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Neurological conditions produce considerable disease burden.To describe quality of life in patients with neurological conditions and informal caregivers receiving postdischarge generic community neurological nursing services, and caregiver burden.A descriptive cross-sectional design was used with researchers administering the WHOQOL-BREF Australian Version questionnaire and Zarit Burden Interview.Most patients and caregivers rated quality of life as 'Good'. The patients' physical, psychological and environment domain scores, and caregivers' physical domain scores, were below norms. Half of the caregivers experienced burden and 42% had risk for depression.A heterogeneous group of patients with neurological conditions had considerable care and support needs for fundamental functioning postdischarge. Quality of life and caregiver burden measures highlight the impact of their circumstances on their health and wellbeing. Research is warranted to determine a comprehensive set of generic needs to guide integrated community nursing services for building patient and caregiver self-management capacity.

Background Nursing is a high-risk occupation for work-related musculoskeletal disorders and many nursing students have a history of musculoskeletal symptoms. Aims To quantify (1) changes in exercise and musculoskeletal symptoms from pre-registration to 12-month registered nurses, and (2) the best predictor of severity of musculoskeletal symptoms from measures of the five physical fitness components and exercise participation. Methods In this longitudinal study, August 2013 to April 2015, 62 (55.9%) of 111 nursing students fitness tested completed questionnaires measuring nursing work history, exercise, and musculoskeletal symptoms at baseline and 12 months post-registration. Findings Nurses’ exercise participation declined post-registration and 38.0% were overweight/obese. At 12 months post-registration, 76.0% experienced musculoskeletal symptoms, mainly affecting the low back, neck, and/or shoulders. Approximately 50% of symptoms were attributed partly/solely to work; yet few were reported to employers or prompted sick leave. For female nurses, increases in whole-body strength were positively associated with increases in whole-body musculoskeletal symptom severity; however, the multiple regression model contained unexplained variability. Discussion Many nursing students entered nursing with modifiable risk factors for work-related musculoskeletal disorders: overweight/obese, earlier musculoskeletal symptoms, and poor exercise habits. As registered nurses, they showed high lifetime and 12-month prevalence of musculoskeletal symptoms and declining exercise. Reporting musculoskeletal symptoms were undervalued. Conclusion(s) Inadequate exercise and high prevalence of musculoskeletal symptoms among novice registered nurses may contribute to/aggravate musculoskeletal disorders. Nurse leaders should understand the exercise habits and fitness of pre-registration and novice registered nurses to develop interventions towards improving health behaviours to reduce musculoskeletal disorder risk.

Neurological disorders are a leading cause of disease burden worldwide, placing a heavy demand on health systems. This study evaluated the impacts and cost savings of a community-based nursing service providing supported discharge for neurological patients deemed high-risk for unplanned emergency department presentations and/or hospital readmissions. It focused on adult patients with stroke, epilepsy, migraine/headache or functional neurological disorders discharged from a Western Australian tertiary hospital. An observational design was used comprising prospective enrolment of patients receiving nurse-led supported discharge and follow-up (Neurocare), 21 August 2018 to 6 December 2019 (N = 81), and hospital administrative data, 1 February 2016 to 31 January 2018, for patients in previous care model (N = 740). Healthcare utilisation and annualised cost savings from reduced rehospitalisation and/or emergency department presentations within 28 days post discharge were compared. Neurocare patients' postdischarge functional and health-related quality of life outcomes, and perceived involvement in self-management and integrated care were surveyed. The hospital's total cost savings are A$101,639 per annum and A$275/patient/year with a return on investment of 2.01. There was no significant difference in hospital length of stay (LOS) between models, but older age was associated with longer length of hospital stay and a predictor for non-neurological readmissions. Neurocare patients showed improved functional status, less equipment and/or service needs, improved health-related quality of life. They felt involved in self-managing their condition with well-integrated postdischarge care. This nurse-led model of transitional care for neurology patients discharged from hospital produced cost savings and a positive return on investment compared with usual care. With service maturity, earlier supported hospital discharge and reduced LOS may follow. Patients' reduced service needs and improved functional status and health-related quality of life may positively impact healthcare utilisation. Future research should include larger patient samples and multiple sites.

