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Purpose: Registered nurses and midwives require a degree of genomic literacy if they are to adequately communicate with other healthcare professionals and provide optimal care to patients, their families, and the community. Several studies have been conducted internationally to assess the genomic literacy of nurses; however, the genomic literacy of Australian registered nurses and midwives has not been investigated. The aim of this study was to measure the genomic literacy of Australian registered nurses and midwives through assessing participants' understandings of genomic concepts most critical to nursing and midwifery practice, as well as their perceived knowledge and attitude towards genomics in nursing and midwifery practice., Design: Cross-sectional survey of Australian registered nurses and midwives using the Genomic Nursing Concept Inventory (GNCI © ), a 31 multiple-choice question survey instrument. Participants were recruited via two key Australian nursing and midwifery organizations over an 8-month period in 2016., Methods: Descriptive and inferential statistical techniques were used to calculate the total GNCI © score and scores on individual subcategories, as well as relationships between demographic variables and GNCI © scores., Findings: Most respondents worked as clinicians (71.4%) in a hospital or hospital-based setting (61.8%). Most registered nurses (80.5%) and midwives (97.2%) reported that genetics was relevant to clinical practice; however, over 80% of registered nurses and midwives believed their knowledge of genetics was poor or average. Genomic knowledge was assessed using the GNCI © . Scores ranged from 3 to 29 (out of a possible 31), with a mean score of 13.3 (SD 4.559) based on 253 (N = 253) respondents, indicating that genomic literacy is low. There was a significant difference between genomic knowledge scores and education and training level (p = .036)., Conclusions: The genomic literacy of registered nurses and midwives in Australia is low. More must be done to ensure Australian registered nurses and midwives have an adequate level of genomic literacy to provide optimal care to patients, their families, and the community., Clinical Relevance: Modern medicine requires a healthcare workforce that is literate in genomics. Findings from this study may serve as the catalyst to improve the genomic literacy of the Australian nursing and midwifery workforce, allowing for improved health outcomes for individuals and the wider Australian public., (© 2018 Sigma Theta Tau International.)

In respect of professional nursing, the term scope of practice is regularly used, yet is often poorly defined both in Australia and internationally. This study explores the determinants of scope of practice from a national sample of Australian registered nurses using an online survey (Scope-QAu). This paper reports on two parts of a large cross-sectional survey wherein 1231 registered nurses in Australia provided data on how they determined their scope of practice. Scope of practice in the Australian nursing context is influenced by a range of professional publications, guidelines and standards, as well as professional peers and one's own judgement. Findings reveal that few demographic characteristics predicted the way nurses determined their own scope of practice. Nurses commonly relied upon three professional publications, peers and line managers, to establish their individual scope of practice. Impact statement: Registered nurses do not rely solely on professional guidelines or regulatory frameworks when determining their scope of practice.

The aim of this integrative review was to update a mixed method systematic review by Skirton, O'Connor, and Humphreys (2012) that reported on nurses' levels of competence in using genetics in clinical practice. Three electronic databases were searched using selected key words. Research studies published in English between January 2011 and September 2017 reporting levels of nurse competence in genetics or genomics were eligible for inclusion. The selected studies were subjected to thematic analysis. Three main themes were identified: (i) genomic knowledge and utilization, (ii) perceived relevance to practice, and (iii) genomic education. While the reviewed papers produced varied findings, many nurses were shown to have poor genomic knowledge and/or competency, and yet there was a consensus that most nurses believe genomics is important to their practice. The present review indicated that in the past 5 years nurses have made minimal progress toward achieving the core genomic competencies appropriate for clinical practice., (© 2018 John Wiley & Sons Australia, Ltd.)

