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Ferry Efendi,1,2 Gading Ekapuja Aurizki,1,2 Ilmiawan Auwalin,3 Lisa McKenna4 1Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia; 2Community, Family and Gerontological Nursing Research Group, Universitas Airlangga, Surabaya, Indonesia; 3Faculty of Economics and Business, Universitas Airlangga, Surabaya, Indonesia; 4School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, AustraliaCorrespondence: Ferry Efendi, Faculty of Nursing, Universitas Airlangga, Campus C Mulyorejo, Surabaya, East Java, 60115, Indonesia, Tel +62 31 591 3754, Email ferry-e@fkp.unair.ac.idIntroduction: Nursing workforce is a pivotal element in tackling the COVID-19 pandemic. However, this has not been comprehensively discussed, particularly in Indonesia. This study aimed to explore stakeholders’ perspectives on Indonesian nursing workforce recruitment and management during the COVID-19 pandemic.Methods: This study employed a qualitative design with an exploratory descriptive approach. Stakeholders who recruited and managed nursing resources in Indonesia were involved. In-depth interviews and focus group discussions with stakeholders representing eight different institutions were undertaken. Data were analysed using thematic analysis. Eight key stakeholders were interviewed.Results: Three themes emerged, namely uncertain recruitment system, nursing labour market situation, and workforce management dynamics. COVID-19 caused reduced workforce capacity and increased demands for health professionals, especially nurses.Conclusion: Uncertainty and volatility happened at the recruitment and management of nursing human resources during the pandemic. Stakeholders were not convinced of overall quality of local nurses recruited to care for COVID-19 patients given workforce was dominated by new graduates and nurses without specialistic qualifications. Employers gave new staff more training to ease their deployment to COVID-19 units to make up for the nurses’ lack of expertise and experience.Keywords: adaptive management, COVID-19, health worker, labour market, pandemic, personnel management

This paper explores the personal, social and structural factors that influence patients' experiences of acute deterioration and medical emergency team (MET) encounter.Patient experience is recognized as a means of assessing healthcare delivery with a positive experience being linked to high-quality healthcare, improved patient safety and reduced length of stay. The experience of acute deterioration is unique, extensive and complex. However, little is known about this experience from the patient's perspective.Constructivist grounded theory, informed by Kathy Charmaz, was used to explore the personal, social and structural factors that influence patients' experiences of acute deterioration and MET encounter.Using a semi-structured interview guide, in-depth individual interviews were conducted with 27 patients from three healthcare services in Victoria, Australia. Data were collected over a 12-month period from 2018 to 2019. Interview data were analysed using grounded theory processes.Contextual factors exert a powerful influence on patients' experiences of acute deterioration and MET encounter. The most significant factors identified include patients' expectations and illness perception, relationship with healthcare professionals during MET call and past experiences of acute illness. The expectations and perceptions patients had about their disease can condition their overall experience. Healthcare professional-patient interactions can significantly impact quality of care, patient experience and recovery. Patients' experiences of illness and healthcare can impact a person's future health-seeking behaviour and health status.Patients' actions and processes about their experiences of acute deterioration and MET encounter are the result of the complex interface of contextual factors.The findings from this study have highlighted the need for revised protocols for screening and management of patients who experience acute deterioration.

Problem There is a lack of understanding of undergraduate nursing students' shared regulatory behaviours and metacognitive processes as they learn to teach in dyad. Insights into this pedagogical approach can provide the opportunity to re-evaluate the best approaches to learning in the collaborative learning space. Aim The aim of this study was to explore the shared guidance and metacognitive and behavioural regulation of undergraduate nursing students involved in dyadic near-peer teaching. Method Secondary qualitative data analysis was conducted on data collected from an earlier study of 14 interviews, which explored final year students undertaking dyadic near-peer teaching. Data were analysed using NVivo12 to identify categories of meaning. Finding Two major categories and five subcategories evolved from the data, regulation of affective behaviours with associated subcategories of anxiety and self-doubt and shared guidance with subcategories of coregulation of cognition, metacognition, and critical thinking. Discussion An important finding is that working in dyad provided a supportive environment for near-peer teaching, enhancing students' self-efficacy and metacognition ability through shared regulation by considering alternate perspectives, through shared understandings, and negotiating different viewpoints. Conclusion It was identified that a dyadic approach in near-peer teaching supports metacognitive shared regulation and metacognitive growth; hence, influencing self-directed, long-life learners, a core nursing profession requirement.