Problem/background Post-discharge healthcare for patients with neurological conditions is indicated to be suboptimal. Aim To capture hospital discharge experiences and ramifications among patients with neurological conditions, and informal caregivers, and their recommended solutions. Methods A modified World Cafe was held November 2016. A facilitator moderated structured group discussions about post-discharge challenges, displayed real-time in GroupMap. Using the software's voting, ratings of priority challenges/issues and solutions were tabulated to identify whole group consensus. Findings Eleven adults with neurological conditions (five females) and four adult informal caregivers (three females) participated. Major post-discharge challenges were: (i) inadequate self-management instruction, (ii) feeling discharged too early, (iii) family pressured to support patient without capacity, (iv) financial impact, (v) difficulties accessing social services, (vi) social isolation, (vii) inadequate support services, and (viii) poor communication with, and between, healthcare providers. Top-ranked solutions were: (i) counseling services at symptom onset, (ii) community neurological nurse referrals to, and liaison with, services, (iii) improved communication with general practitioner, (iv) community neurological nurse facilitating financial assistance, and (v) social worker in pre-diagnostic period facilitating financial assistance and support. Discussion Peridischarge, patients and informal caregivers face a complexity of information and services, and struggle to self-manage conditions, experiencing burden that jeopardises their health and wellbeing. Proposed solutions to post-discharge challenges emphasise self-management, psychosocial support, care coordination, health system navigation, and communication. Conclusion Generic community neurological nurses could link hospital and community-based services. Research is required regarding which translational and after hospitalisation care model improves care coordination and continuity, and care recipients' capacity.

Background Nurse-sensitive patient outcomes that are suitable for general medical and surgical settings are well developed. Indicators developed for general ward settings may not be suitable for stand-alone high acuity areas; therefore, a different set of indicators is required. Aim The aim of this review was to identify suitable indicators for measuring the impact of nurse staffing and nurse skill mix variations on patient outcomes in stand-alone high acuity areas. Methods A systematic review of the literature was undertaken for studies published between January 2000 and November 2016. Suitable indicators were identified based on simple criteria. That is, if there were at least three studies that found a significant relationship between the outcome and staffing variables and at least 50% of all the studies that investigated that outcome reported a significant association, that variable was included in the list of potential outcomes. Findings This review identified eight indicators from 44 eligible research articles. These were: mortality, length of stay, central-line-associated bloodstream infection, ventilator-associated pneumonia, sepsis, falls with injury, reintubation, and medication errors. Discussion Further work is needed to clarify the definitions for each of the indicators. Standard definitions should be developed using algorithms linked to International Classification of Diseases codes to ensure consistency and comparability across studies. The majority of these outcomes could be measured using administrative patient datasets. Reintubation and medication errors may be difficult to measure with available datasets requiring specialised data collections. Conclusion This comprehensive review identified a number of indicators that could be developed for further testing to monitor the quality of nursing care in Intensive Care Units.

Background: Achieving increased participation of Aboriginal and Torres Strait Islander peoples in Australia's health workforce, particularly nursing, is federal government policy imperative. However, the uptake of Aboriginal and Torres Strait Islander students into nursing has stalled and their attrition from tertiary nursing courses is considerably higher than for other students. Aim: To alert the profession to issues impacting enrolled nursing education for Aboriginal and Torres Strait Islander students. Design: Discussion paper. Results: Studies of Aboriginal and Torres Strait Islander students mainly focus on tertiary education for registered nurses whereas vocational education and training (VET) for enrolled nurses is usually overlooked. It is generally assumed that the issues influencing the recruitment, attrition, and retention of Aboriginal and Torres Strait Islander students in higher education universities and other institutions similarly impact enrolled nursing students in the VET sector. Conclusion: Research that contributes robust evidence-based knowledge specifically on strategies addressing issues in enrolled nursing education for Aboriginal and Torres Strait Islander students and their employment uptake is required.