Background: Universities' responsibility to ensure academic integrity is frustrated by software and communication tools that facilitate content reuse coupled with a growing international essay writing economy. A wide range of behaviours constitute academic dishonesty and while a complex phenomenon to examine, existing evidence suggests that there is sufficient proliferation (both in volume and variety) of these behaviours among Australian university students to warrant concern. This proliferation presents faculty and staff with new challenges in ensuring academic integrity., Objectives: This paper reports findings of a nationwide cross-sectional survey of 361 students enrolled in an Australian nursing degree program and describes the extent of academic dishonesty among those surveyed., Design: An online survey adapted from previous work was used to collect data on academic dishonesty, professional dishonesty and social desirability bias. Analysis of this data enabled identification of the prevalence of dishonesty, relationships between individual characteristics and dishonest behaviours, associations between academic and professional dishonesty, and the impact of deterrents to such behaviour., Results: Plagiarism was the most frequently reported form of academic misconduct. Most participants indicated that threat of severe punishment and signing of verification statements would deter undesirable academic behaviour. Despite this, a relatively high proportion of students reported engaging in at least one form of academic misconduct, the likelihood of which was higher among younger age groups. Of concern was that a correlation was found between academic and professional misconduct, the most common being the recording of inaccurate or fabricated vital signs and breaching client privacy., Conclusion: In health professional education, there is a tendency to assume that the nobility of these disciplines would result in a lower incidence of cheating behaviours. The findings of this study support existing literature that refutes this assumption. This study found troubling rates of academic and professional misconduct among the surveyed population., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: International nurses account for 20% of the Australian nurse workforce. This review aims to identify and appraise research findings on the experiences of internationally qualified registered nurses working in the Australian healthcare system., Methodology: The review was structured using Whittemore and Knafl modified framework for integrated reviews. A systematic database search was undertaken. Articles ( n = 48) were identified for appraisal based on set inclusion and exclusion criteria. Evaluation using the Critical Appraisal Skills Program tool resulted in ( n = 16) articles in the final data set., Results: Three broad themes were identified: (a) Transitioning-Need for appropriate, timely, and adequate supports to assist transition to practice; (b) Practicing within local contexts-How expectations were different to the reality of clinical practice; and (c) Experiencing prejudice-when racial prejudice occurred., Discussion: Appropriate programs including cultural-safety education can mitigate adverse workforce dynamics within culturally diverse health care teams to enable provision of culturally congruent health care.

In this 'Issues for Debate' paper, the issue is debate. Today's nurses must be able to advocate, lead, and grow 'big ideas', as well as knowing their way around a patient's body and mind. This paper reports, partly, on a research study into the use of debate to develop clinical reasoning and thinking skills in nursing students. The study was conducted with first and third-year nursing students enrolled at an Australian regional university. Students were asked to comment on the effectiveness of debate as an educational strategy. We combine the results of this research study with literature and discussion into the educational uses of debate to put the argument that using debate in nursing education can be an effective way to foster the type of creative, intelligent, thoughtful and forward-thinking nurses needed in the modern healthcare system., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Bullying in health workplaces has a negative impact on nurses, their families, multidisciplinary teams, patient care and the profession. This paper compares the experiences of Australian and UK baccalaureate nursing students in relation to bullying and harassment during clinical placement. A secondary analysis was conducted on two primary cross-sectional studies of bullying experiences of Australian and UK nursing students. Data were collected using the Student Experience of Bullying during Clinical Placement (SEBDCP) questionnaire and analysed using descriptive and inferential statistics. The total sample was 833 Australian and 561 UK students. Australian nursing students experienced a higher rate of bullying (50.1%) than UK students (35.5%). Students identified other nurses as the main perpetrators (Aust 53%, UK 68%), although patients were the main source of physical acts of bullying. Few bullied students chose to report the episode/s. The main reason for non-reporting was fear of being victimised. Sadly, some students felt bullying and harassment was 'part of the job'. A culture of bullying in nursing persists internationally. Nursing students are vulnerable and can question their future in the 'caring' profession of nursing after experiencing and/or witnessing bullying during clinical placement. Bullying requires a zero tolerance approach. Education providers must develop clearer policies and implement procedures to protect students - the future nursing workforce., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The nursing profession comprises Australia's largest regulated health workforce yet its practice boundaries are poorly understood. The ambiguity surrounding the practice scope of nurses limits the profession's ability to fully respond to Australia's current and emerging health system challenges. The aim of this review is to explore the concept of scope of practice of registered nurses (RN) in Australia, as reflected in contemporary literature. An integrative review of literature relating to the scope of practice of the Australian registered nurse published between 2007 and 2014 was conducted. Twenty primary papers and nine secondary source papers were included in the review. Themes that arose from the analysis are: Scope of practice - an elusive concept; Scope of practice and context; Scope of practice and boundaries; and Scope of practice and advanced practice. Discussion of these themes includes consideration of the professional, legal and ethical significance of scope of practice for the RN, as well as the legislative, professional and contextual influences on, and challenges to, defining scope of practice at both a professional and individual level. For the Australian registered nursing workforce to continue to be a significant and influential contributor to Australia ' s dynamic healthcare context, a clearly articulated scope of practice is both necessary and overdue.

