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ABSTRACT Aim Design Methods Results Conclusion Implications Impact Patient or Public Contribution To implement strategies to improve the care of patients with acute pain in the emergency department (ED).Pre–post implementation study using a Type 2 hybrid effectiveness–implementation design.Implementation strategies were introduced and monitored through the Ottawa Model of Research Uses' assessment, monitoring and evaluation cycles, supported by focused and sustained facilitation.Improvements in time‐to‐analgesia within 30 min (21%–27%), administration of nurse‐initiated analgesia (NIA) (17%–27%) and measurement of pain (65%–75%) were achieved post‐implementation. NIA was the strongest predictor of receiving analgesia within 30 min. Adoption of pain interventions into practice was not immediate yet responded to sustained facilitation of implementation strategies.Collaboration with local clinicians to introduce simple interventions that did not disrupt workflow or substantially add to workload were effective in improving analgesia administration rates, and the proportion of patients receiving analgesia within 30 min. The assessment, monitoring and evaluation cycles enabled agile and responsive facilitation of implementation activities within the dynamic ED environment. Improvements took time to embed into practice, trending upward over the course of the implementation period, supporting the sustained facilitation approach throughout the study.Sustained adoption of evidence‐based pain interventions into the care of people presenting to the ED with acute pain can be achieved through sustained facilitation of implementation. NIA should be at the centre of acute pain management in the ED.This study addressed the lingering gap between evidence and practice for patients with acute pain in the ED. Implementation of locally relevant/informed implementation strategies supported by focused and sustained facilitation improved the care of patients with acute pain in the ED. This research will have an impact on people presenting to EDs with acute pain, and on clinicians treating people with acute pain in the ED. Relevant equator guidelines were followed and the StaRI reporting method used.No Patient or Public Contribution in this study. [ABSTRACT FROM AUTHOR]

To assess the emergency department practice context and identify strategies to improve outcomes of patients with acute pain. Effective treatment of acute pain in the emergency department depends upon clinicians adopting pain interventions into practice. However, it is well-recognized that acute pain is often undertreated. The local practice context strongly influences clinicians' adoption of interventions into their clinical practice. An assessment of this practice context can inform implementation interventions and strategies to improve outcomes for patients with acute pain. Chart audit, staff survey, and staff working groups were conducted from June 2020 to May 2021 Data were analyzed and synthesized across sources informed by assessment elements of the Ottawa model of research use (OMRU) implementation model and expert recommendations for implementing change strategies. The OMRU facilitated contextual assessment of pain treatment practice in the emergency department and the development of implementation strategies. Adoption of evidence-based pain interventions was low in the sample studied. Workflow and workload were the primary barriers to evidence-based pain practices by potential adopters, while positive beliefs and high awareness of evidence-based pain interventions were supportive factors. Implementation strategies were informed by assessment findings and mapped to the Ottawa model and expert recommendations for implementing change elements. The adoption of evidence into practice in the emergency department relies upon a comprehensive assessment of the local context. The use of the OMRU assessment process resulted in meaningful engagement with staff and a deeper understanding of local pain management practices. Clinicians view evidence-based pain management as important, however, there are competing priorities within the emergency department, such as patient flow and triage. This study provides an exemplar of utilizing an implementation framework to identify pain practices within the emergency department. Achieving impactful change in clinical practice to improve patient outcomes should start with the application of implementation methods that enable comprehensive analysis of the local practice context. The assessment should begin with collaboration with local clinicians that persist throughout the life of the study to ensure change is sustainable. [ABSTRACT FROM AUTHOR]

Background/Objective: Initially established to improve access to healthcare, particularly for primary care, the full potential of the nurse practitioner role is yet to be realised in most countries. Despite this, most countries are working to meet an ageing population's increasing healthcare needs and reduce healthcare costs and access disparities. Achieving these outcomes requires reform at multiple levels, including nurse practitioner practice pathways, education and regulation, and identifying the barriers and facilitators to optimising their primary care role. Methods: A rapid scoping review of nurse practitioner practice pathways, education and regulation inclusive of: (1) a systematic search of Medline and CINAHL for peer-reviewed English language articles, including opinion pieces published between January 2015 and February 2022; and (2) a web-based search of nurse practitioner program entry requirements of International Nurse Regulator Collaborative country members with a protected nurse practitioner title and prescribing rights, plus the Netherlands. The individually summarised search data was integrated and synthesised using Popay's narrative approach. Results: Emerging evidence from the included nurse practitioner courses (n = 86) and articles (n = 79) suggests nurse practitioners working in primary care provide safe, effective care and improve healthcare efficiencies. However, different regulatory and educational models are required if the primary care nurse practitioner is to meet growing demand. Conclusions: International variations in entry criteria, curriculum, and regulation shape the global profile of the nurse practitioner primary care workforce and their practice setting. For countries to grow their primary care nurse practitioner workforce to meet unmet needs, different entry requirements, program content and accredited post-registration transitional programs must be urgently considered. [ABSTRACT FROM AUTHOR]