Neurological conditions represent leading causes of non-fatal burden of disease that will consume a large proportion of projected healthcare expenditure. Inconsistent access to integrated healthcare and other services for people with long-term neurological conditions stresses acute care services. The purpose of this rapid evidence assessment, conducted February-June 2016, was to review the evidence supporting community neurological nursing approaches for patients with neurological conditions post-discharge from acute care hospitals. CINAHL Plus with Full Text and MEDLINE were searched for English-language studies published January 2000 to June 2016. Data were extracted using a purpose-designed protocol. Studies describing community neurological nursing care services post-discharge for adults with stroke, dementia, Alzheimer's disease, Parkinson's disease, multiple sclerosis or motor neurone disease were included and their quality was assessed. Two qualitative and three quantitative studies were reviewed. Two themes were identified in the narrative summary of findings: (i) continuity of care and self-management and (ii) variable impact on clinical or impairment outcomes. There was low quality evidence of patient satisfaction, improved patient social activity, depression scores, stroke knowledge and lifestyle modification associated with post-discharge care by neurological nurses as an intervention. There were few studies and weak evidence supporting the use of neurology-generalist nurses to promote continuity of care for people with long-term or progressive, long-term neurological conditions post-discharge from acute care hospital. Further research is needed to provide role clarity to facilitate comparative studies and evaluations of the effectiveness of community neurological nursing models of care.

Background Culturally appropriate health care delivery is essential to improve health outcomes for Aboriginal peoples. There is a shortage of Aboriginal and Torres Strait Islander nurses partly due to disproportionately high non-completion rates among tertiary sector students. The College Persistence Questionnaire V3 (Short Form) provides scales for gauging major predictors of retention. Objective To adapt an instrument for measuring intention to persist among Aboriginal Diploma of Nursing students. Design Instrument adaptation and pretesting. Participants A convenience sample of Aboriginal Diploma of Nursing students (N = 21) at a registered training organisation in Australia. Methods The instrument was mapped against the domain of interest and modified. Ten experts reviewed its content validity; its reading ease and educational grade reading level were assessed. Results The expert panel endorsed individual items as valid (item-level Content Validity Index 0.90–1.00) and scale-level validation was acceptable (average scale-level Content Validity Index = 0.98). The minimally-adapted instrument was ‘fairly easy’ to read and suitable for general adult audiences (Flesch Reading Ease score 71.3) and was below the United States 8th grade reading level (Flesch-Kincaid Grade Level 6.7). Students took < 30 min to complete the questionnaire. All understood its purpose, found instructions clear, and questions easy to answer. Most rated its length ‘Just right’. Conclusion The College Persistence Questionnaire – Registered Training Organisation Version appears suitable for assessing factors influencing retention/attrition among Aboriginal Diploma of Nursing students. Piloting and psychometric evaluation is recommended.

Objectives The aim of this study was to assess the impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes using administrative health data. Design Logistic regression modelling was used with linked administrative health data to examine the association between seven adverse patient outcomes and use of assistants in nursing utilising a pre-test/post-test design. Outcomes included were in-hospital 30-day mortality, failure to rescue, urinary tract infection, pressure injury, pneumonia, sepsis and falls with injury. Setting Eleven acute care metropolitan hospitals in Western Australia. Sample Patients were retained in the dataset if they spent any time on a medical, surgical or rehabilitation ward during their admission and excluded if they only spent time on other ward types, as the outcomes used in this study are only validated for these patient populations. There were 256,302 patient records in the total sample with 125,762 in the pre-test period (2006–2007) and 130,540 in the post-test period (2009–2010). Results The results showed three significant increases in observed to expected adverse outcomes on the assistant in nursing wards (failure to rescue, urinary tract infection, falls with injury), with one significant decrease (mortality). On the non-assistant in nursing wards there was one significant decrease (pneumonia) in the observed to expected adverse outcomes and one significant increase (falls with injury). Post-test analysis showed that spending time on assistant in nursing wards was a significant predictor for urinary tract infection and pneumonia. For every 10% of extra time patients spent on assistant in nursing wards they had a 1% increase in the odds of developing a urinary tract infection and a 2% increase in the odds of developing pneumonia. Conclusion The results suggest that the introduction of assistants in nursing into ward staffing in an additive role should be done under a protocol which clearly defines their role, scope of practice, and working relationship with registered nurses, and the impact on patient care should be monitored.