ePortfolios have been introduced into many higher education degrees in the past decade in an effort to help students to link theory, practice and personal experiences. This pilot study used a survey to examine ePortfolio use from the perspective of undergraduate nursing and postgraduate midwifery students. Fifty-seven students from a regional Australian university completed an online questionnaire which contained questions about the following areas of ePortfolio use: understanding of the tool; psychological perceptions; challenges around use; assessment; outcomes of use; benefits; maintenance of the ePortfolio; and enhanced learning. The majority of respondents were female, undergraduate students, aged 21-30 years. Results indicated that many students found ePortfolio use frustrating; in particular, technological and logistical challenges in using ePortfolios were highlighted. Most students, however, noted ePortfolios could be useful repositories for documents, reflections and learning experiences. Undergraduate students were more likely than postgraduate students to see the positive potential of ePortfolio use. The findings, coupled with the literature, raise questions about the effectiveness of ePortfolio use in nursing and midwifery education and, particularly, whether ePortfolios have been implemented with misguided and misinformed good intention. Further research is required to better understand the logistical and technological aspects of successful implementation of ePortfolios and fully capitalise on their benefits for nursing and midwifery education., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Complications in early pregnancy can lead to pregnancy loss (miscarriage) and ultimately the presentation of a woman to their local emergency department (ED). Miscarriage is a common occurrence, with one in six pregnancies resulting in pregnancy loss.(1) Unfortunately medical and nursing care does not change the likelihood of a threatened miscarriage progressing to pregnancy loss; this is a highly emotional and stressful time for the woman and her family. Research has shown that women have often felt dissatisfied with the care provided in the emergency department and have reported lower levels of satisfaction (Geller et al., 2010(2), Indig et al., 2011(3)). This paper explores the challenges in the provision of emergency department healthcare for women presenting to metropolitan EDs and compares these to those faced by women who present to non-metropolitan EDs with early pregnancy complications., (Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

Background: Aged care services and nursing roles are evolving in response to policy reform and increasing consumer expectations, however the nursing workforce is declining in numbers., Aims: To examine registered nurses' perceptions and experiences of working in aged care., Methods: Descriptive, exploratory study involving thematic analysis of individual interviews., Results: Key issues related to: professional role strain; workforce challenges; managing expectations, relationships and communication; balancing rights and risk in decision-making; changing models of care and impacts of policy and regulation., Conclusion: Expectations and perceptions of aged care nursing are unclear and conflicted. Nurses face significant challenges in meeting consumer, profession, organisational, and policy expectations amidst workforce instability and resource constraints. Structural barriers and aged care policy environments represent significant threats to sustaining nursing in aged care.

Robots, including robotic seals, have been used as an alternative to therapies such as animal assisted therapy in the promotion of health and social wellbeing of older people in aged care facilities. There is limited research available that evaluates the effectiveness of robot therapies in these settings. The aim of this study was to identify, explore, and describe the impact of the use of Paro robotic seals in an aged care facility in a regional Australian city. A qualitative, descriptive, exploratory design was employed. Data were gathered through interviews with the three recreational therapists employed at the facility who were also asked to maintain logs of their interactions with the Paro and residents. Data were transcribed and thematically analysed. Three major themes were identified from the analyses of these data: "a therapeutic tool that's not for everybody," "every interaction is powerful," and "keeping the momentum." Findings support the use of Paro as a therapeutic tool, revealing improvement in emotional state, reduction of challenging behaviours, and improvement in social interactions of residents. The potential benefits justify the investment in Paro, with clear evidence that these tools can have a positive impact that warrants further exploration., Competing Interests: The authors declare that there is no conflict of interests regarding the publication of this paper.

