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Objectives This prospective descriptive study aimed to test the validity and feasibility of the Team Emergency Assessment Measure (TEAM™) for assessing real-world medical emergency teams' non-technical skills. Second, the present study aimed to explore the instrument's contribution to practice regarding teamwork and learning outcomes. Methods Registered nurses (RNs) and medical staff (n = 104) in two hospital EDs in rural Victoria, Australia, participated. Over a 10 month period, the (TEAM™) instrument was completed by multiple clinicians at medical emergency episodes. Results In 80 real-world medical emergency team resuscitation episodes (283 clinician assessments), non-technical skills ratings averaged 89% per episode (39 of a possible 44 points). Twenty-one episodes were rated in the lowest quartile (i.e. ≤37 points out of 44). Ratings differed by discipline, with significantly higher scores given by medical raters (mean: 41.1 ± 4.4) than RNs (38.7 ± 5.4) (P = 0.001). This difference occurred in the Leadership domain. The tool was reliable with Cronbach's alpha 0.78, high uni-dimensional validity and mean inter-item correlation of 0.45. Concurrent validity was confirmed by strong correlation between TEAM™ score and the awarded Global Rating (P

Aim: To test the resuscitation non-technical Team Emergency Assessment Measure (TEAM) for feasibility, validity and reliability, in two Australian Emergency Departments (ED). Background: Non-technical (teamwork) skills have been identified as inadequate and as such have a significant impact on patient safety. Valid and reliable teamwork assessment tools are an important element of performance assessment and debriefing processes. Methods: A quasi experimental design based on observational ratings of resuscitation non-technical skills in two metropolitan ED. Senior nursing staff rated 106 adult resuscitation team events over a ten month period where three or more resuscitation team members attended. Resuscitation events, team performance and validity and reliability data was collected for the TEAM. Results: Most rated events were for full cardiac resuscitation (43%) with 3–15 team members present for an average of 45 min. The TEAM was found to be feasible and quickly completed with minimal or no training. Discriminant validity was good as was internal consistency with a Cronbach alpha of 0.94. Uni-dimensional and concurrent validity also reached acceptable standards, 0.94 and > 0.63 (p = < 0.001), respectively, and a single ‘teamwork’ construct was identified. Non-technical skills overall were good but leadership was rated notably lower than task and teamwork performance indicating a need for leadership training. Conclusion: The TEAM is a feasible, valid and reliable non-technical assessment measure in simulated and real clinical settings. Emergency teams need to develop leadership skills through training and reflective debriefing.

To explore the potential of mobile eye-tracking to identify healthcare students' area of visual interest and its relationship to performance ratings.Eye-tracking identifies an individual's visual attention focus, and has been used as a training technique in medicine and in nursing. In this study participants wore a point of view (PoV) camera within a spectacle frame during simulation education experiences.Thirty-nine final year nursing and paramedicine students individually participated in three 8 minute clinical simulations with debriefing using videoed eye-tracking recordings. Coloured dots on the video depicted the participant's pupil fixation on five targeted areas. Data extracted from the video camera were collated to report time spent on each target (their 'gaze').The mean total gaze of expert designated targets in the environment for three 8 minute scenarios was 40-77%. Of 35 participants' focus on three main areas of interest, their priority was the patient's head (34%), the patient's trunk (24%) and their clinical assistant (5%), with significant differences between nursing and paramedic disciplines (P 0.05). Objectively rated clinical performance improved significantly by the third scenario (P ≤ 0.001). Participants were positive regarding use of eye tracking during debriefing.Eye tracking has the potential to enhance debriefing and educational outcomes, although there are limitations to gaze capture in high fidelity environments and resource cost is high. Further study is warranted to enable better understanding of how expert clinicians achieve high levels of performance.

Professors of nursing and midwifery are recognized as discipline leaders and thus have a key role to play in the development of disciplinary knowledge, especially through their research activity. Watson and Thompson (2008) paraphrased the research and scholarship roles of the professoriate, from the UK National Conference of University Professors, as a requirement to “maintain individual authoritative industry in scholarship and research” (p 981). This article is protected by copyright. All rights reserved.

Purpose To conduct a systematic review of randomized controlled trials to evaluate the evidence for the use of non-pharmacological depression therapies in older Chinese adults. Materials and methods The population was individuals of Chinese extraction over the age of 60 who meet the criteria for depression. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Six healthcare databases were systematically searched for publications to the end date July 2018. Included study variables were extracted and methodological quality assessments were performed. Ten studies reported sufficient data for meta-analysis. Results Fifteen experimental and quasi-experimental studies fulfilled the selection criteria (N = 904 participants). Twelve studies provided sufficient data to evaluate the therapies using Effect Size (ES) (Cohen’sd); ranged from low to high. In the Qigong studies ES varied d = 0.31–0.81, Reminiscence d = 0.20–2.37, and for single studies of Tai Chi d = 1.7 and for Life Story d = 1.46. From the meta-analyses, Qigong was the only treatment that had a significant effect on the severity of depression (Z = −4.47, p Conclusion Overall, there was a large methodological heterogeneity between studies attributed to differing treatments, duration and designs. Reminiscence and Life Story showed an overall effect from a range of measures, as did the exercise therapies Qigong and Tai Chi. Qigong was the only therapy having a significant effect on depression. This therapy may be useful to alleviate depression due to the group and social interaction.

Introduction Emergency nurses are at risk of compassion fatigue. Compassion fatigue caused by exposure to suffering may compromise the individual’s personal wellbeing and reduce work efficiency. Methods A quantitative cross-sectional survey with open responses was conducted using the Professional Quality of Life: Compassion Satisfaction and Compassion Fatigue (ProQOL) scale and open-ended questions. Responses from a convenience sample of 86 nurses from two hospital emergency departments in Victoria, Australia, were analysed. Results The median score for Compassion Satisfaction was 78% with all nurses reporting average to high scores. Most had average levels of Compassion Fatigue: Burnout median score was 53% and Secondary Traumatic Stress median score 49%. No statistically significant correlation was found between scales nor with influencing demographic characteristics. A qualification in emergency nursing was predictive of Compassion Satisfaction. Six descriptive job-associated factors contributed to nurses’ stress: human resources, the organisation, job-specific components, patient mix and professional and personal components. Conclusion/s Average to high levels of Compassion Satisfaction and low to average levels of Compassion Fatigue were found in emergency nurses. Issues contributing to stress were work and role related. An understanding of these stressors may help nurses and nurse managers to ameliorate emergency nurses’ levels of stress and help limit staff burnout.

