the development of the self and a sense of belonging are also essential to successful transition. Further studies should include the pre-entry phase.

Introduction Community nursing and midwifery is changing in response to a shift in care from hospital to home, brought about by increasing costs to care because of an aging population and increasing chronicity. Until now, community nursing positions and scope of practice has been dependent on service focus and location, which has led to the role being unclearly defined. Lack of appeal for a career in community practice and a looming workforce shortage necessitates a review into how community nursing and midwifery transition to practice is supported. Methods This review sought to identify, assess and summarize available evidence relating to transitioning into community nursing and midwifery practice as a speciality. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. A narrative synthesis was then undertaken on papers that examined community nursing and midwifery pathway perspectives which define, and enable or inhibit a contemporary pathway. Thematic analysis used a theoretical framework developed for early career and rapid transition to nursing specialty practice. Results There is a paucity of research that identifies community nursing and midwifery as a discreet scope of practice. Twelve papers were eventually included in the review. Verbatim findings were extracted from the papers and clustered into categories based on the chosen theoretical framework. Major themes were ‘the self’ (professional and personal); ‘transition processes’; and, a ‘sense of belonging’. Sub themes included narrative identifying inhibitors and enablers in each theme. Discussion No definition of community practice or pathway was identified in nursing, although midwifery was clearly defined. Community nursing practice was described as generalist in nature although specialist knowledge is required. Being part of the community in the professional sense and personal sense was considered important. The importance of transition was identified where pre-entry exposure to community practice was seen as important. Stages in transition to practice were recognised as pre-entry; incomer; insider; and, a sense of belonging. The process of transition should be planned and individualised acknowledging past experience whilst acknowledging the specialist nature of community-based practice.

Aims: To describe the action research approach taken to engage a multidisciplinary group of health professionals and managers from five rural health services with government officers in redesigning their emergency care services and informing legislative change. Background: The diminishing size of the medical workforce across rural Victoria in Australia captured the Victorian state government's attention when this threatened the sustainability of emergency care services in rural and remote hospitals in 2006. The government funded the collaborative practice model pilot between 2006 and 2008 to develop and test an alternative model of emergency care service in which nurses practised at a more advanced and autonomous level. Data sources: Data were sourced from a combination of interviews, focus groups and patient records. Review methods: Qualitative data were analysed using convergent interview and thematic analysis. Quantitative data were analysed using frequencies and cross tabulations. Discussion: The three critical success factors owing to action research are presented. It provided a politically safe approach to service, policy and legislative change, ensured collaboration permeated the endeavour and helped to shift the focus from a technical to an emancipatory approach to action research. Conclusion: Action research was key to the success achieved by the participants in changing clinical practice, service delivery and the Victorian Drugs Poisons and Controlled Substances Act (1981) to authorise registered nurses to supply medicines. Implications for practice: This paper offers an approach that nurses in practice, management and government can take to drive changes at practice, service and legislative levels in advanced nursing practice.

Aim: This is the first two-phase Australian study to explore the factors impacting upon compassion satisfaction, compassion fatigue, anxiety, depression and stress and to describe the strategies nurses use to build compassion satisfaction into their working lives. Background: Compassion fatigue has been found to impact on job satisfaction, the quality of patient care and retention within nursing. This study provides new knowledge on the influences of anxiety, stress and depression and how they relate to compassion satisfaction and compassion fatigue. Method: In Phase 2 of the study, 10 nurses from Phase 1 of the study participated in individual interviews and a focus group. A semi-structured interview schedule guided the conversations with the participants. Result: Data analysis resulted in seven main themes: social networks and support; infrastructure and support; environment and lifestyle; learning; leadership; stress; and suggestions to build psychological wellness in nurses. Conclusion: Findings suggest that a nurse's capacity to cope is enhanced through strong social and collegial support, infrastructure that supports the provision of quality nursing care and positive affirmation. These concepts are strongly linked to personal resilience. Implications for nursing management: These findings support the need for management to develop appropriate interventions to build resilience in nurses.