We retrospectively reviewed a consecutive single surgeon series of 57 Ascension pyrocarbon proximal interphalangeal joint arthroplasties, with a mean follow-up of 7.1 years (range 2 years to 11 years 6 months). We assessed the ranges of motion, deformity, stability and pain of the operated joints, grip strength of the hand and patient satisfaction. Of the cases, 44 were for osteoarthritis, five for rheumatoid arthritis and eight for post-traumatic arthritis. The median post-operative active arc of motion was from 0° to 60°. The median post-operative visual analogue pain score was 0.3 out of ten. Thirty six of the joints had no complications; 14 had minor complications (squeak, slight swan neck); three required early reoperation (joint release, flexor tenodesis); and five required implant removal. A total of 69% of our patients would have the same operation if they had to make the decision again. The Kaplan-Meier survival method estimates the mean implant survival to be 10.7 years (95% confidence intervals 9.96-11.37 years). All five failures occurred during the first 2 years.Level of evidence 4 (Case-series)., (© The Author(s) 2015.)

This paper reports on the results of a study into the use of microblogging technology (TodaysMeet) in large, multi-site lectures in a nursing program. The aim of this study was to investigate students' use of the technology and their perceptions of its value in stimulating engagement in a complex learning environment. The study demonstrated that students like the anonymity that the technology provided, allowing them to ask questions without fear of appearing less competent than their peers. Many of the respondents commented positively on the opportunity to engage with students and the lecturer at other campuses. While some students appreciated the opportunity to interact and have feedback from peers, others saw this as a negative aspect of the technology. This study suggests that, used appropriately, microblogging can be incorporated into large lectures to promote student participation and engagement and ultimately enhance the learning process., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Professional nursing practice is informed by biological, social and behavioural sciences. In undergraduate pre-registration nursing programs, biological sciences typically include anatomy, physiology, microbiology, chemistry, physics and pharmacology. The current gap in the literature results in a lack of information about the content and depth of biological sciences being taught in nursing curricula. The aim of this study was to establish what priority is given to the teaching of science topics in these programs in order to inform an understanding of the relative importance placed on this subject area in contemporary nursing education., Method: This study employed a cross-sectional survey method. This paper reports on the first phase of a larger project examining science content in nursing programs. An existing questionnaire was modified and delivered online for completion by academics who teach science to nurses in these programs. This paper reports on the relative priority given by respondents to the teaching of 177 topics contained in the questionnaire., Results: Of the relatively small population of academics who teach science to nursing students, thirty (n = 30) completed the survey. Findings indicate strong support for the teaching of science in these programs, with particular priority given to the basic concepts of bioscience and gross system anatomy. Of concern, most science subject areas outside of these domains were ranked as being of moderate or low priority., Conclusion: While the small sample size limited the conclusions able to be drawn from this study, the findings supported previous studies that indicated inadequacies in the teaching of science content in nursing curricula. Nevertheless, these findings have raised questions about the current philosophy that underpins nursing education in Australia and whether existing practices are clearly focused on preparing students for the demands of contemporary nursing practice. Academics responsible for the design and implementation of nursing curricula are encouraged to review the content of current programs in light of the findings of this research.

This paper aims to explore and discuss the role that ANMAC and the accreditation standards play in pre-registration nursing education nationally. The context of the discussion is situated in the continuum of events that mark the accreditation of nursing education in Australia. The National Registration and Accreditation Scheme has given rise to significant challenges related to the accreditation of nursing programs of education in Australia. Given the importance of accreditation to the quality of nursing education, ANMAC in its appointed role as accrediting authority, must fill the position rather than occupy it. Enhancing transparency and effectiveness is central to ensuring accreditation facilitates quality in nursing education. Given ANMAC's key position, further work is needed in developing a broad base of expertise by fostering scholarly output in the substantive area of nursing accreditation. There is a concerning lack of research centred on the accreditation of programs of nursing education along with the processes associated with it. This problem is not restricted to the Australian context but also extends internationally. In this context, the expertise of accreditors ought to be questioned along with the processes ANMAC use to identify individual capability. As such, the selection of experts needs to be articulated clearly by ANMAC along with the ownership of introducing a research culture into accreditation.