© 2018 International Nursing Association for Clinical Simulation and Learning Simulation-based education has become a ubiquitous teaching approach in nursing. However, ensuring the quality of simulation research is critical. We reviewed the methodological quality of 26 quantitative studies published in Clinical Simulation in Nursing, 2017. The Medical Education Research Study Quality Instrument and Simulation Research Evaluation Rubric showed that nearly all studies were of moderate to high quality (rated ≥50%). Correlation coefficients showed that interrater agreement was high overall (≥0.94). In conclusion, this was a valid approach for examining simulation study quality. Although most included studies were of high quality, some elements of study reporting can be improved upon.

Background Nursing practice is underpinned by science knowledge. While the literature is consistent in identifying limitations in teaching science content to nurses, there is a lack of consensus regarding what should be taught and to what level of detail. No studies to date have systematically surveyed registered nurses (RNs) for their perspectives about the science knowledge that should underpin nursing practice. Aim To establish the relative importance RNs place on science content taught to nurses. Method Practicing RNs across Australia were invited to participate in a cross-sectional survey administered online. The survey asked participants to prioritize 179 science topics according to the relative importance of each item to nursing practice. Findings A total of 1583 RNs completed the survey. Participants indicated strong support for the inclusion of foundational science knowledge in undergraduate pre-registration nursing programs. The majority of topics (88%) were rated as a ‘high priority' (a rating of 4 or 5), particularly anatomy, physiology and pathophysiology. No topic received a rating of less than 3 (of a possible 5). Discussion RNs expressed different views about the prioritization of science content areas for nursing practice compared with the views of academics who teach science to nursing students. Identification of the science content areas that RNs regard as high priority for nursing practice can be used to guide improvements in nursing curriculum development. Conclusion The results of this study demonstrate that practising RNs place high value on various science topics and the teaching of biological sciences generally. This study suggests the need for greater inclusion of key stakeholders, including practicing RNs, when integrating bioscience within nursing curricula.

Aim: To explore Registered Nurses' attitudes and behaviour towards patients' use of complementary therapies. Background: Despite high rates of use of complementary therapies by the general population, little is known of how nurses respond to patients' use of these therapies. Design: A two-phase sequential exploratory mixed methods design. Methods: Nineteen Registered Nurses working in Australia participated in a semi-structured interview in 2015-2016 and emerging themes informed the development of a quantitative survey instrument administered online nationwide in 2016. Findings: Emerging key themes "Promoting safe care"; "Seeking complementary therapies knowledge";" Supporting holistic health care"; and "Integrating complementary therapies in practice" were reflected in survey results. Survey responses (N = 614) revealed > 90% agreement that complementary therapies align with a holistic view of health and that patients have the right to use them. Most nurses (77.5%) discussed complementary therapies with patients and 91.8% believed nurses should have some understanding of the area. One-third did not recommend complementary therapies and there was a lack of overall consensus as to whether these therapies should be integrated into nursing practice. Nurses with training in complementary therapies held more positive views than those without. Conclusion: Nurses were generally supportive of patients' interest in complementary therapies, although their primary concern was safety of the patient. Despite broad acceptance that nurses should have a basic understanding of complementary therapies, there was a lack of consensus about recommendation, integration into nursing practice and referral. Further research should explore how nurses can maintain safe, patient-centred care in the evolving pluralistic healthcare system. Refereed/Peer-reviewed

Objectives To examine the attitudes of undergraduate pre-professional medical students toward involvement in interprofessional learning, using the Readiness for Interprofessional Learning Scale. Methods A cross sectional survey of 478 Australian medical students in the clinical years (3, 4 and 5). Results Positive attitudes (mean: 72%), varied significantly across course years 3, 4 and 5 ( p ≤ .05). More negative attitudes to IPL in the middle (second) year of clinical placement (course year 4) compared with the prior year. A three-factor explanatory model was adopted: Shared Learning (11 items) (Cronbach alpha .92), Professional Identity (5 items) ( α = .75) and Teamwork/Collaboration (2 items) ( α = .51) components. Conclusions Medical students' attitudes suggest that interprofessional education should be offered early in the medical course. This study confirms the Readiness for Interprofessional Learning Scale-Med as reliable tool when used with undergraduate/pre-professional medical students.

Aim To review changes in utilisation of dietetics services through the Medicare Chronic Disease Management program over the last decade and describe patient uptake in 2013. Methods Dietetics service data were extracted from published Medicare statistics for the periods (i) January 2004 to December 2013 and (ii) January to December 2013. Data comprised individual dietetics services by state and patient demography, and group services data for provider professions regarding type 2 diabetes: dietitians, diabetes educators and exercise physiologists. t-test was used to investigate the association of dietetics' individual service utilisation and workforce statistics. Results Individual dietetics Chronic Disease Management consultations in private practice have increased annually since 2004. Dietetics has remained the third largest provider. In 2013, a total of 302 910 individual consultations were conducted; 7% of allied health consultations. Likewise, individual services for Indigenous Australians increased since 2008. Utilisation of group services for type 2 diabetes comprised

Background: Simulation-based education is one strategy that may be used to teach nursing students to recognize and manage patient deterioration. Method: Final-year preregistration nursing students (n ¼ 97) completed three face-to-face laboratory-based team simulations with a simulated patient (actor) and 330 students individually completed a three-scenario Web-based simulation program: FIRST 2 ACTWeb. Results: Both groups achieved moderate performance scores (means: face to face, 49%; e-simulation, 69%). Course evaluations were positive, skill gain showing a greater effect size in the face-to-face program than for e-simulation, and higher satisfaction and more positive appraisal. Conclusion: Face-to-face simulation and e-simulation are effective educational strategies with e-simulation offering greater feasibility. Either strategy is likely to add value to the learning experience. Cite this article

Objective to explore the views of midwives and maternal–child health nurses regarding factors that influence breast feeding initiation and continuation, focusing on how support for women could be improved to increase breast feeding duration. Design a focus group study. Setting hospital or domiciliary (home-visiting) midwives and community-based maternal and child health (MCH) nurses in one region of Victoria, Australia. Methods twelve MCH nurses and five midwives who provided supportive services to women in the immediate postnatal period attended one of three audio-recorded focus groups. Thematic findings were identified. Findings four key themes were: ‘Guiding women over breast-feeding hurdles', ‘Timing, and time to care'; ‘Continuity of women's care' and ‘Imparting professional knowledge'. Given the a pattern of hospital discharge of mother and infant on day one or day two after birth, participants thought the timing of immediate postnatal breast-feeding support was critical to enable women to initiate and continue breast feeding. Community-based MCH nurses reported time gaps in uptake of new mother referrals and time-pressured face-to-face consultations. Both groups perceived barriers to continuity of women's care. Conclusions health services subscribe to the Baby Friendly Health Initiative and government policies which support breast feeding, however providers described time pressures and a lack of continuity of women's care, including during transition from hospital to community services. Implications for practice there is a need to examine administration of service delivery and how domiciliary and community nurses can collaborate to establish and maintain supportive relationships with breast feeding women.

