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The aim of this project was to better understand nurse navigators work with children and families who are living with severe autism spectrum disorder to achieve improved health and wellbeing outcomes. Nurse navigators were introduced into the public health sector in Queensland in 2016, with 400 navigators currently working across 16 health services in diverse geographic and demographic settings. Narrative inquiry was used to explore one nurse navigator's journey working with children and families living with severe Autism. The challenges of rigid health systems to adapt to the requirements of children with special needs, particularly in relation to care in the emergency department and where interventional procedures are necessary were apparent. Nurse navigators can effectively co-ordinate the care of an extremely vulnerable patient cohort and provide essential advocacy in a health system that is rigid and lacking the flexibility to deal with individual needs.

Summary: Background: Skilled facilitators are essential to drive effective simulation training in healthcare. Competency‐based frameworks support the development of facilitation skills but, to our knowledge, there are no frameworks that specifically address context‐sensitive priorities developed with practitioners working in low‐resource settings. Methods: We aimed to develop a core competency framework for healthcare simulation facilitation in low‐resource settings using a modified Delphi process. We drew on the domain expertise of members of the Vital Anaesthesia Simulation Training Community of Practice, with the study guided by a four‐member steering group experienced in the conduct of simulation in low‐resource settings. In survey round 1, participants (n = 54) were presented with an initial competency set derived from a previous qualitative study and co‐created a set of 57 competencies for effective simulation facilitation in low‐resource settings. In survey round 2, participants (n = 52) ranked competencies by relevance into three performance categories: techniques; artistry; and values. In survey round 3, participants (n = 50) ranked competencies on their importance. The steering group collated results and presented a draft core competency framework. In survey round 4, participants (n = 50) voted with 98% agreement that this framework represented the most relevant and important competencies for effective facilitation of simulation sessions in low‐resource settings. Results: The final 32‐item framework encompasses core competencies found in existing standards and includes important new concepts such as demonstration of cultural sensitivity; humility; ability to recognise and respond to potential language barriers; facilitation team collaboration; awareness of logistics; and contingency planning. Discussion: This competency‐based framework highlights specific practices required for effective simulation facilitation in low‐resource settings. Further work is required to refine and validate this tool to train simulation facilitators to deliver effective training to improve patient safety. [ABSTRACT FROM AUTHOR]

Introduction: The challenging work environments mental health nurses (MHNs) encounter can negatively impact their mental health, psychological well‐being and physical health. While these impacts have been investigated in quantitative research, little is known about work‐related stress from the perspective of MHNs. Aim: To explore the stresses faced by nurses working in mental health settings and to gain an understanding of the underlying workplace context. Method: A descriptive qualitative study with data collected via semi‐structured individual telephone interviews conducted with n = 21 Western Australian MHNs. Data were analysed using reflexive thematic analysis. Results: A total of 85 codes were generated that led to the identification of 13 subthemes and 4 main themes: (1) mental health nursing context, (2) work environment stressors, (3) factors that alleviate stress and (4) the impact of workplace stress. Discussion: Many of the stressors MHNs were exposed to are modifiable, such as understaffing and poor skill mix. Modifiable stressors increased risk for MHNs, impeded patient care and exacerbated inherent stressors such as patient acuity and complexity. Implications for Practice: This study collected data that provide rich descriptions of the experiences of MHNs and identify modifiable work‐related stressors that could be alleviated through effective leadership and management. [ABSTRACT FROM AUTHOR]

Integration is a hallmark of mixed methods research and is constantly evolving. Joint displays have emerged as an effective method of integration at the analysis and interpretation level, facilitating visual comparison of quantitative and qualitative findings to present inferences greater than the quantitative and qualitative findings alone. Although literature reviews and concept analyses frequently precede mixed methods investigations, these are not commonly included in the integration process. To advance mixed methods research, we present a novel method of integrating data sources including rigorous literature reviews using joint display, that builds on the concept of creating a sum that is greater than quantitative and qualitative findings alone, with examples from two research studies. [ABSTRACT FROM AUTHOR]

