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Pressure injuries are a significant problem for immobile patients in acute care and can have a profound impact on patients' health and well‐being, putting pressure on healthcare systems and strain on the healthcare economy. Nurses play a pivotal role in preventing pressure injuries. A study using multiple methods was conducted to explore pressure injury prevention practices in four inpatient units within a tertiary‐level Australian Hospital. Quantitative and qualitative methods were used to gather data across a 9‐month period. Observations, audits, surveys and interviews were used to collect data across five time points. Statistical analysis of the quantitative data was undertaken, and thematic analysis was used to analyse qualitative data. Data were integrated using a realist evaluation framework. Ethical approval for the study was granted. The quantitative results demonstrated significant reductions in pressure injury prevalence from 11.5% at commencement to 4.8% at completion of the study. Hospital‐acquired pressure injuries also reduced from 4.6% to 1.9%. These results were achieved even though nursing knowledge and attitudes did not increase during the study period. Three qualitative themes were identified: Making Nursing Care Visible, Understanding the 'Why' and Engagement is Key. This study demonstrates that pressure injuries can be prevented with improvements in nursing care processes. Nurses' knowledge and attitudes towards pressure injury prevention did not change throughout this study and further research is required on how nurses' knowledge and attitudes contribute towards pressure injury prevention practices. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To evaluate the influence of an ageing simulation intervention on qualified acute care nurses' empathy towards older people. Background: Life expectancy is increasing globally with an increased incidence of older people accessing healthcare services. As such, it is essential for qualified nurses within hospital settings to connect with older people by establishing healthful relationships. Empathy is an essential component of healthful nurse‐patient relationships. Fortunately, empathy can be taught through education. Design: A convergent mixed‐methods design was utilised. Methods: Nurses (N = 95) undertook an 8‐hour ageing simulation intervention. Data were collected from April 2019 to May 2020 across three time points: before the intervention (T0); immediately after (T1) and at three months follow‐up (T2). A mix of convenience (intervention) and purposeful (follow‐up) sampling techniques were utilised. Quantitative data were collected via the Interpersonal Reactivity Index survey (n = 86) and analysed using repeat measures ANOVA to compare mean scores across time points. Qualitative data were collected via debriefing discussions (N = 95) and focus groups (n = 38), and analysed using a systematic thematic analysis method. Data convergence occurred during the interpretation phase. Study reported with the TREND checklist. Results: Primarily, when quantitative and qualitative findings were merged they confirmed each others' empathy outcomes. Quantitative results showed a statistically significant increase in affective and cognitive empathy levels among nurses post‐intervention. Qualitative findings expanded on quantitative results and revealed an increase in nurses' affective, cognitive and behavioural empathy represented in themes 'enhancing my empathy', 'impact of ageing', 'from self to others' and 'person‐centred moments'. Conclusions: This study adds empirical evidence how a mixed‐methods design can be used to evaluate the influence of an ageing simulation intervention on nurses' empathy levels. Relevance to clinical practice: Ageing simulation interventions are a suitable experiential educational approach to improve acute care nurses' affective, cognitive and behavioural empathy towards older people. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore how nurses and midwives engage with patient experience data collected via a mobile health app to inform person‐centred practice improvements. Background: A large amount of data is collected in healthcare, yet there is limited evidence outlining how nursing and midwifery staff utilise patient experience data to inform person‐centred quality and safety improvements. Methods: This study utilised action research, underpinned by Practice Development methodology and has been reported using the SQUIRE 2.0 checklist. Six clinical units (medical short stay, acute medical, surgical, oncology/haematology, day surgery and maternity) in a large health district in Australia engaged in three cycles of data collection using a mobile health app. The app captured patient experience data relating to the person‐centred KPIs developed and tested by McCance et al. (2012). Staff used the data to develop and evaluate person‐centred practice. Results: A number of improvements in scores and practice occurred through engaging with the data in a cyclical way. All six clinical