Introduction Non-technical skills (NTS) teamwork training can enhance clinicians' understanding of roles and improve communication. We evaluated a quality improvement project rating teams' NTS performance to determine the value of formal rating and debriefing processes. Methods In two Australian emergency departments the NTS of resuscitation teams were rated by senior nurses and medical staff. Key measures were leadership, teamwork, and task management using a valid instrument: Team Emergency Assessment Measure (TEAM™). Emergency nurses were asked to attend a focus group from which key themes around the quality improvement process were identified. Results Main themes were: ‘Team composition' (allocation of resuscitation team roles), ‘Resuscitation leadership' (including both nursing and medical leadership roles) and ‘TEAM™ ratings promote reflective practice' (providing staff a platform to discuss team effectiveness). Objective ratings were seen as enabling staff to provide feedback to other team members. Reflection on practice and debriefing were thought to improve communication, help define roles and responsibilities, and clarify leadership roles. Conclusion Use of a non-technical skills rating scheme such as TEAM™ after team-based clinical resuscitation events was seen by emergency department nurses as feasible and a useful process for examining and improving multi-disciplinary practice, while improving team performance.

Background: Bullying in health workplaces has a negative impact on individual nurses, their families, multidisciplinary teams, patient care and the profession. Aim: This paper compares the experiences of bully and harassment of Australian and UK baccalaureate nursing students during clinical placement. Method: 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 SEBDCP questionnaire and analysed using descriptive and inferential statistics. The total sample consisted of 833 Australian and 561 UK students Results: Australian nursing students experienced a higher rate of bullying (50.1%) than UK students (35.5%). Across both cohorts (Aust 53%, UK 68%). students identified other nurses as the main perpetrators and few bullied students chose to report the episode/s (Aust 28.5%, UK 19.4%). The main reason given for not reporting was fear of being victimised (Aust 53.6%, UK 54.5%). Sadly, a number felt ‘it is part of the job’ (UK: 21.6%, Aust: 23.9%). Conclusions: It is clear that a culture of bullying in nursing persists internationally. Nursing students are vulnerable and often experience and/or witness bullying episodes during clinical placement, leading them to question their future in the ‘caring’ profession of nursing. Bullying behaviour requires a zero tolerance by the nursing profession and education providers need to develop clear policies and implement procedures that protect students as the future nursing workforce.

Objective To examine factors that influence the establishment and continuation of breastfeeding among women living in a southern region of Victoria. Method Sequential mixed methods design including paper-based survey and focus group enquiry. Finding Women who had breastfed their infants (n = 170) reported reliance on midwives, lactation consultants and maternal and child health nurses for breastfeeding advice and support in the immediate and medium postnatal periods. Women who chose a private hospital appeared to receive less immediate postnatal support than those in a public hospital. Access to individual guidance from midwives and MCH nurses was regarded as critical to overcoming breastfeeding difficulties, in the face of the alternative suggested by people to ‘give up’. They described themes of: ‘Women's experience of nurses/midwives’, ‘Expectations versus reality’, ‘Not giving up despite difficulties’, and ‘Breastfeeding support’. Sources of lay support were not universal. Conclusion The duration of breastfeeding might be extended by early problem resolution. To enhance breastfeeding participation, further examination of the extent and timeliness of service provision by health service providers is necessary.

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.

How willing are today's medical, nursing and other healthcare students to undertake some of their studies as shared learning? There is a lack of evidence of students' views by discipline despite this being a priority task for higher education sectors. This study explored the views of nursing, midwifery, nursing-emergency health (paramedic), medical, physiotherapy and nutrition-dietetics students.Senior undergraduate students from six disciplines at one university completed the Readiness for Interprofessional Learning Scale prior to participating in interprofessional clinical learning modules.For 741 students, the highest ranked response was agreement about a need for teamwork (mean 4.42 of 5 points). Nursing students held significantly more positive attitudes towards Teamwork/Collaboration, and were more positive about Professional Identity than medical students (p.001). Midwifery and nursing-emergency-health students rejected uncertainty about Roles/Responsibilities compared with medical students (p.001). One-third of all students who had prior experience of interprofessional learning held more positive attitudes in each of four attitude domains (p.05).Overall, students' attitudes towards interprofessional learning were positive and all student groups were willing to engage in learning interprofessionally. Early introduction of IPL is recommended. Further studies should explore the trajectory of students' attitudes throughout the university degree.

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.

Nurses are frequently exposed to dying patients and death in the course of their work. This experience makes individuals conscious of their own mortality, often giving rise to anxiety and unease. Nurses who have a strong anxiety about death may be less comfortable providing nursing care for patients at the end of their life. This paper explores the literature on death anxiety and nurses’ attitudes to determine whether fear of death impacts on nurses’ caring for dying patients. Fifteen quantitative studies published between 1990 and 2012 exploring nurses’ own attitudes towards death were critically reviewed. Three key themes identified were: i). nurses’ level of death anxiety; ii). death anxiety and attitudes towards caring for the dying, and iii). death education was necessary for such emotional work. Based on quantitative surveys using valid instruments, results suggested that the level of death anxiety of nurses working in hospitals in general, oncology, renal, hospice care or in community services was not high. Some studies showed an inverse association between nurses’ attitude towards death and their attitude towards caring for dying patients. Younger nurses consistently reported stronger fear of death and more negative attitudes towards end-of-life patient care. Nurses need to be aware of their own beliefs. Studies from several countries showed that a worksite death education program could reduce death anxiety. This offers potential for improving nurses’ caring for patients at the end of their life.