Introduction: Nurse Navigators were introduced in Queensland, Australia, in 2016. Nurse Navigators coordinate person‐centred care, create partnerships, improve care coordination and outcomes and facilitate system improvement, independently of hospital or community models. They navigate across all aspects of hospital and social services, liaising, negotiating and connecting care as needed. People stay with Nurse Navigators for as long as required, though the intent is to transition them from high‐care needs to self‐management. Nurse Navigators are a working model in rural and remote areas of Queensland. Objective: To describe where the rural and remote Nurse Navigator position fits within the Rural Remote Nursing Generalist Framework and to define the depth and breadth of the rural and remote Nurse Navigator's scope of practice. Design: Using template analysis, data from focus groups and interviews were analysed against the domains of the recently released National Rural and Remote Nursing Generalist Framework. Navigators working in rural and remote areas across Queensland Health were invited to an interview (n = 4) or focus group (n = 9), conducted between October 2019 and August 2020. Findings: Rural and remote Nurse Navigators are proficient in all domains of the framework and actively champion for their patients, carers and the communities where they live and work. Discussion: This research demonstrates that rural and remote Nurse Navigators are a working model of advanced nursing practice, acting as 'champions' of The Framework. Conclusion: The Nurse Navigator model of care introduced to Queensland exemplifies proficient registered nurse practice to the full extent of their knowledge and skill. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of a co-designed intervention to reduce time spent on clinical documentation and increase time for direct patient care. Design: A pre- and post-test interventional study with multi-method evaluation, reported according to the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs guidelines. Methods: An intervention to decrease the burden of documentation was co-designed and implemented. Pre- and post-intervention data were collected via time and motion studies and the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. Documentation audits were conducted to assess intervention fidelity. Results: Twenty-six shifts were observed (13 pre-intervention, 13 post-intervention). Although the coronavirus pandemic contributed to decreases in staffing levels by 38% (from 118 to 73 staff), the number of task episodes completed increased post-intervention, across all shift patterns. Documentation took less time to complete postintervention when assessing time per episode. A mean increase of 201 episodes was observed on morning shifts, 78 on evening shifts and 309 on night shifts. There were small increases for time spent on direct patient care compared to pre-intervention but there was less time per episode. Results from the BurDoNsaM survey indicated that participants felt documentation took less time post-intervention. Documentation audits found completion improved as staff gained familiarity, but deteriorated when staffing levels were reduced. Conclusion: The intervention was able to reduce time spent completing documentation, increasing the time available for direct patient care. Implications for the profession and/or patient care: Completing clinical documentation is part of the daily work of nurses and midwives. Clinical documentation needs to accurately capture key information in a concise and streamlined manner to avoid unnecessary burdens and release time for direct patient care. Impact: • This study tested a co-designed intervention to address the burden of clinical documentation for nurses and midwives, • The intervention reduced time spent on clinical documentation and increased time for direct patient care, • This study could be replicated to reduce the burden of clinical documentation in other settings and benefit clinicians and patients by releasing more time for direct patient care. Reporting Method: The study is reported using the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs (TREND) guidelines. Patient or Public Contribution: The research project and intervention evaluated in this study were co-designed through a clinician-researcher collaboration. A research team that consisted of clinically based nurses and midwives and nurse scientists was formed to address the burden of clinical documentation. As the end-users of clinical documentation, the clinically based nurse and midwife co-investigators were involved in the design, conduct, interpretation of the data, and preparation of the manuscript. [ABSTRACT FROM AUTHOR]

Purpose: To explore levels of Navigator resilience, well‐being, burnout, and turnover intent. Design: A longitudinal, multi‐methods study concurrently collected quantitative and qualitative data over three years. Methods: A survey and Action Learning Groups. Findings: No statistically significant change in resilience, well‐being, burnout, or turnover intent. Supports, self‐care and leaving the position, were used to maintain well‐being. Conclusions: While quantitative measures did not change, qualitative data demonstrated how adaptive coping mechanisms maintain well‐being. Recommendations for nurses working in Navigator, or similar community/public health roles include work‐based programs targeting support, good leadership, governance systems including their impact on turnover intent. Clinical evidence: Job turnover intent can be used as a mechanism to monitor resilience and well‐being. [ABSTRACT FROM AUTHOR]