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

This was the first Australian study investigating the acceptability, feasibility and sustainability of a nurse-led model of chronic disease management in general practice. A concurrent mixed-methods design was used within a 12-month intervention of nurse-led care in three general practices. Adult patients with type 2 diabetes, hypertension and/or stable ischaemic heart disease were randomized into nurse-led or standard care. Semi-structured interviews explored perceptions of key stakeholders towards this model including patients in the nurse-led arm, and all practice staff pre- and posttrial. The data were thematically analysed and the emergent themes were: importance of time; collaborative relationships; nurse job satisfaction, confidence and competence; patient self-management and choice. Our findings showed that nurses provided chronic disease management that was acceptable, feasible and sustainable. The collaborative involvement of doctors was intrinsic to patient acceptability of nurse-led care that facilitated job satisfaction, and therefore retention and growth within this nursing speciality.

Review Questions/Objectives: This review seeks to answer the following question(s): How effective are: 1. simple behavioural interventions such as reward systems 2. complex behavioural interventions 3. alarms 4. pharmaceuticals such as desmopressin and tricyclics 5. and complementary interventions such as acupuncture and hypnosis in managing primary nocturnal enuresis in children The inclusion criteria for this review: Types of participants: Studies that examined children (as defined in the trial) aged up to and including the age of 16 years, who suffered from a primary diagnosis of NE will be included. Types of interventions: The Cochrane reviews that form the basis of this review have divided interventions for management of NE in children into seven categories. These categories will also be used in this review: 1) alarms 2) simple behavioural and physical interventions (such as fluid restriction, lifting and reward systems) 3) complex behavioural and educational interventions (use a number of different behavioural and educational interventions in combination such as dry bed training) 4) complementary and miscellaneous interventions 5) desmopressin 6) tricyclic and related drugs 7) drugs other than desmopressin and tricyclics Types of outcome measures: Outcomes of interest to this review have been specified by the identified Cochrane reviews and include: 1) change in the number of wet nights per week 2) number of participants failing to attain 14 consecutive dry nights (the accepted criterion for continence) 3) mean number of wet nights at follow-up 4) relapse (as defined by each trial)