Students of nursing enter their programmes of study with preconceived ideas of what a career in their chosen profession will entail. The literature suggests that images from the media and past experiences contribute to these perceptions. Although it is positive images of the profession that will usually attract an individual to a career in nursing, often more negative perceptions will direct students away from potentially rewarding areas of specialization. This paper describes career projections of nursing students enrolled in the first year of four preservice nursing programmes at the rural campus of one Australian university. Part of a larger study, the data reported here indicate that most respondents intend to practice in the areas of midwifery, paediatrics and emergency nursing. Oncology, community nursing, aged care and mental health nursing all ranked poorly across three rounds of surveys. These findings have implications for practicing nurses and nurse educators who seek to dispel inaccurate images of these important specializations., (© 2013 Wiley Publishing Asia Pty Ltd.)

The transition of nursing education from the hospital setting to the university sector over recent decades has opened dialog about who is guiding the development of nursing students' professional identity. In addition, there is ongoing debate over real or perceived gaps between nursing student learning in the university and the clinical area, how this translates into professional behaviors and how well students make the transition between the two settings. This paper presents the findings of an integrative literature review into the topic of role modeling in undergraduate nursing education. This review was conducted to identify and appraise research findings about role modeling of professional behaviors for undergraduate nursing students. Literature reviewed from 2000 onwards assesses what is currently known about role modeling of undergraduate nursing students. A systematic search of the databases of CINAHL, Scopus and PubMed from 2000 onwards resulted in the selection of 33 articles for deeper analysis. Two clear themes emerged from the literature, the first relating to nurse clinicians as role models for students during clinical placements and the second relating to nurse academics as role models in the academic setting. Findings from this integrative literature review show an imbalance in the recognition of the role modeling of professional behaviors in the clinical versus the academic setting. Nurses in academic settings have more contact with the students over their period of study and as such, the significance of nurse academics as student role models requires further investigation., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Health assessment is a fundamental aspect of the professional nursing role. The teaching of skills in physical assessment is therefore a large component of pre-registration nursing programmes. As the nursing curriculum becomes more crowded with what is deemed to be essential content, there is a need to rationalise what is taught in preparatory nursing programmes to ensure readiness for practice. The study outlined in this paper, as part of a larger project, explored the teaching of physical assessment skills in pre-registration nursing programmes across Australia. Fifty-three academics completed the 121 item online survey, indicating whether each skill was taught with practice, taught with no practice or not taught at all. The results suggest that only half the skills were being taught by more than 80% of the academics and 23 skills (19%) were taught by more than 90%. Of the 121 skills commonly taught--69 skills (57%) were taught with student practice and 29 (24%) were taught with no student practice. The results of this study raise questions about the teaching of physical assessment in pre-registration nursing programmes. The suggestion is not that skills that are used regularly or infrequently should be removed from the curriculum, rather, the authors propose that consideration be given to whether the teaching of skills that are never likely to be used is occurring at the expense of comprehensive mastery of core skills.

The nursing profession has experienced significant change over the last 100 years. Consequently, the workforce of the 21st century is a diverse entity that is edging toward the specialization of nurses in a specific clinical setting. In such an environment, a common knowledge base is demanded of nurses - a factor that has affected the development of second level, or enrolled nurses (ENs). The forces at play raise questions about nursing roles and scopes of practice. The establishment of education pathways that promote career development has been the stimulus for conversations about the effectiveness of the transition of EN to registered nurse (RN). This paper presents a review of the literature that identifies and explores common emerging themes (making the move from EN; adapting to Bachelor of Nursing; transitioning to RN) associated with this transition through the process of undertaking baccalaureate studies in nursing.