Background Nursing education appropriate to the learning needs of Aboriginal and Torres Strait Islander students is essential to prepare them for registration as nurses. Despite incentives to encourage the recruitment and retention of such students, a disproportionate number commence but do not finish their nursing studies. Objectives To describe the barriers and enablers to the retention of Aboriginal students in a Diploma of Nursing course (Enrolled/Division 2) in Western Australia. Design An exploratory descriptive design was used. Settings One metropolitan educational facility catering for Aboriginal people offering an 18-month course in a block release format. Participants A convenience sample of 16 students aged 18 + years. Methods Newly enrolled students (n = 10) participated in an investigator-developed survey to explore their motivation for entering the course. Nine of these students and a further seven students who were nearing the end of their course participated in focus groups to explore their experiences of nursing education. Results Survey respondents had a mean age of 32.7 years; most were female, had nominated family as influential in the decision to enroll, and commenced with a friend. Regarding recruitment and retention, the qualitative data highlighted the importance of students': perceptions of the training organisation, characteristics, experiences of nursing education, and sources of support. Conclusions Strategies that develop individual's resilience and engage supportive networks can assist Aboriginal students to negotiate tertiary nursing study. Academic skills assessments supplemented with tailored educational support at entry can resource students to navigate increasingly complex course content. Flexibility throughout the course enables students to negotiate study in a context of ongoing family and financial obligations.

Summary Background The nursing workforce is critical to improving patient outcomes. Without adequate evidence to guide decision making, restructuring of the nursing workforce to meet increasingly complex patient care needs in the context of registered nurse shortages might fail to produce desired outcomes. Objective To develop a suite of nursing-sensitive outcome indicators for monitoring the safety of multi-day adult medical and surgical patients associated with nurse workloads and nursing workforce models. Design A feasibility study was conducted. Setting Adult acute metropolitan public hospitals in Western Australia. Data sources Patient data for testing the suite were sourced from 2006 to 2010 coded discharge morbidity abstracts. Method Indicator development followed the American Nurses Association (2011) approach: clarifying indicator scope and purpose; determining selection criteria; reviewing the literature for potential indicators; identifying data sources; review by experts; documenting each indicator; and determining baselines. Results The proposed suite comprises 9 indicators pertaining to medical and surgical patients: failure-to-rescue; in-hospital 30-day mortality; average length of stay; hospital-acquired urinary tract infections, sepsis, pneumonia and pressure injuries; falls with injury occurring in hospital; nurse staffing levels (comprising skill mix and nursing care hours per patient day). Conclusions Sufficiently robust administrative data is available to calculate retrospective monthly and annual rates of nursing-sensitive outcomes at unit level and further analysed by ward category for metropolitan patients. Further work is required to pilot test the suite and develop processes for reporting to the Department of Health and hospitals on the impact of nurse staffing and care delivery models on patient outcomes.

Purpose: The aim of this study was to explore staffing issues and the workload drivers influencing nursing activities in designated small rural hospitals of Western Australia. A problem for small rural hospitals is an imbalance between nurse staffing resources and work activity. Sample: A purposive sample of 17 nurse leaders employed at designated small rural hospitals in Western Australia. Method: A qualitative research design was used. Data were collected by focus group and semi-structured interviews and review of Western Australian Country Health Service records. Thematic analysis was used to interpret data. Findings: A minimum nurse staffing model is in use. Staff workload is generated from multiple activities involving 24-hour emergency services, inpatient care, and other duties associated with a lack of clinical and administrative services. These factors together impact on nursing staff resources and the skill mix required to ensure the safety and quality of patient care. Conclusion: Nurse staffing for small rural hospitals needs site-specific recording techniques for workload measurement, staff utilisation and patient outcomes. It is imperative that evidence guide nurse staffing decisions and that the workload driving nursing activity is reviewed. Keywords : rural health nursing; nursing staff; skill mix; workload; workload measurement; hospitals, rural; rural health services DOI: http://dx.doi.org/10.14574/ojrnhc.v16i1.370