Breast engorgement is a condition that affects breastfeeding mothers early in the postpartum. The discomfort and tenderness as a result of the engorgement is a major contributing factor to the early cessation of breastfeeding. Many treatments for breast engorgement have been attempted and explored.To examine the effectiveness of cabbage leaf treatment on pain and hardness of the engorged breasts of post-partum women and its influence on the duration of breastfeeding in women with breast engorgement.Postpartum lactating mothers 13 to 50 years of age and of any parity in the first two weeks postpartum with breast engorgement.Cabbage leaf treatment on breast engorgement in reducing pain, hardness and increasing the duration of breastfeeding.Primary outcomes: engorgement, severity of the distention, hardness to touch and pain associated with breast engorgement. Secondary outcome: duration of breastfeeding.Quantitative studies including RCTs, quasi-randomized trials and quasi-experimental studies.Studies in English language from inception of the relevant databases to 2010 were considered for inclusion in this review.The databases searched included: CINAHL, MEDLINE, SCOPUS, EMBASE, Web of Science, Science Direct. The search for unpublished studies included: Google Scholar, Mednar, Proquest.Studies were assessed by two independent reviewers for methodological validity using standardised critical appraisal tools from the Joanna Briggs Institute.Data were extracted using the standardised data extraction tools from the Joanna Briggs Institute.The results were presented in narrative format as the meta-analysis was not appropriate because study methods were heterogeneous.Four studies were included in this review: one RCT and two quasi-randomised studies and one quasi-experimental study. In one RCT after the first cabbage leaf application, fewer mothers were reporting breast engorgement through their second to fourth assessments as compared to the control group. On the second assessment a smaller proportion in the intervention group thought their breasts were engorged (51% vs 57%, p = 0.68). In one study the experimental group receiving cabbage leaf treatment improved from a pre-treatment score of 5.17 (70%) to 3.02 (20%) (p =0.001). In addition, hot and cold compresses appeared to reduce scores more effectively than cold cabbage leaf (p0.001). In one study both cabbage leaf and hot and cold compresses interventions decreased numerical pain scores (p≤0.001) and thus pain in breast engorgement. In a study results showed statistically significant reduction in pain scores for both room temperature 2.0 points (37%) and chilled cabbage leaf 2.1 points (38%) (p=0.0001). There was no statistical difference in mean pre and post treatment scores of room temperature and chilled cabbage leaf (p=0.84).In one study pre and post treatment scores using the Bourbonnais scale showed a statistically significant reduction in pain scores: 1.8 points (30%) with cabbage leaf and 2.2 points (39%) with gel packs (p=0.0001). In one study it was found that 18% more mothers who received the cabbage leaf intervention were exclusively breastfeeding at six weeks (p= 0.09). Less mothers had stopped breastfeeding prior to eight days (8.88% vs 24% p= 0.09) and overall duration of breastfeeding was longer in the intervention group (36 vs 30 days, p=0.04).Overall results showed that cabbage leaf treatment used on women with breast engorgement did reduce pain, the hardness of the engorged breasts and increased the duration of breast feeding.The current available evidence suggests that cabbage leaf treatment helps reduce pain in breast engorgement and lengthens breastfeeding duration, although some studies have also reported that cabbage leaf treatment is not effective.Cabbage leaf may be useful in the treatment of breast engorgement. The chilled cabbage leaf may be used for breast engorgement in breastfeeding women but there is insufficient evidence to suggest the generalized use of cabbage leaf in protocols for the treatment of breast engorgement.Researchers should aim to achieve more homogeneity across the studies by using similar tools and instruments (preferably validated) to compare the effectiveness of cabbage leaf treatment; measuring similar outcomes (i.e pain scores, breast engorgement scores, duration of breastfeeding).

Background Breast cancer is the most common cancer in women. With increasing numbers of women surviving breast cancer, there is a need to move beyond the traditional ways of evaluating clinical outcomes and include patient-based outcomes such as the quality of life.Objectives To integrate and summarise the best evidence related to the quality of life of women diagnosed with breast cancer during and up to ten years after treatment for breast cancer.Types of participants: Adult women (over the age of 18 years) diagnosed with breast cancer who are or have received treatment for breast cancer in the last ten years (i.e. surgery, chemotherapy, radiation therapy and/or hormonal therapy).The quality of life of women diagnosed with breast cancer during and up to ten years after treatment.Women with breast cancer from both developed and developing countries.Types of studies: Studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory and ethnography, action research and feminist research.Search strategy The search sought to find both published and unpublished studies between 1990 and 2010, limited to the English language. Eleven electronic databases were searched including CINAHL, PubMed, Scopus and PsycArticles.Methodological quality Methodological quality was assessed independently by two reviewers using a standardised critical appraisal instrument from the Joanna Briggs Institute.Data extraction Qualitative data were extracted from the included studies using a standardised data extraction tool from the Joanna Briggs Institute.A total of 42 findings from seven qualitative studies were extracted and rated as unequivocal or credible. Eleven categories were produced. Three synthesised findings were generated based on the meta-aggregation of the categories: (1) "effective care for patients will be achieved if clinicians are aware of the impact of breast cancer and its treatment on the physical and psychosocial domains of women's quality of life"; (2) "for effective patient-centred care, clinicians must be cognisant of the ways breast cancer and its treatment modalities affect social relationships"; (3) "clinicians should be aware that women use religion and spirituality to cope with breast cancer treatment and improve their quality of life".This review concludes that the breast cancer diagnosis and its treatment can have a significant effect on several domains of women's quality of life. Healthcare providers caring for patients need to be well informed about each individual woman's physical and psychosocial concerns and be cognisant that any attempt to offer support must be targeted to meet the specific challenges faced by each individual woman.Support and guidance could be provided by healthcare providers through the use of counselling services, psycho-education and organisation of support groups. Elements of counselling and psycho-education should include, when appropriate, joint sessions with the woman's spouse/partner. As spirituality emerged as a coping mechanism, it is important that women be able to nurture their spiritual relationship in an environment which is supportive.The lack of studies within the Asian context indicates that further research is warranted to examine the impact of breast cancer and its treatment on the quality of life of women from diverse multi-ethnic populations. Further research into self-help strategies to improve the psychosocial well-being of women with breast cancer is warranted.It is noted that when faced with adversity, women seek comfort in religion and spirituality and a study into the relationship between spirituality and quality of life, as well as the effect of culture and religion on the quality of life, is warranted.