The purpose of pre-service nursing education programs is to prepare competent graduates who are able to function as safe, professional registered nurses. An extensive element of these programs is the teaching of physical assessment skills, with most programs educating students to perform over 120 such skills. Previous research from North America suggests that the majority of skills taught to nurses in their pre-service programs are not used in practice. As part of a larger study, an online survey was used to explore use of 121 physical assessment skills by Australian nurses. Recruitment occurred via mailed invitation to members of the Australian Nursing Federation. Data were extracted from 1220 completed questionnaires returned by nurses who were mostly employed in New South Wales, were female and experienced nurses. Respondents indicated that they used only 34% of skills routinely. Results reinforce evidence found in the literature that many of the skills taught to nurses are either not used at all (35.5%) or are used rarely (31%). These findings have implications for the teaching of physical assessment skills in pre-service nursing programs, and raise questions about the value of extensive skills teaching in the context of contemporary health care. Further research into barriers to the use of physical assessment skills in nursing and the need for comprehensive skills preparation for the generalist nurse is likely to offer some solutions to these questions.

Rural registered nurses' experiences of advanced clinical nursing practice were explored whilst they were enrolled in an advanced primary care course of study. Thirty-two nurses employed in rural health services in Victoria, Australia, studied advanced practice nursing by distance education with a clinical component. At course conclusion, focus groups and a quantitative on-line survey were conducted to explore outcomes. Nurses reported positive self-perceptions of their educational preparation with scores of >7/10 for competence, confidence, preparedness for advanced practice and job satisfaction. Focus group discussions concurred with positive survey results. The course was valuable in developing skills and knowledge, enabling more holistic patient care. The main themes that emerged related to the advancement of the nurse as a professional, and enhancement of patient care. Within their scope of practice, nurses assessed, diagnosed and treated minor patient illness presentations either independently or collaboratively with medical advice. The context of rural health services dictated practice and levels of autonomy. Nurses perceived the new role reduced an overload of medical work, whilst increasing patients' access to care. As a result of the course 24% of participants reported a change in their work role. Nurses employed in rural health services reported positive potential for advanced collaborative practice in rural health care, in association with medical professionals. Defined role boundaries, role responsibilities and dedicated advanced practice positions will be required to achieve implementation of the role.

Nurses have a role in addressing the burden of disease in remote or isolated areas of Queensland. Activities to prevent chronic and acute disease and injury, while promoting a health lifestyle, are a part of nurses' work that help to meet the goal of keeping a population healthy. The findings presented in this paper, as part of a broader study into the role of nurses working in remote or isolated areas of Queensland, describe how registered nurse in these locations address local burden of disease. Participants discussed the increased workload that engaging in health promotion and disease prevention activities creates for them when providing health-care services for their communities. Establishing stronger working relationships with visiting members of the primary health-care team, while addressing organizational barriers, might have a significant impact on the nurses' ability to help reduce the burden of disease in these areas., (© 2010 Blackwell Publishing Asia Pty Ltd.)

Nurses represent the largest occupational group of health care professionals in Australia. The ratio of nurses to population is relatively consistent, unlike other health care professional groups (including medical doctors and allied health staff) whose numbers decline as population density and distance from metropolitan areas increases. Nurses working in areas where other health care professionals are limited or absent have expanded scopes of practice with their work being more generalist than specialist. The role of nurses in remote and isolated areas of Queensland, Australia was the focus of a commissioned multi-case research project. Findings reported in this paper relate to the position of registered nurses as part of an interprofessional team. These findings indicated that, in some instances, local health care teams were limited to a single nurse and Indigenous health care worker/s, while in others the teams were more diverse. In all cases collegial support was available either locally or via telecommunication technology. Understanding the role of each team member, having useful strategies to enhance communication and work collaboratively were identified as essential criteria for "good practice".