Aims This paper presents the relative merits and comparative costs of conducting trial of void using Hospital-In-The-Home vs. the Day Procedure Unit. Background Hospitals increasingly discharge patients with acute urinary retention with indwelling urinary catheters. For these to be removed and patients supported to return to normal urinary function, outpatient or in-home services are used. To date, the relative effectiveness and costs of Hospital-In-The-Home care and Day Procedure Unit care for trial of void have not been examined. Design This retrospective study used a static-group comparison design. Methods Hospital administrative data from 1 February 2009–30 March 2011 for patients having trial of void in the Day Procedure Unit (n = 107) and Hospital-In-The-Home (n = 163) of a tertiary hospital in Western Australia were compared in terms of patient outcomes and costs. Results Day Procedure Unit patients had longer wait times than Hospital-In-The-Home patients; there was no difference between the two groups for average per patient days of service or successful first trials. Hospital-In-The-Home care did not increase the overall period of care. Per patient average ward-equivalent cost in the Day Procedure Unit was A$396 higher than the Hospital-In-The-Home ward-equivalent cost. The average cost saving per patient for Hospital-In-The-Home care including trial of void cost and emergency department visits was A$117. Conclusion Patient outcomes from Hospital-In-The-Home trial of void in low-risk patients were comparable to those of Day Procedure Unit care and less costly. Hospital-In-The-Home care for this well-defined procedure could permit more efficient management of patient throughput.

As the producer of community education resources and editor of the newsletter for the Hepatitis Council of Western Australia (HCWA) from 1997 to 2003, I was concerned about media representations of...

AIMS AND OBJECTIVES: To describe modifications to a second extended version of the Nordic Musculoskeletal Questionnaire for online use in nursing populations, and check validity and reliability. BACKGROUND: The Nordic Musculoskeletal Questionnaire has been used to assess the severity and impact of musculoskeletal symptoms in occupational groups. The reliability of a previous extended version was established for paper-based, self-administration among nursing students. This current study extended the questionnaire to collect more information regarding musculoskeletal symptoms in all nine body regions and their work-relatedness, as an instrument is needed to gather evidence about the impact of fitness levels on occupational musculoskeletal disorders among nurses. DESIGN: Psychometric evaluation. METHOD: Sixty-five undergraduate nurses completed the online extended Nordic Musculoskeletal Questionnaire twice. Content validity was examined by expert review and construct validity by exploratory factor analysis of 90 responses from the first completion. Reliability was checked by examining internal consistency, kappa statistics, proportions of observed, and positive and negative agreements, intra-class correlation coefficient and standard error of measurement. RESULTS: The instrument had high internal consistency and exploratory factor analysis revealed it was a relatively homogenous (unidimensional) measure of musculoskeletal symptom severity. Age of onset of symptoms questions were reliable, with high mean intra-class correlation coefficients and low mean standard errors of measurement. Overall, questions showed high mean strengths of agreement and proportions of observed agreement: three-quarters of the prevalence questions and 99% of the severity/impact questions had 10% or fewer disagreements. CONCLUSIONS: Modifications to the Nordic Musculoskeletal Questionnaire and online administration did not diminish its validity or reliability for obtaining information about the severity of nurses' musculoskeletal symptoms. RELEVANCE TO CLINICAL PRACTICE: Occupational musculoskeletal disorders are an issue for nurses. This questionnaire can be used to monitor nurses' musculoskeletal health, and in musculoskeletal disorder prevention studies.

A phenomenological approach was used to explore the experiences of 11 adults attending Awareness Through Movement lessons in the Feldenkrais Method to manage chronic-episodic back pain. Semistructured interviews were analyzed. The results suggest improving self-efficacy through somatic education and awareness potentially offers a way forward given the back pain epidemic.