Simulation modalities are numerous in nursing education, with a need to reveal their range and impact. We reviewed current evidence for effectiveness of medium to high fidelity simulation as an education mode in pre-licensure/pre-registration nurse education. A state-of-the-art review and meta-analyses was conducted based on a systematic search of publications in English between 2010 and 2015. Of 72 included studies, 43 were quantitative primary studies (mainly quasi-experimental designs), 13 were qualitative studies and 16 were reviews of literature. Forty of 43 primary studies reported benefits to student learning, and student satisfaction was high. Simulation programs provided multi-modal ways of learning. A meta-analysis (8 studies, n = 652 participants) identified that simulation programs significantly improved clinical knowledge from baseline. The weighted mean increase was 5.0 points (CI: 3.25–6.82) on a knowledge measure. Other objectively rated measures (eg, trained observers with checklists) were few. Reported subjective measures such as confidence and satisfaction when used alone have a strong potential for results bias. Studies presented valid empirical evidence, but larger studies are required. Simulation programs in pre-licensure nursing curricula demonstrate innovation and excellence. The programs should be shared across the discipline to facilitate development of multimodal learning for both pre-licensure and postgraduate nurses.

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.

Background There are international concerns in relation to the management of patient deterioration which has led to a body of evidence known as the ‘failure to rescue’ literature. Nursing staff are known to miss cues of deterioration and often fail to call for assistance. Medical Emergency Teams (Rapid Response Teams) do improve the management of acutely deteriorating patients, but first responders need the requisite skills to impact on patient safety. Methods/design In this study we aim to address these issues in a mixed methods interventional trial with the objective of measuring and comparing the cost and clinical impact of face-to-face and web-based simulation programs on the management of patient deterioration and related patient outcomes. The education programs, known as ‘FIRST2ACT’, have been found to have an impact on education and will be tested in four hospitals in the State of Victoria, Australia. Nursing staff will be trained in primary (the first 8 min) responses to emergencies in two medical wards using a face-to-face approach and in two medical wards using a web-based version FIRST2ACTWeb. The impact of these interventions will be determined through quantitative and qualitative approaches, cost analyses and patient notes review (time series analyses) to measure quality of care and patient outcomes. Discussion In this 18 month study it is hypothesised that both simulation programs will improve the detection and management of deteriorating patients but that the web-based program will have lower total costs. The study will also add to our overall understanding of the utility of simulation approaches in the preparation of nurses working in hospital wards. (ACTRN12616000468426, retrospectively registered 8.4.2016).

Background Internationally, non-urgent presentations are increasing the pressure on Emergency Department (ED) staff and resources. This systematic review aims to identify the impact of alternative emergency care pathways on ED presentations – specifically GP cooperatives and walk-in clinics. Methods Based on a structured PICO enquiry with either walk-in clinic or GP cooperative as the intervention, a search was made for peer-reviewed publications in English, between 2000 and 2014. Medline plus, OVID, PubMed, and Google Scholar were searched. The Critical Appraisal Skills Program (CASP) guidelines were used to assess study quality and data was extracted using an adapted JBI Qualitative Assessment and Review Instrument (QARI). Subsequent reporting followed the PRISMA guideline. Results Eleven high quality quantitative studies met the inclusion criteria. Walk-in clinics do have the potential to reduce non-urgent emergency department presentations, however evidence of this effect is low. GP cooperatives offer an alternative care stream for patients presenting to the ED and do significantly reduce local ED attendances. Community members need to be made aware of these options in order to make informed treatment choices. Conclusion GP cooperatives in particular do have the potential to reduce ED workload. Further research is required to uncover recent trends and patient outcomes for walk-in clinics and GP cooperatives.

Objective To conduct a systematic review to appraise and review evidence on the impact of simulation-based education for undergraduate/pre-licensure nursing students, using existing reviews of literature. Design An umbrella review (review of reviews). Data Sources Cumulative Index of Nursing and Allied Health Literature (CINAHLPlus), PubMed, and Google Scholar. Study Selection Reviews of literature conducted between 2010 and 2015 regarding simulation-based education for pre-licensure nursing students. Data Extraction The Joanna Briggs Institute methodology for conduct of an umbrella review was used to inform the review process. Results of Data Synthesis Twenty-five systematic reviews of literature were included, of which 14 were recent (2013–2015). Most described the level of evidence of component studies as a mix of experimental and quasi-experimental designs. The reviews measured around 14 different main outcome variables, thus limiting the number of primary studies that each individual review could pool to appraise. Many reviews agreed on the key learning outcome of knowledge acquisition, although no overall quantitative effect was derived. Three of four high-quality reviews found that simulation supported psychomotor development; a fourth found too few high quality studies to make a statistical comparison. Simulation statistically improved self-efficacy in pretest-posttest studies, and in experimental designs self-efficacy was superior to that of other teaching methods; lower level research designs limiting further comparison. The reviews commonly reported strong student satisfaction with simulation education and some reported improved confidence and/or critical thinking. Conclusion This umbrella review took a global view of 25 reviews of simulation research in nursing education, comprising over 700 primary studies. To discern overall outcomes across reviews, statistical comparison of quantitative results (effect size) must be the key comparator. Simulation-based education contributes to students' learning in a number of ways when integrated into pre-licensure nursing curricula. Overall, use of a constellation of instruments and a lack of high quality study designs mean that there are still some gaps in evidence of effects that need to be addressed.

The authors regret that the original text: The SAGAT instrument has been previously validated (Bell et al., 2006) is incorrect and should read: The SAGAT technique has been demonstrated as valid, sensitive and reliable measure of situation awareness in diverse applications (Endsley, 2000). Endsley, M. R. (2000) Direct measurement of situation awareness: Validity and use of SAGAT. In Endsley, M.R. & Garland, D.J. (Eds.), Situation awareness analysis and measurement (pp 147–173). New Jersey: Lawrence Erlbaum Associates. The authors would like to apologise for any inconvenience caused.

Aim: Uptake of Medicare-funded chronic disease management items has increased exponentially since the programme commenced in 2004. We aim to report on national utilisation of the five most referred of 13 allied health services and to examine patient uptake rates. Methods: Annual statistics generated from national Medicare billing data from January 2010 to December 2010 were extracted from the Medicare public database and compared by profession, state and per capita population. Results: The five most utilised individual services were: (in decreasing order) podiatry, physiotherapy, dietetics, chiropractic and speech pathology. They provided 94% of all allied health consultations nationally, on referral from general practitioners. Per capita utilisation revealed wide variation in uptake by state and territory; some states had far less services than the national average. Patterns of referral instanced by age range and gender of clientele differed between professions. Most dietetics clients were middle aged (45-74years) and this fits with expectations of chronic disease incidence. There was inequity of access to group services for the management of type 2 diabetes, with most services (85%) provided in South Australia and New South Wales. Conclusion: Dietetics providers have maintained and improved their referral rate and continue to be the third most utilised Medicare chronic disease management allied health service. Six years into the programme, further exploration is warranted to understand the reasons for wide variation in rates of patient uptake for the service provider professions. © 2012 The Authors. Nutrition & Dietetics