Aims and objectives To explore patient decision delay, the symptom experience and factors that motivated the patient experiencing myocardial infarction to go to the emergency department. Background Reperfusion for myocardial infarction is more effective if performed as soon as possible after the onset of symptoms. Multiple studies show that prehospital delay is long and can average several hours. Design A qualitative descriptive design using semi-structured interviews. Methods All consecutive myocardial infarction patients who between July 2013–January 2014 at a single-centre metropolitan tertiary hospital in Western Australia were included. Patient responses to an open-ended question were recorded and transcribed verbatim. Data were analysed using Braun & Clarke (Qual Res Psychol, 3, 2006, 77–101) thematic analysis method. Results Of the 367 eligible, 255 provided consent. Three themes emerged from the qualitative analyses: (1) onset and response to symptoms, and this included three subthemes: context of the event, diversity of symptom interpretation and response to symptoms; (2) help-seeking behaviour, and this included the patient seeking help from various lay and professional sources; and (3) help-seeking outcomes, which include calling the emergency ambulance, going to emergency department, seeing a general practitioner, seeing a general practitioner who advised them to go home. Conclusion The context of the event, their symptomatology and the layperson who was the first point of contact influenced the decision for the patient to go to the emergency department. Many patients used private transport or contacted their general practitioner. New knowledge from this study emphasises the importance of the layperson understanding the appropriate response is to seek prompt care through immediate emergency transport by ambulance to emergency department. Relevance to clinical practice This study highlights the need to educate both the patient and the wider public, not only to seek prompt care but to also to call the emergency ambulance to arrange transport to the emergency department.

For this study, we examined the nature of the unique relationships trait-negative affect and compassion satisfaction had with compassion fatigue and its components of secondary traumatic stress and burnout in 273 nurses from 1 metropolitan tertiary acute hospital in Western Australia. Participants completed the Professional Quality of Life Scale (Stamm, 2010), Depression Anxiety Stress Scale (Lovibond & Lovibond, 2004), and the State–Trait Anxiety Inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983). Bivariate correlation and hierarchical regression analyses were performed to examine and investigate 4 hypotheses. The results demonstrate a clear differential pattern of relationships with secondary traumatic stress and burnout for both trait-negative affect and compassion satisfaction. Trait-negative affect was clearly the more important factor in terms of its contribution to overall compassion fatigue and secondary traumatic stress. In contrast, compassion satisfaction’s unique protective relationship only related to burnout, and not secondary traumatic stress. The results are therefore consistent with the view that compassion satisfaction may be an important internal resource that protects against burnout, but is not directly influential in protecting against secondary traumatic stress for nurses working in an acute-care hospital environment. With the projected nursing workforce shortages in Australia, it is apparent that a further understanding is warranted of how such personal variables may work as protective and risk factors. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