To evaluate the effectiveness of an online program on nurse preceptors' knowledge and self-efficacy in their roles to support students' clinical education, and to examine their online experience.Professional development of nurse preceptors is paramount to fostering work readiness of future graduate nurses on entering the workforce. The support from academic institutions in developing preceptors' roles in clinical teaching and assessment is pivotal.This study employed a mixed-methods design.A total of 59 nurse preceptors from six healthcare institutions participated in an online preceptor program by collaborating with academic educators in facilitating student clinical learning and assessment through telesimulation following web-based instruction. Pre-test and post-tests were administered to evaluate the preceptors' knowledge and self-efficacy in their roles. Survey questionnaires and focus group discussions were conducted to evaluate their online experience. SQUIRE 2.0 guidelines were applied.The preceptors demonstrated significant improvements (p .001) in knowledge and levels of self-efficacy in their preceptor roles immediately and 1 month after the program. The following four themes emerged from their learning experiences: 'interactive learning approach', 'academic-practice collaboration', 'better understanding of clinical assessment tool' and 'application of teaching strategies'. The preceptors reported positively on their motivation to learn using the web-based instruction and on their telesimulation experience.The study findings demonstrated effectiveness and feasibility of an online preceptor program to enhance preceptors' roles in supporting nursing students' transition to clinical practice, using a mix of web-based technologies to provide preceptors with self-directed and experiential learning approaches.This study contributed to the development of an innovative online preceptor program that provided opportunity for academic-clinical collaboration and has broad applicability. The telesimulation created robust remote simulation experiences for preceptors, allowing them to collaborate with academic educators in facilitating students' clinical practice amid the COVID-19 pandemic.

Aim: To assess the effectiveness of two graduate nurse programs on new graduate nurses’ overall competence at 3, 6, 9 and 12 months. Secondary aims were to assess new nurses’ job satisfaction at 12 months and explore their experiences of support. Background: Most clinical settings have implemented transition programs to help new nurses to adapt to their new environments and expand their competences. To this day, very few studies have assessed the effectiveness of these programs. Design: Longitudinal mixed-methods study. Methods: The study was conducted at two teaching hospitals in Australia. New nurses were recruited during orientation. Data were collected at baseline (T0; n = 88), 3 (T1; n = 29), 6 (T2; n = 15), 9 (T3; n = 11) and 12 months (T4; n = 9). At each time point, the questionnaire included demographic and the Nurse Competence Scale. At T4, the questionnaire also included the Nurse Satisfaction Scale. Semi-structured interviews were conducted from T1 to T4. This study conforms to the STROBE guidelines. Results: Competence increased significantly at T1, with participants stating that they learned by “getting out” of student mode. At T2, despite no significant difference in competence, participants expressed they were more confident and in control, because they felt supported. Again, at T3, there was no significant increase in competence. Finally, at T4, competence increased significantly, with participants acknowledging that they still had a lot to learn. Conclusion: This study supports that 12-month transition programs are necessary for NGNs to expand their competence. One major factor influencing NGNs during their first year was how well they felt supported and encouraged to seek help when they needed it. Relevance: There is a need to understand how new NGNs enrolled in transition programs expand their competences. Their professional development depends on a supportive environment where NGNs feel confident in asking questions or for help.

Objective This study aimed to explore Indonesian nurses’ perspectives about their discharge preparation processes to enhance the discharge readiness of parents of preterm infants in the NICU. Methods A descriptive qualitative study with in-depth interview was used in this study. Eight purposively sampled NICU nurses were involved; all interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results Three themes emerged that described nurses’ perceptions related to their own discharge preparation process for parents of preterm infants: (1) diversity in discharge preparation; (2) Mother-Infant interaction during daily cares; and (3) Internal and external barrier to discharge preparation. Conclusions Nurses prepared parents of preterm infants for hospital discharge by providing health education, support systems and empowering mothers in their infant's care until they attained independence in caring for their baby prior to baby's discharge from the hospital. A multidisciplinary team with clear hospital policies and guidelines to follow along with improved nursing competence in the education and discharge process for parents of NICU babies are necessary to ensure the successful transition from the hospital NICU to home. Nurses prepared parents of preterm infants for hospital discharge by providing health education, support systems, and empowering mothers in their infant's care until they attained independence in caring for their baby prior to baby's discharge from the hospital NICU. A multidisciplinary team with clear hospital policies and guidelines to follow along with improved nursing competence are needed for successful implementation of effective discharge planning.