Aim and Objective: To explore the perceptions of nursing students regarding the treatment of men in nursing during their clinical placement. Background: Negative placement experiences of men who are nursing students is a risk factor for student attrition. Hence, exploring gender disparity in treatment during placement from both men and women studying nursing will contribute to improving student experience and reducing attrition. Design: Survey capturing both quantitative and qualitative data. Methods: Nursing students were surveyed between July and September 2021 across 16 Schools of Nursing in Australia. In addition to the Clinical Learning Environment Inventory (CLEI‐19), an open‐ended question explored if men received different treatment during clinical placement. Results: Those who expressed difference in treatment of men were less satisfied with their clinical learning experience (p <.001). Of the 486 (39.6%) who responded to the open‐ended question, 152 (31%) indicated a difference in the treatment of men, reporting that men received: (a) better (39%); (b) different, not exclusively better or worse (19%); and (c) worse (42%) treatment from either the clinical facilitator or ward staff. While both men and women perceived gender differences in the treatment of men during placement, men were more likely to report worse treatment. Conclusion: Despite the advances achieved in recruiting men in nursing, negative experiences during clinical placement are characterised by stereotypes, prejudice and discrimination, adversely impact retention. Relevance to clinical practice: Nurse educators need to recognise specific support students require during placement regardless of gender. Our findings reinforce the adverse impacts of inequitable treatment on both men and women nursing students on learning, clinical performance, morale and ultimately on retention in the nursing workforce. Addressing gender stereotyping and discrimination in the undergraduate nursing program is an important step in promoting diversity and inclusivity in the nursing workforce. [ABSTRACT FROM AUTHOR]

Clinical simulation is a popular method of educating undergraduate student nurses, however it is currently unknown, which specific simulation approach is the most effective at optimizing student learning in the context of the deteriorating patient. This study piloted a novel form of simulation called Rapid Cycle Intentional Simulation, to evaluate undergraduate nurses' perception and performance in recognizing and responding to clinical deterioration, compared to the standard simulation approach. A two-phased, prospective, nonequivalent control group design study was implemented, recruiting a total of 138 second year undergraduate nursing students. Simulation groups were randomly assigned to the intervention or standard simulation approaches. The simulation evaluation included observations, student satisfaction and self confidence in learning scale and student knowledge test. There were no significant differences in knowledge, perceived confidence, or satisfaction between standard and Rapid Cycle Intentional Simulation. Qualitative observer reflections suggest regular interruptions of Rapid Cycle Intentional Simulation, facilitated critical thinking and willingness to engage in feedback. Findings suggests this novel simulation approach, where the facilitator intentionally interrupts the simulation scenario to realign students through real time feedback, improved student performance, engagement, challenged learning avoidance behaviors, and increased student confidence to critique their practice. [ABSTRACT FROM AUTHOR]