To synthesise the evidence on how community-dwelling adults with type 1 and type 2 diabetes mellitus experience hypoglycaemia and the strategies they use to control it.Using a three-step search strategy, all published and unpublished qualitative studies in English from January 2000 to August 2010 were retrieved. Participants diagnosed with type 1 or type 2 diabetes mellitus, experienced in self-managing their hypoglycaemia, and who lived independently in the community and attended primary care or outpatient clinics were included. An initial limited search was conducted in MEDLINE and CINAHL to identify keywords and index terms, which were then used in a second search across the CINAHL, PUBMED, SCOPUS, PsycINFO, PsycARTICLES, Web of Science, JSTOR, EMBASE and MEDNAR databases. Additionally, the reference lists of all retrieved papers were hand-searched for additional studies. Retrieved studies were assessed for methodological validity using the standardised Joanna Briggs Institute-Qualitative Assessment and Review Instrument (JBI-QARI). Data, in terms of research findings, were extracted from included studies using the standardised JBI-QARI data extraction tool. Five studies (six papers) were included in the review.The 20 findings from the six papers were grouped into three categories, which were then synthesised into one overall finding - that is 'People with diabetes mellitus can self-manage their diabetes and thus prevent hypoglycaemic episodes more effectively when health professionals provide psychological, physiological and spiritual support, and an individually targeted education programme'.Within the constraints of this review, it appears that the patient-identified priority is to maintain normality in blood glucose self-management. There is also evidence that some people lack the knowledge to identify and self-manage hypoglycaemia.To enable community-dwelling adults with diabetes mellitus to self-manage hypoglycaemia, healthcare professionals should provide individualised information and emotional support and regularly discuss and assess the person's level of knowledge, awareness of hypoglycaemia and their ability to self-manage.

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.

This study aimed to explore how community-dwelling Singaporean Chinese adults diagnosed with type 2 diabetes mellitus experience hypoglycaemia. A qualitative interpretive research design was employed. Semi-structured interviews were conducted with six participants from a Singaporean diabetes specialist outpatient clinic, transcribed verbatim and analysed using qualitative manual thematic analysis. Eight major themes emerged: experiencing symptoms, knowing hypoglycaemia is manageable, using acute measures, using preventative strategies; applying knowledge, identifying causes of hypoglycaemia, forming relationships and working with health-care professionals. Participants underestimated the impact of hypoglycaemia mainly due to their experiencing mild and infrequent episodes, and knowledge deficits. Health-care professionals' roles were limited to information providers, and they were perceived as detached and impersonal. Theimplications are that health-care professionals need to provide more client-focused education, and improve the quality of their interpersonal relationships to ensure shared decision-making with their clients.

The recent emergence of virulent respiratory infectious diseases such as Severe Acute Respiratory Syndrome (SARS) and Influenza A/H1N1 viruses predisposes nurses to occupational risks. This qualitative study investigated how Chinese Singaporean nurses perceived the risks of exposure to these infectious diseases and the factors that influenced this risk perception. Data were collected through face-to-face interviews and were analyzed using Braun and Clarke's process of thematic analysis. Three themes emerged: living with risk; the experience of SARS; and acceptance of risk. The nature of nursing work was perceived to place participants at risk of infection. Another significant finding of this study is that the government's, organizations' and nurses' perceptions of new emerging respiratory infectious diseases were influenced by their previous experience with SARS. Similar to previous studies, nurses working at the 'front line' believed that infection from these diseases was an unavoidable occupational hazard.

Aim. This study investigated the factors affecting effective communication between Singaporean registered nurses and inpatient oncology adults. Background. In oncology nursing, where conversations entail emotionally loaded topics and patients’ receptivity is greatly affected by their life-threatening disease and its trajectory, effective communication is crucial. Design. This is a qualitative study situated within the interpretivism paradigm. Method. Ten registered nurses from the oncology wards of a major teaching hospital in Singapore were interviewed. Data were transcribed verbatim and thematically analysed. Conclusion. Factors that influenced effective nurse–patient communication were found in the characteristics of the patient, the nurse and the environment. While there are common factors influencing communication in all contexts of practice, this study has suggested that a multicultural community such as Singapore presents special challenges in the oncology inpatient setting. Language barriers are significant, particularly between overseas trained nurses and patients who cannot converse in English. Cultural taboos also increase nurses’ discomfort when discussing sensitive topics. Additionally, the government’s promotion of Singapore as a medical ‘hub’ increases the cultural and ethnic mix of inpatients. A particular concerning finding is Singapore society’s poor perception of and lack of respect for nurses, which is partly contributed by Singapore’s ‘user-pays’ health system and lowly-paid foreign nurses. Relevance to clinical practice. Nurses should be mindful of how patients’ disease trajectory and psychological state affect communication. Nurses should also take patients’ cultural background into consideration when approaching sensitive topics. Language and cultural induction classes should also be made available, especially for overseas trained nurses working in Singapore. Nursing Associations in Singapore need to work on programmes that will increase the prestige of nursing. Further research involving a more representative sample is warranted to understand how Singapore’s ‘user-pays’ health care system affects effective nurse–patient communication.