units saw an improvement in four or more of the KPIs in the patient survey results from cycle one to cycle three, with two clinical units improving in all eight. On average across the six units, there was also an increase in time nurses/midwives were visible to their patients, an increase in clinical documentation reflecting the patients' needs and what was important to them, an increase in positive comments and a decrease in negative comments in patient stories. Conclusion: This study shows that collecting and utilising data from the person‐centred KPIs in a collaborative and cyclical way lead to enhanced patient experience and the development and implementation of person‐centred quality and safety improvements. Relevance to clinical practice: Capturing and utilising data that are meaningful to nursing/midwifery teams in a cyclical, action‐orientated approach result in person‐centred practice improvements that enhance the experience of those that are receiving and delivering patient care. [ABSTRACT FROM AUTHOR]

Aim: To implement and evaluate a co‐designed staff well‐being programme. Background: Working in health care can be physically and psychologically demanding. The job demands–resources model indicates job resources moderate the impact of job demands on staff well‐being. Well‐being initiatives introduced by organisations improve staff commitment, and reduce absences and incidents. Methods: A qualitative descriptive design was applied. In 2019, within an Australian local health district, 232 health care professionals across eight hospitals and two community settings attended a six‐week well‐being programme, which included a variety of self‐care strategies, for example mindfulness. Nine 1‐hr focus groups were completed 2–4 weeks post‐programme. Data were analysed using thematic analysis to explore participants' thoughts and experiences. Results: Participants experienced joy from workshops and guilt for leaving peers with their workload. Participants developed strong interpersonal relationships with workshop attendees within a 'safe well‐being space'. Broader impacts expressed by participants were; learnt coping mechanisms and proactive self‐care practices and can be easily embedded into daily routines. Participants shared their 'toolkit' with colleagues, family and friends, positively impacting the well‐being of people around them. Conclusion: Participants encouraged by their new well‐being 'toolkit' engaged with colleagues, better managed stressors and shared learnings. Implications for Nursing Management: Building well‐being capability within a health organisation requires nursing management to make staff well‐being a strategic priority, use a co‐design approach and embed coping mechanisms at the grassroots levels. [ABSTRACT FROM AUTHOR]

Aim and objectives: To explore the thoughts and experiences of aged care nurses following participation in an ageing‐suit simulation intervention. Background: Globally, people are living longer, and for nurses, there are increasing challenges to meet the needs of the higher numbers of older people in hospital. Educating nurses to understand the ageing process and the experiences of older people in hospital is crucial to addressing these challenges. Ageing‐suits were identified as a possible approach to assist with these educational needs. Design: This study adopted a qualitative descriptive design. Method: A convenience sample of nurses (n = 15) were selected from a single aged care ward. Volunteered nurses participated in a four‐hour ageing‐suit simulation session. Their immediate thoughts and experiences were explored via postsimulation debriefs, and three 30‐to 50‐min follow‐up focus groups were conducted at 3 months to explore perceptions on the impact of their experience on clinical practices. The data were analysed with the Braun and Clarke's six‐step thematic analysis method. To ensure quality reporting of this study, the COREQ checklist was utilised (see Appendix S1). Results: Data analysis generated three main themes. Nurses in the study highlighted that the experience of the ageing‐suit resulted in "it feels real" (theme 1) and helped them in "enhancing understanding" (theme 2) about older people and their practices and supported a process of "changing me" (theme 3). Conclusion: Ageing‐suits are emerging as a promising innovative educational approach for aged care nurses to gain insight into the challenges of ageing and subsequently making changes to themselves and their individualised practices towards older people. Future research is required to determine whether this educational approach is useful for a broader population of healthcare professionals. Relevance to clinical practice: Ageing‐suits were identified as a worthwhile educational approach for aged care nurses to improve their specialised clinical practices with older people. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To assess the impact of the proactive organisational resource allocation in terms of a 6‐week well‐being initiative to support public healthcare professionals' workplace engagement, well‐being and job satisfaction. Background: Burnout of healthcare professionals can be a major cost to the Australian economy and public healthcare sector. According to the social exchange theory, when healthcare professionals perceive that their organisation proactively allocates resources to caring for its employees, then they are more likely to reciprocate and become more engaged in their work roles. Design: The study used a pre‐ and postsurvey of healthcare professionals who participated in the well‐being initiative. Methods: Between February–June 2019, 172 healthcare professionals were surveyed before and after a well‐being initiative. The survey included questions on workplace engagement, workplace well‐being and job satisfaction. Paired t tests were used to determine whether the difference between before and after averages was significant. The TREND statement was used to ensure the quality reporting of this study. Results: The well‐being initiative had a positive impact on the healthcare professionals involved in the initiative. Nursing staff benefitted the most from the well‐being initiative, while the full‐time staff members and highly experienced demonstrated an increase in engagement. Conclusion: Well‐being initiatives can be a targeted strategy to help alleviate burnout amongst healthcare professionals and build a mutually beneficial relationship between management and employees. Relevance to clinical practice: This study shows how implementing a staff well‐being initiative increases workplace engagement, which benefits both the individual and the organisation. [ABSTRACT FROM AUTHOR]

The aim in this study was to understand current practice and use of nitrous oxide for management of procedural-related pain and procedural anxiety, to identify perceived barriers to use of nitrous oxide and to develop an understanding of patients, families, and nurse awareness and knowledge of the use of nitrous oxide in an Australian tertiary pediatric oncology/hematology short stay unit. Three online questionnaires (patients, parents, and nursing staff) were developed and completed between September and November 2015. Most children and young people (61%) report receiving nitrous oxide for at least one procedure. Patients, parents, and nurses rated nitrous oxide as highly effective and would like more access to nitrous oxide for the child's pain management. Several barriers to use were reported. These findings suggest that nitrous oxide is effective for pain management; however, its use is inconsistent. Findings can potentially develop standardized processes and improve nurse education and accreditation, which may increase the safety, efficacy, and utilization of nitrous oxide for children's procedural pain management. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between multiple measures of visual impairment ( VI) and incident mobility limitations in older adults. Design Prospective observational cohort study. Setting Memphis, Tennessee, and Pittsburgh, Pennsylvania. Participants Health, Aging and Body Composition study participants aged 70 to 79 without mobility limitations at the Year 3 visit (N = 1,862). Measurements Vision was measured at the Year 3 visit, and VI was defined as distance visual acuity ( VA) worse than 20/40, contrast sensitivity ( CS) less than 1.55 log Contrast, and stereoacuity ( SA) greater than 85 arcsec. Incident persistent walking and stair climbing limitation was defined as two consecutive 6-month reports of any difficulty walking one-quarter of a mile or walking up 10 steps after 1, 3, and 5 years of follow-up. Results At Year 3 (baseline for these analyses), 7.4% had impaired VA, 27.2% had impaired CS, and 29.2% had impaired SA. At all follow-up times, the incidence of walking and stair climbing limitations was higher in participants with VA, CS, or SA impairment. After 5 years, impaired CS and SA were independently associated with greater risk of walking limitation (hazard ratio ( HR) CS = 1.3, 95% confidence interval ( CI) = 1.1-1.7; HRSA = 1.3, 95% CI = 1.1-1.6) and stair climbing limitation ( HRCS = 1.4, 95% CI = 1.1-1.8; HRSA = 1.3, 95% CI=1.1-1.7). Having impaired CS and SA was associated with greater risk of mobility limitations ( HRwalking limitations = 2.0, 95% CI = 1.6-2.5; HRstair limitation = 2.1, 95% CI = 1.6-2.8). Conclusion Multiple aspects of VI may contribute to mobility limitations in older adults. Addressing more than one component of vision may be needed to reduce the effect of vision impairment on functional decline. [ABSTRACT FROM AUTHOR]