• Nursing student performance in escalating patient deterioration needs improvement. • Comprehensive assessment, environmental scan in combination with clear and timely escalation are all areas for improvement. • Repeated practice simulation has been shown to improve student response to deteriorating patient simulation. Graduate nurses are unprepared to recognize and respond to patient deterioration. Simulation involving micro-debriefing with feedback and opportunities for repeated performance can improve simulated clinical practice. A prospective quasi-experimental design evaluating two simulation approaches (Standard simulation versus Rapid Cycle Intentional Simulation) recruited 138 second year undergraduate nursing students. During simulations the intervention groups demonstrated behaviors associated with situational awareness, in context of a deteriorating patient. Conversely control groups initiated incorrect clinical actions throughout the scenario, potentially harming the simulated patient. Simulation that involves interruptions and micro-debriefings has been shown to improve student performance in deteriorating patient simulations. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the context and culture of nursing surveillance on an acute care ward. Background: Prevention of patient deterioration is primarily a nursing responsibility in hospital. Registered nurses make judgements and act on emerging threats to patient safety through a process of nursing surveillance. Organisational factors that weaken nursing surveillance capacity on general wards increase the need for patient rescue at the end point of clinical deterioration with poorer outcomes. Yet little is known about cultures that enable and sustain ward nursing surveillance for patient safety. Design: Workplace observations and semistructured interviews using a critical lens as the first stage of a larger emancipatory practice development project. Methods: Researcher immersion including 96 hr of nonparticipant observation with 12 semistructured interviews during July–August 2017. This study adhered to the COREQ guidelines. Results: We offer a metaphor of nursing surveillance as the threads that support the very fabric of acute care nursing work. These hidden threads enable nurses to weave the tapestry of care that keeps patients safe. This tapestry is vulnerable to internal and external forces, which weaken the structure, putting patients and staff at risk. Conclusion: Understanding local context is essential to supporting practice change. This workplace observation challenges us to find ways to creatively engage nurses with the underlying cultural and systems issues that so often remain hidden from view in the deteriorating patient literature. Relevance to clinical practice: Building cultural values that strengthen nursing surveillance is a prerequisite for safe and effective hospital care. As such, practice‐based research that empowers frontline nurses and teams to develop person‐centred workplace cultures can hold the key to unlocking sustainable improvements in patient safety. [ABSTRACT FROM AUTHOR]

A period of re-negotiation is expected when introducing a new teaching and learning approach in a Bachelor of Nursing course. This study, underpinned by a social constructivist framework, used action research to uncover the interactions, challenges and outcomes when implementing an inquiry-based learning approach to support the development of students' clinical reasoning and capability to think like a nurse. Data collection involved non-participant observation of 32 tutorial groups (600 first-year students and 8 teachers) over the first two weeks of semester. Analysis was informed by Charmaz's social constructivist approach. The findings revealed three interconnected constructs: Opting in and out (students), Driving and reframing (teachers) and Creating and realising new understandings (both students and teachers). Introducing a new approach necessitated conscious planning and deliberate behaviour change on behalf of the teacher and student. Use of an inquiry-based learning approach which embedded clinical reasoning, investigative prompts and learning scaffolds in the form of case exemplars assisted students to 'think like a nurse'. • The teacher role in inquiry-based learning is pivotal to facilitate active learning. • Use of consistent scaffolds and frameworks enhanced students' active learning. • Digital technologies facilitate learning but may detract from engagement. [ABSTRACT FROM AUTHOR]

This scoping review aimed to explore nursing students experience as simulation observers and their level of engagement in learning through use of clinical decision-making models and learning scaffolds. A gap continues to exist between the published empirical literature, the role and experiences of the simulation observer and teaching scaffolds that enhance learning outcomes, despite the increased understanding of simulation and its role in preparing nursing students for practice. Further, little is known about the nursing student's experience of clinical reasoning whilst observing simulation and the impact of scaffolding observations using clinical decision-making models. This scoping review was conducted using the methodological framework of Arksey and O'Malley (2005) and the PRISMA checklist for systematic reviews (Page et al., 2020). A comprehensive search of the literature published in Medline and CINAHL databases between 1999 and 2020 was undertaken in May 2019. The studies selected for this review (n = 18) were analyzed thematically. The validated Mixed-Methods Appraisal Tool assessed quality of the quantitative, qualitative and mixed methods studies. The role of the observer in simulation was explored and included observation to transform practice in self and observation to transform practice in others, namely peers in the nurse role in simulation. Application of the MMAT indicated that of the 18 studies included only 6 (33.3%) had a clear research question. Research aims or objectives were found in another six studies (33.3%). In this review 13 studies (72%) included answers to the research question or aim, three (17%) did not and in two (11%) it was impossible to tell. Results of this review indicate the paucity of research relating to nursing student's experience of clinical reasoning while observing simulation. Further, it highlights the value of nurse educators optimizing the observer role and maximizing learning by scaffolding observer activities within the simulation experience. • The observer role can enhance learning outcomes in simulation. • The observer role is undervalued. • Clinical reasoning models are a valuable learning tool to maximise nursing student learning. [ABSTRACT FROM AUTHOR]