Objective: To measure the impact of the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2 ACT) simulation program on nursing observations and practice relevant to patient deterioration in a rural Australian hospital. Design: Interrupted time series analysis. Setting: A rural Australian hospital. Participants: All registered nurses (Division 1) employed on an acute medical/surgical ward. Intervention: The FIRST2 ACT simulation program. Outcome measures: Appropriate frequency of a range of observations and administration of oxygen therapy. Results: Thirty-four nurses participated (83% of eligible nurses) in the FIRST2 ACT program, and 258 records were audited before the program and 242 records after. There were statistically significant reductions in less than satisfactory frequency of observations (P = 0.009) and pain score charting (P = 0.003). There was no measurable improvement in the administration of oxygen therapy (P = 0.143), while the incidence of inappropriate nursing practice for other measures both before and after the intervention was too low to warrant analysis. Conclusion: FIRST2 ACT was associated with measurable improvements in nursing practice.

Early recognition and management of patient deterioration are essential nursing skills, and can be improved through education and experience. However, both nursing students and registered nurses may have few opportunities to develop and maintain the emergency management skills necessary to ensure patient safety. Using both theory and empirical evidence, we have developed a simulation-based educational model, 'FIRST2ACT' (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends), to provide nurses with a high-fidelity learning experience. The model has been tested in three different settings: it is highly acceptable to learners, adaptable to different training needs, and shows promise in improving actual clinical performance.

Aim: Nutrition screening is increasingly conducted in hospitals during the patient admission process. We aimed to explore the ease of use of two tools in the conduct of screening by nutrition technicians (NTs), and to compare validity. The tools are Malnutrition Universal Screening Tool (MUST) and Modified Malnutrition Screening Tool (Mod-MST). Methods: A sample of 262 consecutive adult hospital patients in medical wards was screened during December 2008 to January 2009. Trained NTs used both tools to screen each patient. Dietitians who were blinded to screening results then assessed each patient using Subjective Global Assessment as a reference tool. Time taken for screening was recorded and ease of tool use was explored in interviews with technicians. Results: The specificity of MUST and Mod-MST was 85% and 83%, respectively, with sensitivity of 80% and 77%. Both tools were easy to use and could be applied to all patients, including those unable to answer interview questions. However, the MUST took two to three times longer to complete (5–7 min) using objective data. The Mod-MST collected subjective data that required interpretation by technicians. Conclusion: Specificity and sensitivity of the two tools were less than optimum at ≤85%, as some patients would be misclassified. Both tools were valid and feasible to use with all medical patients, including those with whom communication cannot be established. The Mod-MST is recommended, as choice of malnutrition screening tool needs to balance efficacy with time taken to be useful for mass screening programs.

To critically examine the evidence for simulation based learning in midwifery education.Simulated Learning Programs (SLPs) using low to high fidelity techniques are common in obstetric professionals' education and focus on the development of team work, labour and obstetric emergencies.A systematic review incorporating critical appraisal approaches, setting clear objectives and a defined search and analysis strategy. Evidence from obstetrics, neonatology, technical and non-technical skills (teamwork) was included where it informed the development of midwifery curricula. Studies in English from 2000 to 2010 were included searching CINAHL Plus, OVID Medline, Cochrane, SCOPUS and ProQuest and Google Scholar.Twenty-four papers were identified that met the inclusion criteria. All were quantitative reports; outcomes and levels of evidence varied with two notable papers indicating that simulation had an impact on clinical practice. Benefits of SLP over didactic formats were apparent, as were the development of non-technical skills confidence and competence. The study outcomes were limited by the range of evidence and context of the reports which focussed on obstetric emergency training using a number of simulation techniques.There is evidence that simulated learning of midwifery skills is beneficial. Simulation learning has an educational and clinical impact and advantages over didactic approaches. Where clinical practice is infrequent i.e. obstetric emergencies, simulation is an essential component of curricula. Simulation enhances practice and therefore may reduce the time taken to achieve competence; however there is no evidence from the literature that simulation should replace clinical practice.

This paper explores the prevalence of 'near death experience' phenomena associated with a resuscitation event and examines the current state of evidence for causation. Patients' reports of unusual recollections associated with a period of unconsciousness (perceived as approaching death) have fascinated individuals and the medical fraternity. Near death experiences (NDE) are reported in 4-9% of general community members and up to 23% of critical illness patients, although they can occur in healthy individuals who may think they are in peril. One explanation is that paranormal visions that include seeing bright lights, a tunnel and having feelings of peace may be a stage of enlightenment as death approaches. More objective explanations point to neuro-chemical changes in a stressed or dying brain as explanation for nearly all the elements of near death experience. However if this is so, NDE should occur in all patients who are critically ill and near death. In general, patients report positive psychological outcomes after a near death experience. Nurses can support patients during a time of crisis by assisting them and their families to comprehend the experiential event using effective communication and listening skill.

This paper explores the domains of influence affecting practice nurses’ ability to find, evaluate and use clinical evidence. A cross-sectional survey of general practice nurses (n = 590) in Victoria, Australia in 2008 provided data for a principal components analysis. The research replicates a study undertaken in the UK using the Developing Evidence-Based Practice Questionnaire. Five domains of influence on nurses’ translation of evidence were identified: skills in finding/reviewing evidence; barriers to finding/reviewing evidence; knowledge from published sources; knowledge from other sources; and barriers or facilitators to change. Each domain was interpreted as underlying the relationship of nurses with evidence-based practice and was comparable to the original study’s findings when subjected to factor analysis. Findings from this study show that the Developing Evidence-Based Practice Questionnaire—Au is a valid and useful instrument in determining the influences on practice nurses’ ability to effect knowledge translation and conduct practice based on evidence. Given these findings, a new model is proposed that explains the influence of a number of domains on Australian general practice nurses’ translation of knowledge into practice.