Heart failure is a global health problem which affects a large percentage of the older population. Cardiac rehabilitation programs have been implemented to aid patients in successfully managing their heart condition. However, non-adherence to cardiac rehabilitation programs is common in this group of patients. This results in higher morbidity and mortality rates, rehospitalisation and ultimately higher healthcare costs. There is a need to have a better understanding of the impact that knowledge and beliefs have on patients' adherence levels, so that healthcare providers can implement appropriate strategies to promote their adherence.This review aimed to establish the best evidence regarding the impact of knowledge and beliefs on adherence to cardiac rehabilitation programs in patients with heart failure; and to make recommendations for healthcare practice and future research.Patients above the age of 18, who had been diagnosed with heart failure and had been admitted to a cardiac rehabilitation program in inpatient or outpatient settings.This review considered studies that evaluated the impact of heart failure patients' knowledge and beliefs of their disease, medication, diet, exercise and other lifestyle change recommendations, on their adherence to cardiac rehabilitation programs.Heart failure patients' knowledge, beliefs and adherence toward their medication regime, low-sodium diet, exercise, and other lifestyle change recommendations.Quantitative study designs published in the English language, up to December 2010 were considered for inclusion.Using a three-step search strategy, the following databases were assessed: CINAHL, PubMed, SCOPUS, Web of Science, OvidSP, MDConsult, ScienceDirect, Sociological Abstracts, Mosby's Nursing Consult, Mednar and TRIP.Two independent reviewers assessed each paper for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute.Information was extracted by two independent reviewers, from each paper using the standardised data extraction tool from the Joanna Briggs Institute.The findings are presented in narrative form, as statistical pooling was not possible, due to the different instruments used in measuring the outcomes.Twelve quantitative studies were included in this review (one RCT, one pre-test/post-test single group study, and ten descriptive studies). The present findings suggest that the relationship between knowledge and adherence is unclear. However, patient beliefs on medication, symptom monitoring, illness and control were found to have stronger associations of adherence to cardiac rehabilitation programs.Implications for practice Healthcare institutions need to provide adequate support for patients with heart failure; individualise adherence-enhancing interventions to cater for varying patient needs; and work on empowering patients.Implications for research Future quantitative research should be undertaken to investigate the relationship between knowledge and beliefs, determine their combined effect on adherence and examine the effectiveness of strategies used to improve patient knowledge and beliefs. Quantitative and qualitative studies could also be conducted to ascertain the factors correlated with patient knowledge, beliefs, and adherence.