RATIONALE AIMS AND OBJECTIVES: Horizontal violence has been defined as aggressive or hostile behaviour directed at an individual or between colleagues from the same working group. Measuring the prevalence of horizontal violence requires valid measures. To date, there has not been a review of the psychometric properties of available measurement tools for horizontal violence.A rapid review of the MEDLINE and BUSINESS EBSCO databases was conducted to identify studies testing the validity of any measure of horizontal violence in any workplace setting. Title and abstract and full-text screening, data extraction and quality appraisal were completed by two researchers working independently. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) was used to determine the methodological quality of studies, including details of the psychometric properties of included papers.Fourteen papers reporting 17 studies were included in the review. Seven measures of horizontal violence (Civility Norms Questionnaire Brief; Negative Acts Questionnaire-Revised; Inventory of Violence and Psychological Harassment; Leyman Inventory Psychological Terror Mobbing of Single Cases of Harassment in Employees Relations; Shortened Negative Acts Questionnaire-Revised; Uncivil Workplace Behaviour Questionnaire) were identified. Most included studies were methodologically robust. Six measures had strong psychometric properties except for the Mobbing of Single Cases of Harassment in Employees Relations (MSCH) where key information about psychometric properties was not reported.We identified six measures of horizontal violence that had good psychometric properties. The Negative Acts Questionnaire-Revised has been most extensively tested in different settings but is not necessarily a more precise measure than others.

Background Nurses' role in vital signs monitoring places them in an ideal position to recognise and respond to clinical deterioration in general wards. However, enrolled nurses (ENs) and registered nurses (RNs) do not always work collaboratively, and this can lead to delays in recognition and escalation of clinical deterioration in general wards. Objectives The aim of the study was to explore the collaboration experiences between ENs and RNs in recognising and responding to clinical deterioration in general ward settings. Methods A qualitative descriptive study involving 12 ENs and 11 RNs was conducted in a 1250-bed tertiary hospital in Singapore using semistructured interviews. Interviews were transcribed and thematically analysed. Findings Three main themes emerged from the data analysis. The first, “reaching a collective understanding of patients' conditions’, identifies nursing shift handover as the primary method of obtaining patient information essential for ENs and RNs to work collaboratively to deliver safe patient care. However, the dissociation of ENs during the handover process created information gaps on patients at risk of clinical deterioration. The second, “role expectations of each other”, describes expectations that both groups of nurses had for each other's functions and responsibilities and the importance of mutual support in the nursing teamwork process. The third, “lacking in shared decision-making”, depicts a top-down approach in decision-making, wherein ENs were often not engaged in the decision-making process related to patient care. Conclusions A less-than-optimal collaborative EN–RN relationship was observed in this study, which sometimes caused delays in recognising and responding to deteriorating ward patients. This study illuminates the need for intraprofessional learning opportunities in prelicensure nursing programmes and the workplace to foster effective EN–RN collaborative practice. Nurse managers and educators are instrumental in fostering EN–RN collaboration and providing ongoing education on nursing teamwork skills and competencies.