Aim: Dietitian and general practitioner collaboration in the nutrition care of a patient is important to assist patients to achieve their nutrition goals. This paper aims to review the published literature on dietitians' correspondence practices with recipient general practitioners regarding nutrition interventions recommended to patients. Methods: A literature search was conducted of publications from 1995 to December 2009. Key words were used to search the electronic databases Medline, CINAHL Plus, ProQuest, PsycINFO and Google Scholar. Twenty papers that addressed this topic were selected by two authors for inclusion in the review. Results: There is evidence that dietitians often fail to provide general practitioners with formalised correspondence that describes dietitians' nutrition interventions with patients. Doctors report they lack patient information via dietitians' correspondence. Information about nutrition care of hospital patients often remains within hospital records. Doctors prefer standardised letter formats with content presented succinctly. The letter should include a nutrition diagnosis, agreed goals, a plan for ongoing dietetic visits and instructions for a general practitioner's supportive actions. Conclusion: Dietitians need skill in drafting reports or letters useful for general practitioners by selecting content of value to doctors and using a suitable style. Implementation of shared electronic records in Australia will facilitate information transfer to help realise collaborative patient care. Further investigations of dietitian–general practitioner correspondence are warranted to determine best practice.

Medical emergency team performance including non-technical skills, is receiving increased attention due to the influences on patient safety. The Team Emergency Assessment Measure (TEAM) was developed to enable standardized performance assessment and structured team debriefing. From several studies, the TEAM has demonstrated a substantial body of normative data confirming its validity and reliability. This includes high uni-dimensional validity, significant subscale relationships between Teamwork and Leadership and between Teamwork and Task Management (p

Aim: To explore private practice dietitians’ experiences of Medicare Chronic Disease Management allied health program operations, particularly regarding workplace environments, patient management practices and acceptance of the program. Methods: A cross-sectional national survey was administered electronically in 2008. All private practice members of Dietitians Association of Australia were invited to participate. A 38-item questionnaire asked about referrals, patients, fees, billing and participant demographics. Descriptive statistics, c 2 and Spearman’s rank order correlation coefficient were used for analysis (if P < 0.05). Results: There were 356 (47%) dietitian participants; 94% were Medicare providers. Most (75%) worked in private practice 20 hours per week (median 12.0) and half (47%) in sole practices. Medicare referrals made up 0–100% of their practices. Patients were seen as complex because of their chronic conditions. Many dietitians reported inability to complete initial patient education within funded consultation time. Consultation time was often increased and patients were required to pay more than the scheduled fee. Fees were lower for follow-up consultations. Dietitians’ acceptance of the Medicare-Plus Chronic Disease Management program was low. Conclusion: Current Medicare policy arrangements provide insufficient initial consultation time for counselling; and available frequency of follow-up consultations is low. As a consequence, eligible patients have limited access to low-cost dietetics services. The results support a need for review of the Medicare-Plus Chronic Disease Management policy for dietetics interventions and alignment with other counselling services to better meet the needs of providers and also of patients with chronic conditions and diet-related risk factors.

Aim To develop a valid, reliable and feasible teamwork assessment measure for emergency resuscitation team performance. Background Generic and profession specific team performance assessment measures are available (e.g. anaesthetics) but there are no specific measures for the assessment of emergency resuscitation team performance. Methods (1) An extensive review of the literature for teamwork instruments, and (2) development of a draft instrument with an expert clinical team. (3) Review by an international team of seven independent experts for face and content validity. (4) Instrument testing on 56 video-recorded hospital and simulated resuscitation events for construct, consistency, concurrent validity and reliability and (5) a final set of ratings for feasibility on fifteen simulated ‘real time' events. Results Following expert review, selected items were found to have a high total content validity index of 0.96. A single ‘teamwork' construct was identified with an internal consistency of 0.89. Correlation between the total item score and global rating ( rho 0.95; p k 0.55) and retest reliability ( k 0.53) were ‘fair', with positive feasibility ratings following ‘real time' testing. The final 12 item (11 specific and 1 global rating) are rated using a five-point scale and cover three categories leadership, teamwork and task management. Conclusion In this primary study TEAM was found to be a valid and reliable instrument and should be a useful addition to clinicians' tool set for the measurement of teamwork during medical emergencies. Further evaluation of the instrument is warranted to fully determine its psychometric properties.

cant r.p. & cooper s.j. (2010) Simulation-based learning in nurse education: systematic review. Journal of Advanced Nursing66(1), 3–15. Abstract Title. Simulation-based learning in nurse education: systematic review. Aim. This paper is a report of a review of the quantitative evidence for medium to high fidelity simulation using manikins in nursing, in comparison to other educational strategies. Background. Human simulation is an educational process that can replicate clinical practices in a safe environment. Although endorsed in nursing curricula, its effectiveness is largely unknown. Review methods. A systematic review of quantitative studies published between 1999 and January 2009 was undertaken using the following databases: CINAHL Plus, ERIC, Embase, Medline, SCOPUS, ProQuest and ProQuest Dissertation and Theses Database. The primary search terms were ‘simulation’ and ‘human simulation’. Reference lists from relevant papers and the websites of relevant nursing organizations were also searched. The quality of the included studies was appraised using the Critical Appraisal Skills Programme criteria. Results. Twelve studies were included in the review. These used experimental or quasi-experimental designs. All reported simulation as a valid teaching/learning strategy. Six of the studies showed additional gains in knowledge, critical thinking ability, satisfaction or confidence compared with a control group (range 7–11%). The validity and reliability of the studies varied due to differences in design and assessment methods. Conclusion. Medium and/or high fidelity simulation using manikins is an effective teaching and learning method when best practice guidelines are adhered to. Simulation may have some advantage over other teaching methods, depending on the context, topic and method. Further exploration is needed to determine the effect of team size on learning and to develop a universal method of outcome measurement.

Background: The purpose of the study was to ascertain the place of knowledge and evidence in the context of Australian general practice nursing. General practice nursing is a rapidly developing area of specialized nursing in Australia. The provision of primary care services in Australia rests largely with medical general practitioners who employ nurses in a small business model. Methods: A statistical research design was used that included a validated instrument: the developing evidence-based practice questionnaire (Gerrish et al. 2007). A total of 1,800 Victorian practice nurses were surveyed with a return of 590 completed questionnaires, equaling a response rate of 33%. Findings: Lack of time to access knowledge for practice was a barrier for participants in this study. In-service education and training opportunities were ranked as the number one source of knowledge for general practice nurses. Experiential learning and interactions with clients, peers, medical practitioners, and specialist nurses were also considered very important sources of knowledge. Research journals were ranked much lower than experiential learning and personal interactions. Participants assessed their own skills at sourcing and translating evidence into practice knowledge as low. Younger general practice nurses were more likely than older nurses to assess themselves as competent at using the library and Internet to locate evidence. Discussion: The predominantly oral culture of nursing needs to be identified and incorporated into methods for disseminating evidence from research findings in order to increase the knowledge base of Australian general practice nurses. Conclusions: Findings from this study will be significant for policy makers and funders of Australian nursing in general practice. The establishment of a career structure for general practice nurses that includes salaried positions for clinical nurse specialists would assist in the translation of evidence into knowledge for utilization at the point of care.