Internationally, shortages in the nursing workforce, escalating patient demands, and financial constraints within the health system have led to the growth of unlicensed nursing support workers. Recently, in relation to the largest publicly funded health system (National Health Service), it was reported that extensive substitution of registered nurses with unskilled nursing support workers resulted in inadequate patient care, increased morbidity and mortality rates, and negative nurse outcomes. We argue that it is timely to consider regulation of nursing support workers with their role and scope of practice clearly defined. Further, the addition of these workers in a complementary model of care (rather than substitutive model) should also be explored in future research, in terms of impact on patient and nurse outcomes. © The Author(s) 2014 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.

Objective the ongoing attrition of the midwifery workforce frustrates future workforce planning and the provision of maternity services in Western Australia. This project determined factors contributing to the intention of the midwives to move jobs and/or leave the profession. Design a cross-sectional survey approach was taken for this descriptive research utilising a self-administered questionnaire developed by the Nursing and Midwifery Office, Department of Health, Western Australia. Setting public and private health sectors in Western Australia, April–May 2010. Participants 1,600 midwives employed in the public and private health sectors throughout Western Australia were invited to participate: 712 responded (44.5%), one-fifth of the state's registered midwives. Findings most midwives worked part-time in a clinical role in public hospitals. Almost half intended moving jobs within 5 years and/or leaving midwifery. Excluding midwives of retirement age, the most common reasons for intending to move jobs were family commitments, working conditions and role dissatisfaction. Those intending to leave midwifery cited work-life balance, career change and family commitments. Midwives thought addressing the following issues would improve midwifery retention: flexible work arrangements, remuneration, staffing and caseload, workplace culture, professional development and models of care. Key conclusions retaining the midwifery workforce requires attention to workforce practices particularly flexible work arrangements and workloads; models of care to strengthen midwives' relationships with clients and colleagues; and accessible professional development. Implications for practice a review of workplace practices at unit and institution levels is urgently required in Western Australia so that midwives can achieve work-life balance and practice to the full extent of their professional role. These changes are necessary to forestall premature retirement of skilled and experienced midwives from the profession and workforce churn.

Background: Publicly funded homebirth programs were not available as an option in Victoria until 2010. Sunshine Hospital in the Western suburbs of Melbourne was one of two sites chosen by the Department of Health to pilot such a program. Aim: To examine the demographics of women choosing this model and explored the reasons for choosing this publicly funded model of care. Method: Seventy-seven women (50%) of 153 eligible women participated. Data were collected via a postal questionnaire. Analysis of the data included descriptive statistics, percentages and frequencies. Results: Women who choose to birth with a publicly funded model of care are very similar to the documented homebirth population. Most women choose to give birth at home for a combination of factors including continuity of carer in cases of transfer, medical backup provided by the hospital, the skills of the midwives and also that the model was free of charge. The main reasons for choosing a homebirth; more generally were: to avoid medical intervention in labour, more control of the birthing environment and the greater flexibility to change positions during labour and birth. Conclusions: Themain advantage of this newermodel is that it is an option available to more women, as there are no costs involved. This has implications for care planning into the future for equitable birthing choices for women.

Palliative care emphasizes an interdisciplinary approach to care to improve quality of life and relieve symptoms. Palliative care is provided in many ways; in hospices, hospital units, and the community. However, the greatest proportion of palliative care is in the community. In hospice and palliative care units in hospitals, clinical pharmacists are part of the interdisciplinary team and work closely with other health care professionals. Their expertise in the therapeutic use of medications is highly regarded, particularly as many palliative care patients have complex medication regimens, involving off-label or off-license prescribing that increases their risk for drug-related problems. However, this active involvement in the palliative care team is not reflected in the community setting, despite the community pharmacist being one of the most accessible professionals in the community, and visiting a community pharmacist is convenient for most people, even those who have limited access to private or public transport. This may be due to a general lack of understanding of skills and knowledge that particular health professionals bring to the interdisciplinary team, a lack of rigorous research supporting the necessity for the community pharmacist's involvement in the team, or it could be due to professional tensions. If these barriers can be overcome, community pharmacists are well positioned to become active members of the community palliative care interdisciplinary team and respond to the palliative care needs of patients with whom they often have a primary relationship.