Objectives To examine the relationship between 25-hydroxyvitamin D (25( OH)D) levels and cognitive performance over time in older adults in the Health, Aging and Body Composition (Health ABC) Study. Design Prospective cohort study. Setting Community-dwelling participants in Pittsburgh, Pennsylvania, and Memphis, Tennessee. Participants Well-functioning adults aged 70 to 79 at baseline with serum 25( OH)D measured at the 12-month follow-up visit and cognitive function measured at baseline and 4-year follow-up visit (N = 2,777). Measurements Vitamin D status was categorized as 25(OH)D levels of less than 20.0 ng/mL, 20.0 to 29.9 ng/mL, or 30.0 ng/mL or greater. Cognition was measured using the modified Mini-Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST). Linear regression models adjusting for multiple covariates, including age, education, sex, race, site, season, physical activity, and comorbidities, were used in the analysis. Results Sixty-eight percent of participants had 25(OH)D levels of less than 30.0 ng/mL. Lower 25(OH)D levels were associated with lower baseline cognitive scores on the 3MS (adjusted mean 89.9, 95% confidence interval (CI) = 89.4-90.4 for <20.0 ng/mL; adjusted mean 90.8, 95% CI = 90.4-91.3 for 20.0-29.9 ng/mL; adjusted mean 90.6, 95% CI = 90.2-91.1 for ≥30.0 ng/mL; P trend = .02) and the DSST (adjusted mean 35.2, 95% CI = 34.5-36.0 for <20.0 ng/mL; adjusted mean 35.9, 95% CI = 35.2-36.6 for 20.0-29.9 ng/mL; adjusted mean 37.0, 95% CI = 36.3-37.8 for ≥30.0 ng/mL; P trend = .01). Participants with low 25(OH)D levels had greater declines in 3MS scores over 4 years than those with higher levels (least square mean change −1.0, 95% CI = −1.5 to −0.6 for <20.0 ng/mL; least square mean change −0.8, 95% CI = −1.2 to −0.3 for 20.0-29.9 ng/mL; least square mean change −0.2, 95% CI = −0.7 to 0.2 for ≥30.0 ng/mL; P = .05). There was no significant difference in DSST decline according to 25(OH)D level. Conclusion Low 25( OH)D levels were associated with worse global cognitive function and greater decline over time according to the 3 MS. Intervention trials are needed to determine whether vitamin D supplementation can reduce cognitive decline. [ABSTRACT FROM AUTHOR]

This paper presents three research case studies of children who have had surgery for a cardiac condition and discusses the experiences of the children and their families through their responses to the Heart Beads programme, as well as the insights gained by staff. The Children's Hospital at Westmead has a significant population of children with cardiac conditions. For many of these, diagnosis signals the beginning of a long, arduous journey with multiple procedures and admissions. The hospital has a family-centred care focus, and the cardiac ward undertook a project to implement and progress changes consistent with this approach. Staff developed the Heart Beads programme to enhance the care of children being treated for cardiac conditions. The programme involves children receiving distinct beads specific to each cardiac procedure, treatment, or event in recognition of their experience. A total of 7 staff members and 11 families were interviewed and particular stories were noted by staff. The case studies presented illustrated how nursing staff were able to recognize potential improvements to care and acknowledge the experiences of patients and families. Assumptions questioned as a result of the programme related to the complexity of the child's condition and gender. The death of a child and the acknowledgement of the child's life is also considered. Heart Beads allowed staff to reflect on the positive aspects of the care they provided. [ABSTRACT FROM AUTHOR]

Aims. To present and discuss the significance of a bead program in assisting families to put together the story of a child's journey through cardiac intervention. The main focus of the article is the importance to families of developing a narrative in making sense of the experience of discovering their child has a cardiac condition and how this is enhanced by the bead program. Background. The Heart Beads Program involved giving families beads related to procedures and processes the children undergo while they are in hospital. Research on narratives related to illness suggests that forming a narrative that incorporates the health condition facilitates the ability to talk about these experiences and helps to make sense of and deal with the stressors related to such traumatic life events. Design. A qualitative methodology was used to evaluate the program employing semi-structured interviews and content analysis following a grounded theory approach. Methods. Interviews were undertaken with 11 families to highlight their experiences of being involved in the Heart Beads Program. Themes were identified from the interviews and critical discussion was used to structure and connect the themes. Results. The major theme that emerged from the analysis of the interviews was the importance of the beads in enabling the telling of the child's story. Five subthemes were identified in this theme: symbolism, encouraging/uplifting, acknowledgement, connection with others and imagining the future. The themes are outlined and expressed through specific comments from interviews. Conclusions. The Heart Beads are seen as presenting a significant way for children and families to comprehend their time in hospital as part of the child's life story. Relevance to clinical practice. The program can offer the opportunity for health care professionals to relate to the child and family's story and to engage with that story in a person centred way. [ABSTRACT FROM AUTHOR]