Aim: Issues of trust are important factors that affect communication in professional–client relationships. This paper aims to explore trust in communication from the viewpoint of both clients (the truster) and dietitians. Methods: The qualitative research techniques were based on grounded theory. Purposive samples of 46 dietitians and 34 of their adult outpatients were drawn from health services (hospitals, community services and private clinics) in one state of Australia. Clients from eight centres were aged from 21 to 80+ years. Audio-recorded in-depth interviews and focus groups were used to gather data. Transcribed narratives were open-coded and examined for deviant cases. Themes identified in dietitian and client data sets describing clients' trust were compared. Results: The themes identified confirmed a typology of trust (from the perspective of the truster) present in the health care literature. Clients' trust was derived from institutional context or reputation. Interpersonal trust perceived in verbal and non-verbal communications with a dietitian were in evidence. Dietitians' value attributes of integrity and respect were identified as traits that help build trust and demonstrate dietitians' professionalism. The findings were built into a concept model of trust. Conclusions: Behaviours shown that convey a sense of acceptance, understanding and individual management may lead to positive communication, and hence help build a client's trust in a professional. The link between trust, performance and dietetics clients' outcomes should be investigated further.

Aim: To examine process evaluation methods used by Australian dietitians in nutrition education of individual clients. ndi_1334 87..93 Methods: A qualitative–quantitative design was used. A purposive sample of 46 clinical dietitians working in Victorian hospitals, community or private practice attended audio-recorded focus groups or an in-depth interview. Themes identified were used to develop a questionnaire to survey Australian dietitians asking about client education strategies and evaluation methods. Two hundred and fifty-eight dietitians (16%) responded to a Web-based questionnaire. Criterion for extraction of results was 70% agreement. Descriptive statistics, chi-squared and Spearman’s rank order correlation analyses were used (if P 0.05). Results: Eleven process evaluation strategies were used by 84% of dietitians. Results clustered into a typology of four evaluation strategies: evaluating planning of the intervention; evaluating assimilation of new information; evaluating intention to change behaviour; and determining a patient’s satisfaction with a consultation. Only two methods were used ‘often’ by more than half the respondents, indicating a wide range in choice of strategies. Seven of 11 strategies in use evaluated information assimilation. There was no significant difference by work category, state of employment or seniority. Evaluative questions to be answered are: Did they agree to it? Did they learn it? Will they use it? What has changed? Conclusion: Process evaluation is best achieved by simultaneous teaching and evaluation. Dietitians may benefit from further skills training to more fully utilise patient-centred planning. Further investigation is warranted to define best practice.

Decline in nutritional status during hospitalisation highlights the importance of achieving high-quality foodservice. This research aimed to explore patient satisfaction with hospital foodservices from on-site and off-site cook-chill production systems. Two cross-sectional surveys of hospital inpatients were conducted in an acute medical and a subacute rehabilitation ward before and after a change to off-site cook-chill production. The survey used a validated instrument (Acute Care Hospital Foodservice Patient Satisfaction Questionnaire). Sixty-six patients in 2006 and 51 patients in 2007 recorded unchanged results across factors of food quality, staffing service quality, meal service quality and physical environment quality. Satisfaction with foodservice was rated ‘good’ or ‘very good’ by the majority of patients in both surveys. The research instrument was able to deconstruct various issues relating to patients' satisfaction and six individual items correlated with overall satisfaction with foodservice. To maximise patient satisfaction, further research into these, and additional dimensions of foodservice quality is needed to determine how improvements may be achieved.

Aim: The present study examined dietitians’ and clients’ perceptions of competence required for the process of nutrition education of individuals and used results to validate performance criteria. Methods: A sequential qualitative–quantitative design was used. A quota sample of dietitians in one Australian state (n = 46; 12%), working in hospital, community or private practice, attended a focus group or interview. A quota of their clients (n = 34) from eight centres was interviewed. Participants were asked about dietitians’ skills and attributes. Audio-taped data were transcribed verbatim and open-coded to identify themes; results were used to develop an 88-item questionnaire asking about educational strategies, counselling skills and professional attributes. Australian dietitians in the targeted population (n = 258; 16%) responded to a Web-based survey in 2006. Descriptive statistics were used for ranked data and between-group relationships were examined using c 2 . Criterion for item acceptance was 70% agreement. Results: Results from two phases of research and from dietitians and clients revealed agreement about dietitians’ desirable nutrition education skills. In the questionnaire results, no significant differences were found in educational strategies used by employment category, by year of qualification or experience. Forty-two performance criteria were confirmed and clustered into an eight-step process model. Underpinning skills of ‘nutrition knowledge’, ‘professional and ethical values’ and ‘communication skill’ were identified as necessary attributes and are described. Conclusions: Performance criteria for nutrition education of individuals were confirmed as valid. A process model is presented, which describes a proficient practice level. This should be evaluated further as a nutrition education and counselling practice assessment tool.

Aim: To examine outcome measures used by Australian dietitians in evaluating their nutrition education of individual patients. Methods: A sequential qualitative—quantitative design was used. First, a purposive sample of 46 clinical dietitians working in Victorian hospitals, community or private practice attended an audio-recorded focus group or in-depth interview. Transcribed narratives were open-coded to identify themes and results used to develop a questionnaire to survey Australian dietitians nationally to ask about patient education strategies and evaluation methods. In 2006, 258 dietitians (16%) responded to a Web-based questionnaire. Criterion for extraction of results was 70% agreement on response items when measured on a 5-point scale. Descriptive statistics were used and between-group analyses were conducted using c 2 and Spearman’s rank order correlation (if P < 0.05). Results: Nine outcome measures were confirmed as valid in the categories of direct nutrition outcomes, clinical and health status outcomes and patient value-based care outcomes. There was no significant difference in practice by work category, or time since qualification. Evaluation was most commonly performed prospectively at completion of a consultation, or as part of review consultations. The most common barrier to outcomes research was a lack of time. However, a lack of research skill or health team collaboration may also be a barrier as dietitians did not routinely research or report on outcomes for groups of patients, with potential to identify possible practice improvements. Conclusion: Research training may be needed. Further investigation is recommended to develop best practice policies for dietetics outcomes research.