A long-established approach, Confirmatory Factor Analysis (CFA) is used to validate measurement models of latent constructs. Employing CFA can be useful for assessing the validity and reliability of such models. The study adapted previous instruments and modified them to suit the current setting. The new measurement model is termed NENA-q. Exploratory factor analysis (EFA) revealed the instruments of the NENA-q model formed a construct of the second order with four dimensions, namely organizational contribution (OC), academic institution contribution (AIC), personality traits (PT), and newly employed nurses’ adaptation (NENA). Researchers administered the questionnaires to a sample of 496 newly employed nurses working in hospitals under the Ministry of Health (MOH) for the confirmation of the extracted dimensions. The study performed a two-step CFA procedure to validate NENA-q since the model involves higher-order constructs. The first step was individual CFA, while the second step was pooled CFA. The validation procedure through confirmatory factor analysis (CFA) found the model achieved the threshold of construct validity through fitness index assessment. The model also achieved convergent validity when all average variance extracted (AVE) exceeded the threshold value of greater than 0.5. The assessment of the composite reliability (CR) value indicates all CR values exceeded the threshold value of 0.6, which indicates the construct achieved composite reliability. Overall, the NENA-q model consisting of the OC construct, AIC construct, PT construct, and NENA construct for CFA has met the fitness indexes and passed the measurements of the AVE, CR, and normality test. Once the measurement models have been validated through CFA procedure, the researcher can assemble these constructs into structural model and estimate the required parameter through structural equation modelling (SEM) procedure.

Aim: The first scoping review is to map and synthesize the stressors, problems and coping strategies surrounding the health issues of migrant domestic workers. Design: Scoping review using Arksey and O'Malley's five-stage framework. Methods: Ten electronic databases were systematically searched by keywords for literature published between January 1995 and December 2019. Data were extracted into tables and collated and summarized into themes for presentation. Results: Twenty-seven reports were included in the final review. Analysis revealed that stressors to health included abuse, poor health service accessibility, ongoing financial hardship despite demanding working conditions and social isolation. Physical and mental health problems were identified for which migrant domestic workers largely depended on social networks and religion to cope with stressors and health problems. Training para-professional peer leaders of migrant domestic workers by community nurses and including them in interprofessional teams is a possible way for nurses to promote their health and well-being.

Background While midwives are positioned as critical providers for improving sexual, reproductive, maternal and newborn health outcomes in the Middle East and North African (MENA) countries, the standards of midwifery have not been explored systematically in this region. Aim The purpose of this scoping review was to provide an overview of existing literature on midwifery practice, education, and regulation in MENA countries in the context of ICM standards. Methods A search was conducted inclusive of English and Persian written studies published between 2000 and 2019 in CINAHL plus; Ovid MEDLINE; PubMed; Scopus; and grey literature. Title and abstract and full-text review were performed in Covidence, and data extraction and synthesis performed using NVivo 12. Results The initial search identified 7,994 articles. Overall, 139 studies were included in the review. Although, the primary concept of most included studies was “midwifery practice”, “midwifery regulation” was addressed in limited way. Approximately 90% were from Middle Eastern countries. Forty-two per cent of studies used cross-sectional designs, and most originated from Iran, Jordan, and Palestine. Diversity was found in midwifery education, practice and regulation across the MENA countries. Midwives from different nations had uneven levels of proficiency, scope of practice, and education. Midwifery curricula were aligned with ICM competencies in some countries. Most countries had midwifery associations and were members of ICM. Some countries had regulations recognising midwifery as an autonomous profession. Conclusion Midwifery practice, education and regulation in MENA countries were not always comparable with ICM standards, although some progress was evident.

Team communication problems have been reported to be responsible for up to 80% of medical errors in healthcare settings. Although simulation is a recognized means to learn communication skills, little is known about students’ team communication in a simulated setting. This review sought to explore what is known about undergraduate health professionals team communication in simulated emergency settings. The Joanna Briggs Institute framework was used to identify studies through five databases. After titles and abstracts and full texts review, 22 studies were identified for analysis and synthesis using inductive thematic analysis. Three key themes emerged: the context of simulation, teamwork and communication, and student interpretations. Simulation is a successful tool to experience communication and teamwork for students. Non-technical skills enhanced students’ performance of clinical skills based on expert rating and in understanding shared values, collaboration, and respect for each other, and improving confidence. Simulation is a suitable approach to measure and enhance team communication and teamwork. Exploration of gender, age, and ethnicity and other factors to assess their impact on communication should be the focus of future research in this area.