To determine healthcare workers' perceptions of risk from exposure to emerging acute respiratory infectious diseases and the perceived effectiveness of strategies used to facilitate healthy coping in acute hospital and community healthcare settings.Electronic databases (Cumulative Index to Nursing and Allied Health Literature, Ovid, PubMed, ScienceDirect, Scopus and Wiley InterScience) were searched using a three-step search strategy to identify the relevant quantitative and qualitative studies published in English from 1997 to 2009. The grey literature was not included in the review. The identified studies were evaluated using the Meta-Analysis of Statistics, Assessment and Review Instrument and the Qualitative Assessment and Review Instrument from the Joanna Briggs Institute. Fourteen quantitative studies were included and the findings included in a narrative summary. The findings from the two qualitative studies were categorised into a meta-synthesis that generated two synthesised findings.Findings indicated that healthcare workers perceived personal and familial health risks and stigmatisation from their exposure to emerging acute respiratory infectious diseases, but the majority were accepting of these risks. Organisational implementation of infection control measures, avoidance of patients and complying with personal protective equipment were identified as risk-mitigating strategies. Demographic, individual and organisational factors were found to influence their risk perceptions and their adoption of strategies to mitigate the risk.It appears that healthcare workers' risk perceptions can influence their behaviour towards patients with emerging acute respiratory infectious diseases as well as their use of risk-mitigating strategies. Institutions need to ensure that appropriate infection control safeguards are in place to protect workers and their families. Institutions can also offer incentives to encourage healthcare workers to comply with the policies and procedures introduced to mitigate risk.Institutions and government need to ensure that policies and procedures are communicated and adequate institutional measures (i.e. personal protective equipment; education and training; and personal support) are implemented to safeguard healthcare workers during and after pandemic outbreaks.Future research needs to examine how perception of risk related to acute emerging respiratory infectious diseases, epidemic or pandemic, and the factors that would influence healthcare workers': decisions to stay within the workforce and provide care or resign from the workforce and compliance with institutional and government policies and procedures, as well as compliance to use of personal protective equipment.

The attainment of a work–life balance is an important issue for recruitment, retention and workforce planning. This paper aims to report on the free text data provided by the aged-care sector nurses around perceptions of important work–life issues. Data were written responses of aged-care nurses to the open-ended request at the end of a survey, which asked them to list up to five political/social/environmental issues concerning them outside of their work. For aged-care nurses, when asked to list political/social/environmental issues they were concerned about outside of work in late 2007, there emerged considered issues around work and life. Among the top eight themes there is an intriguing balance between the themes work, industrial relations, aged care/elder care and health-care services compared with the themes environment, water, societal values and housing. Qualitative insights into the political/social/environmental issues aged-care nurses are concerned about outside of your work suggest their desire for a labour/life or work/life harmony. Aged-care nurses place an equal importance on the nature of labour and the basics of life. The findings provide information for aged-care sector managers and workforce planners on areas in need of consideration to recruit and retain a workforce within aged care.