There is a substantial number of Iranian war veterans, exposed to sulfur mustard, who suffer from serious long term progressive health problems involving their respiratory organs, eyes, and skin. Little is known, however, about these casualties' experiences of living with the consequences of sulfur mustard poisoning. This qualitative study aims to provide greater insight into how war veterans live with the consequences of the poisoning and involved 17 Iranian war veterans who had been poisoned by sulfur mustard during the Iran-Iraq conflict. Each participant was interviewed using a semi-structured interview schedule and the data generated through this process was analyzed using constant comparative data analysis technique. Data analysis resulted in "religious beliefs and practices" as a main category, which included two sub-categories: religious value centered life and religious support. Findings suggest that religious belief assists veterans to accept the impact of poisoning on their lives and adapt their lifestyles accordingly, to participate in religious social activities and feel socially supported, and to be hopeful about the future and live their lives as fully as possible.

This article reports on a pilot vocational study programme for provision of antenatal services in the general practice environment. The concurrent evaluation study assessed practice nurses' experiences of undertaking the pilot programme, the level and applicability of the content, and the mode of delivery. General practitioners' understanding of the role of the nurse in providing antenatal services, and the actual and potential impact of this new role on models of service delivery and care were also investigated. Women receiving care from practice nurses within this new model of service delivery and care were also of interest in this study. Findings showed that the current role of the general practice nurse in caring for pregnant women is restricted to assisting the general practitioner to complete their assessment of clients. Organizing clinical placement with a midwife was a major barrier to completing the pilot programme.

This exploratory, descriptive study investigates the experiences of Iranian war veterans living with chronic disease acquired as a result of chemical warfare. Sulphur mustard (SM) is considered one of the most important agents of chemical warfare and was widely used during the Iran-Iraq conflict in 1980-1988. There are approximately 100 000 Iranian SM casualties who suffer from serious long-term progressive health problems involving their respiratory organs, eyes and skin. Seventeen male Iranian war veterans aged between 30 and 59 years and four victims' family members participated in the study. Data was generated during individual in-depth interviews that used open-ended questions. Grounded theory techniques, including the constant comparative method of concurrent data generation and analysis, were employed in the analysis of data. Preliminary results indicate two main thematic categories: social isolation and physical disability. It is argued that a lack of knowledge about the outcomes of SM poisoning, physical restrictions and difficulty in adjusting socially decreases war veterans' functional capacity and levels of independence.

Objective: To examine the role of the registered nurse in remote and isolated areas of Queensland, the Northern Territory, South Australia and Western Australia; and to illustrate the impact of the burden of disease on nursing practice., Data Sources: A literature search was undertaken using electronic databases and the grey literature (including policy documents, project reports and position descriptions)., Data Synthesis: The role of the nurse in remote areas is diverse, and varies according to the context of practice. Although some states and territories offer formal programs to prepare nurses for the role, it is unclear whether this is routinely provided. The burden of disease is higher in remote Australia, and although nurses work to reduce the burden, the need to provide primary care can be at the expense of primary health care., Conclusions: Whilst the nature of nursing practice is influenced by many factors, considerable agreement exists between states and territories around the role of the registered nurses in remote and isolated communities. The higher burden of disease in remote and isolated areas of Australia impacts on nursing practice, and nurses are uniquely placed to assist in reducing the burden of disease. Greater agreement around what constitutes 'remote' is needed.

In 1996 Hegney published a seminal review of the literature concerning the status of Australian rural nurses. This article updates and expands that original paper by reporting on an integrative review exploring the same topic area between the years 1996 and 2008. Findings show that definitions of rural nursing are now integrated with those of remote nursing on a continuum of distance and contextual difference. The role and function of rural nurses is examined, along with a discussion of the importance of a primary health care approach in meeting community needs. The influence of social determinants of health is explored in this context. The culture of rural health workplaces in relation to the role and function of rural nurses is also a feature of this review. Research into the rural nursing workforce and, in particular, the recruitment and retention of staff are examined, with the high attrition rate of new or novice rural nurses pinpointed as a common theme in these studies. Important legislative changes that have affected rural nursing practice are also identified. This article concludes with a discussion of the latest research into Australian rural nursing, focusing on education in rural universities and the potential to develop new or novice nurses through the development of supportive relationships.