Aim: To critically examine Australian dietitians' experiences of nutrition education and counselling dilemmas arising from their training, competence and experience in education of individual clients. Methods: Participants were a self-selected sample of Australian dietitians who were working with clients in community, hospital, private practice or other employment. They responded to a researcher-developed Web-based questionnaire asking about skills required for education and counselling of individual clients in 2006. Data were collected electronically and descriptive statistics used to compare response distributions, and open-ended responses were examined by content and thematic analysis. Results: Of 258 respondents, half-qualified to enter dietetics since 1998. There was a change in the focus of practice from information-giving (as taught 30 years ago) to use of two-way communication. Dietitians aimed to use counselling, together with discussion and instruction, as methods for educating and interacting with clients. Four-fifths of dietitians recently qualified (1998–2006) were satisfied with their initial preparation for nutrition education and counselling roles. However, many commented that training courses were too focused on knowledge acquisition rather than skills development in nutrition counselling. Planned skill development in employment was described and dietitians were in favour of a system of mandatory counselling topics within continuing professional development CPD in order to improve counselling skill proficiency and aim for expert skills. Conclusion: Practising dietitians' perceptions indicated a need for greater focus on development of expert nutrition education and counselling skills, both in initial training and in the workplace, because these were seen as key skills for practice in the 21st century.

Objective: To describe Victorian private practitioner dietitians’ experience of the Enhanced Primary Care (EPC) program funded under national heath insurance. Design: Dietitians’ experience of the EPC program was investigated between August 2004 and July 2005. A purposive sample of 10% (n = 15) of Victorian dietitians in private practice was interviewed via semi-structured interviews or focus groups. Focus group/interview data were audio-taped, transcribed verbatim and thematically analysed using NVIVO software to manage data. Subjects: Victorian dietitians. Setting: Dietetic private practice. Main outcome measures: Issues identified from narrative themes. Results: Thirteen (86%) participants were registered with the Medicare Australia and managed EPC-referred patients. Two chose not to. All those using the program supported it but voiced frustrations experienced in the first year. Five themes emerged from narrative analysis involving difficulties with implementation in the following areas: referral issues, client preparedness, annual number of consultations limit, impact of financial cost on client and non-reimbursed administration costs. Conclusion: For clients with chronic illness, access to dietitians in private practice under Medicare EPC is an important service. As increasing numbers of dietitians nationally work with EPC patients with chronic illness or complex care needs, there is a need for information sharing between professional groups about billing procedures and chronic care management. More dietitians need to structure practice to initiate bulk-billing. Rigorous evaluation is needed to understand which diagnosis types can benefit from the program and to implement an evidence-based model of chronic care improvement for dietetics consultations.

E-simulation involves goal-based role play using digital simulations that take place via a computer screen. Learners interact with the program via multi-media applications such as animation and video, graphics, sound, vision, and text through the use of advanced Web authoring tools. When the simulation is Web-based (via a remote server), this allows data collection and real-time feedback. We aimed to explore how the Internet has been utilized for the purposes of e-simulation in healthcare education. We describe published resources focusing on pre-registration education for undergraduate nursing and medicine students. Many studies in these domains have developed e-simulation as components of research, but we identified only four that were openly accessible (without fees). We describe four Web-based simulation programs that will benefit learners through better understanding of cardiopulmonary resuscitation; patient deterioration recognition and management; communication with the mentally ill; and knowledge of cultural competence. These programs have the advantage of being available across borders and are accessible to a broad audience wherever there is adequate Internet access. The approach appears to be highly acceptable to learners and offers the opportunity for repeated practice. The time is right for greater distribution and sharing of Web-based simulation resources for teaching in both undergraduate and at professional levels. Web-based simulation programs are a valuable resource that can be used in combination with traditional forms of laboratory and classroom teaching, in order to facilitate the development of students’ clinical competence.

Summary Background High-fidelity simulation pedagogy is of increasing importance in health professional education; however, face-to-face simulation programs are resource intensive and impractical to implement across large numbers of students. Objectives To investigate undergraduate nursing students' theoretical and applied learning in response to the e-simulation program—FIRST2ACT WEBTM, and explore predictors of virtual clinical performance. Design and setting Multi-center trial of FIRST2ACT WEBTM accessible to students in five Australian universities and colleges, across 8 campuses. Participants A population of 489 final-year nursing students in programs of study leading to license to practice. Methods Participants proceeded through three phases: (i) pre-simulation—briefing and assessment of clinical knowledge and experience; (ii) e-simulation—three interactive e-simulation clinical scenarios which included video recordings of patients with deteriorating conditions, interactive clinical tasks, pop up responses to tasks, and timed performance; and (iii) post-simulation feedback and evaluation. Descriptive statistics were followed by bivariate analysis to detect any associations, which were further tested using standard regression analysis. Results Of 409 students who commenced the program (83% response rate), 367 undergraduate nursing students completed the web-based program in its entirety, yielding a completion rate of 89.7%; 38.1% of students achieved passing clinical performance across three scenarios, and the proportion achieving passing clinical knowledge increased from 78.15% pre-simulation to 91.6% post-simulation. Knowledge was the main independent predictor of clinical performance in responding to a virtual deteriorating patient R2 = 0.090, F(7, 352) = 4.962, p Discussion The use of web-based technology allows simulation activities to be accessible to a large number of participants and completion rates indicate that ‘Net Generation’ nursing students were highly engaged with this mode of learning. Conclusion The web-based e-simulation program FIRST2ACTTM effectively enhanced knowledge, virtual clinical performance, and self-assessed knowledge, skills, confidence, and competence in final-year nursing students.

International studies indicate that the recognition and management of deteriorating patients in hospitals are poor and that patient assessment is often inadequate. Face-to-face simulation programs have been shown to have an impact on educational and clinical outcomes; however, little is known about performance in contemporary healthcare e-simulation approaches. Using data from an open-access Web-based patient deterioration program (FIRSTACTWeb), the performance of 367 Australian nursing students in identification of treatment priorities and clinical actions was analyzed using a military model of Course of Action Simulation Analysis. Participants' performance in the whole program demonstrated a significant improvement in knowledge and skills (P ≤ .001) with high levels of participant satisfaction. Course of Action Simulation Analysis modeling identified three key participant groupings within which only 18% took the "best course of action" (the right actions and timing), with most (70%) completing the right actions but in the wrong order. The remaining 12% produced incomplete assessments and actions in an incorrect sequence. Contemporary approaches such as e-simulation do enhance educational outcomes. Measurement of performance when combined with Course of Action Simulation Analysis becomes a useful tool in the description of outcomes, an understanding of decision making, and the prediction of future events.