Urinary incontinence (UI) has been defined as a condition in which the involuntary loss of urine is a social or hygienic problem and is objectively demonstrable. Urinary incontinence is a common health problem that carries with it significant medical, psychosocial and economic burdens. Fecal incontinence has been defined as the involuntary or inappropriate passing of liquid or solid stool and can also include the incontinence of flatus. Studies suggest that twice as many men suffer from fecal incontinence compared to urinary incontinence whilst more than three times as many women suffer from urinary incontinence compared to fecal incontinence. The general consensus in the literature is that barriers exist for seeking help for those with incontinence. REVIEW QUESTION: 'How effective are educational interventions at raising men's awareness of bladder and bowel health?' Adult and adolescent males (age 12 years and over). Any intervention, program or action that provided information, or attempted to raise awareness of men's bladder and bowel health. The primary outcomes of interest included any measure defined by included studies such as: TYPES OF STUDIES: As this review attempted to evaluate the effectiveness of an intervention or interventions, reviewers considered studies using concurrent controls. The search strategy was designed to identify both published and unpublished material and was restricted to English language publications with a publication date of 10 years prior to the search with the exception of a review of seminal papers before this time. The quality of included studies was assessed by two reviewers using the Joanna Briggs Institute Checklists for experimental and observational studies. For each included paper the type of information that was extracted and tabulated in a database followed the JBI Data Extraction Form for Experimental and Observational Studies. Where possible relative risk (RR), odds ratios (OR), Mean differences and associated 95% confidence intervals (95% CI) were calculated from individual studies. For homogeneous studies quantitative results were combined into a meta-analysis for evaluation of the overall effect of an intervention. Where heterogeneity existed between studies the results were presented in a narrative summary. The review identified 12 RCT and 2 controlled trials. Ten studies evaluated the effectiveness of interventions on the incidence of urinary incontinence symptoms in men after prostatectomy Only two trials examined interventions to manage post-micturition dribble, one evaluated the effectiveness of lifestyle and behavioural modifications to manage lower urinary tract symptoms and one evaluated the use of a consensus guideline for the management of continence by primary health care teams in an urban general practice.No controlled trials evaluated interventions to improve men's knowledge or management of bowel health, or to improve men's attendance at promotional events.Few of the RCT described the method of randomisation and no trials reported using blinding either to assessment or to treatment.Two studies did not provide the measures of dispersion (no standard deviation), one study provided graphical data only and one presented no data whatsoever.Pelvic floor muscle exercises with or without additional interventions are effective at reducing the incidence of urinary incontinence in men >65 years who have had a prostatectomy.Education on lifestyle and behavioural modifications may be more effective in reducing lower urinary tract symptoms than doing nothing.Pelvic floor muscle exercisesmay be effective in treating post-micturition dribble in men with or without erectile dysfunction.Providing verbal feedback to participants to support pelvic floor muscle exercises technique appears to be as effective as biofeedback for improvement of urinary incontinence symptoms in this group.No evidence for the effectiveness of education interventions on faecal incontinence orNo evidence for the effectiveness of education interventions to improve men's attendance at promotional events. The results of this review have highlighted that with the exception of pelvic floor muscle exercises (PME) after prostatectomy, few controlled trials have examined the effectiveness of any interventions at raising awareness of bladder and bowel health in males aged 12 years and over.The majority of trials that evaluated interventions to manage bladder and bowel health presented data for both male and female in a combined form making it impossible to estimate the effect of the intervention(s) on male participants only. In some cases, where the male data were presented separately, the population was too small to provide adequate power, and therefore most comparisons between treatment groups were found to have statistically insignificant differences in effectiveness. There is little quantitative evidence for the effectiveness of interventions to improve men's awareness of bladder and bowel health. Therefore few recommendations can be made. Pelvic floor muscle exercises with or without additional interventions such as biofeedback could be used to reduce the incidence of urinary incontinence in men who have had a prostatectomy.Education on lifestyle and behavioural modifications may be more effective in reducing lower urinary tract symptoms than doing nothing.Pelvic floor muscle exercises may be effective in treating post-micturition dribble in men with or without erectile dysfunction.With the exception of instruction of pelvic floor muscle exercises for men after prostatectomy, little quantitative research has been performed that establishes the effectiveness of interventions on men's awareness of bladder and bowel health. While numerous interventions have been trialed on mixed gender populations, and these trials suggest that the interventions would be effective, their effectiveness on the male component cannot be definitively established. Therefore, well designed controlled trials using male sample populations only are needed to confirm these suppositions.

Palliative care professionals, particularly nurses, understand that it is crucial to deliver culturally and religiously appropriate care to the dying while attending to their physical needs. This article provides a brief overview of the different types of Buddhism and the major beliefs of Buddhists, particularly around suffering and death. It explores the impact of some of the current practices of end-of-life care from the Buddhist perspective, with an emphasis on Buddhist goals, beliefs, and practices at the time of death. It outlines the importance of advanced care planning, particularly with respect to the use of analgesia, palliative sedation, and any special dietary requirements. It notes that regardless of advanced care planning, nurses should continue to assess the needs of the patient, and in discussion with family, titrate medication and provide an environment that helps the Buddhist reach his/her spiritual goals. It outlines the importance of the environment in achieving this goal, particularly as the Buddhist practitioner will wish to use non-medication practices, such as meditation and chanting, to finish the last meditation before death. The paper provides guidance on how nurses can ensure a good death for the dying Buddhist, and their family or loved ones, especially in the area of choice in terminal pain management and palliative sedation therapy.