This paper describes the preliminary phase of a longitudinal research project involving students enrolling in three different pre-registration nursing programs in two locations in rural Victoria, Australia. This initial report discusses the demographic characteristics, entry pathway, course choice and career aspirations of students enrolled in these programs at both the main rural campus and an outreach satellite school of a major Australian university. Demographic findings from this study demonstrate that most of participants were female, aged between 18 and 50 years. The majority of participants resided in non-metropolitan areas and were enrolled in the flagship Bachelor of Nursing Program, with a large number having entered their chosen course of study via a non-traditional pathway. Career projections reported by participants demonstrate the intention of those from non-metropolitan areas to remain in this location on completion of their studies. Participants indicated their preferred areas of future practice to be in midwifery, emergency and paediatrics. Overall the findings of this part of the study summarise the characteristics of students entering nursing courses via various mechanisms. Exploration and comparison of these characteristics raise a number of issues for discussion, particularly in relation to conversion of level 2 (enrolled) nurses to level 1 (registered) status, and intended career specialisation and location of practice for students of nursing in rural areas.

Changes to the nursing profession over recent decades have provoked an increasing migration of nursing education into the tertiary sector. For nurses who live and work in developing nations, such as Malaysia, opportunities for further study might be limited, particularly for those located in more remote regions. This paper reports on a research study of registered nurses who undertook baccalaureate degree studies in off-campus mode in Malaysian Borneo. A grounded theory methodology was employed in this research, which is part of a larger study into the nature and outcomes of change experienced as a result of postregistration degree studies. This paper explores the reasons why nurses in this location enrolled in one such course and the extent to which completion of their studies addressed their motivational goals. The findings indicate that the experience of learning and acquisition of knowledge was well beyond what was expected, resulting in a sense of achievement that was similarly unanticipated.

A 28-year-old woman presented with right shoulder pain and, after a delay, a diagnosis of clavicular stress fracture was made. The patient gave no history of repetitive abnormal loading of the upper limbs which could have assisted the diagnosis. The authors wish to raise awareness of this rare diagnosis such that it can be considered in the differential for shoulder pain of unclear origin.

Aim: To assess morbidity, mortality and cancer-related outcomes after supervised rectal resection for cancer by surgical specialist registrars (SpRs)., Patients: A total of 205 consecutive patients (115 male; median age 64 years [range, 24-90 years]) under the care of six consultant surgeons, who underwent elective rectal resection of their rectal cancer between 1995-1999 were studied. The modified Dukes' stages were A in 28 patients (13%), B in 47 (21%), C in 103 (51%), and D in 30 (15%)., Results: Sixty-eight patients (35 males) of mean age 64 years (range, 38-82 years) underwent supervised resection (60 anterior resections. 8 abdomino-perineal resections) by a SpR. Of these, 7 (10%) were modified Dukes' stage A, 16 (22%) stage B, 37 (54%) stage C, and 8 (13%) stage D. Postoperative morbidity (SpRs 32% versus consultants 41%; P = 0.25) and mortality (SpRs 3% versus consultants 6%; P = 0.1) were comparable with consultant outcomes. Local recurrence rates (SpRs 9% versus consultants 9%; P = 0.5) and crude survival (SpRs 64% versus consultants 61%; P = 0.31) were also comparable after a median follow-up of 48 months (range, 24-72 months)., Conclusion: Operative and cancer-related outcomes are not compromised by supervised SpR resections of rectal cancer in selected patients.

A clinical trial was conducted in three hospitals to determine if common tap water is suitable for use as a conductive medium in electrocardiography (ECG). It compares two consecutive ECG recordings of 100 patients, the first recordings were obtained with water as the conductive medium, the second tracings used the electroconductive gel Redux Creme. Analysis involved comparison of the height of the R wave in lead V4 and tracing reports from a cardiologist 'blind' to the medium used. Results indicated that there was no statistically significant difference in the conductive ability of the two media. Analysis of the clinical performance of the media indicated that in 82% of the traces water was equal to or better than gel in clarity, and in 90% of traces water was equal to or better than gel in suitability for diagnosis. One implication of the study is the possibility of significantly reducing the cost of ECG procedures while ensuring the quality of tracings remains at a clinically acceptable level.