Objective This study aims to determine the relationship between anxiety levels and spiritual activity with motivation to recover in TB patients. Method This research utilized correlational research design with cross sectional approach. There were ninety two patients of TB who sought treatment at three primary health centers in Surabaya between October-November 2018. Data were collected using the HRS-A (Hamilton Rating Scale Anxiety) questionnaire, the Spiritual Activity Questionnaire and the Motivation for Healing Questionnaire. Data were analyzed using the Spearman's Rho test. Results There was significant correlation between anxiety and motivation to recover (p = 0.000; r = −0.436). In addition, the spiritual activity also significantly correlated with motivation to recover (p = 0.000; r = 0.743). Conclusion An increased level of anxiety decreased motivation to recover in patients with TB, but increased of spiritual activity were increased motivation to recover in patients with TB.

To explore transition experiences of Middle Eastern qualified midwives into practice in Australia.This was a qualitative study using multiple case narrative approach underpinned by structuration theory.A total of 19 Middle Eastern qualified midwives from different states of Australia participated in this study. Individual semi-structured interviews were conducted between November 2020 and September 2021, digitally recorded and then transcribed. Transcriptions were analysed in three stages, with three main categories generated in the second stage and a core category that was developed in third.Entering the Australian workforce, Middle Eastern qualified midwives had to reframe their professional identities to fit the new system by adjusting to three aspects of the practice, including preparation for practice, scope of practice and context of practice. While they were prepared by medically oriented curricula, worked in systems that had limitations for midwives to practise in antenatal and postnatal and lacked regulation standards, they learned to practise autonomously in their full scope in a standardized context in Australia.Middle Eastern qualified midwives in Australia re-evaluated their practice in their home countries, realized the gaps and adjusted to new ways of practising in Australia.To effectively use the potential of Middle Eastern midwives for workforce sustainability in Australia, support should be available to enable them to develop the necessary competencies for safe practice in Australia including provision of context-specific transition programmes prior to registration and supporting mentorship after their integration into the Australian healthcare workforce.Patient or public contribution does not apply to this study as its purpose was to explore the transition experiences of Middle Eastern qualified midwives themselves.

Introduction: Anemia during pregnancy is a significant threat to health and safety of mothers and children. Objective: This study aimed to investigate factors associated with receiving iron supplements during pregnancy among women in Indonesia. Methods: This study used data from the Indonesian demographic and health survey 2017. The dataset used was individual data with a target population of women aged 15-49. A total of 14,564 women aged from 15 to 49 years were included in the analysis. A binary logistic regression model explored associations between the independent variables and the received iron supplements. Results: In this study, most interviewed women (n=12,939; 88.84%) received iron supplements during pregnancy. Factors found to be associated with receiving iron supplements during pregnancy included pregnant women aged >35 years (AOR=2.20; 95% CI=1.34-3.61), lived in the eastern and middle part of Indonesia (AOR=1.71; 95% CI=1.20-2.42; AOR=1.75; 95% CI=1.49-2.06), attended antenatal care consultations (AOR=1.40; 95% CI=1.18-1.65), had blood tests (AOR=1.52; 95% CI=1.32-1.76), knew the signs and symptoms of danger of pregnancy complications (AOR=1.56; 95% CI=1.29-1.89), had vaginal bleeding during pregnancy (AOR=1.25; 95% CI=1.03-1.50), had 1-2 total children ever born (AOR=1.18; 95% CI=1.00-1.40), and were exposed to information via the Internet (AOR=1.18; 95% CI=1.00-1.39) and newspapers or magazines (AOR=1.17; 95% CI=1.01-1.35). Conclusions: The study highlighted that despite free access to iron supplementation during pregnancy, some women failed to receive iron supplements during pregnancy. Also, women of reproductive age living in the eastern part of Indonesia, who did not have blood tests, were absent from attending antenatal care and did not know the signs and symptoms of dangerous pregnancy complications were among those who failed to receive iron supplements during pregnancy. Thus, identifying and promoting awareness of those at high risk of not receiving iron supplements should be a priority for the government and health workers in providing health services.

The use of nonpharmacological modalities in managing symptoms experienced by patients with cancer is increasingly important in providing holistic care. However, limited studies have reported on integrating nonpharmacological interventions to improve physical and psychological symptoms of women with gynecological cancer.The aim of this study was to examine the effect of a multimodal nursing intervention (MNI) on sleep quality, fatigue, and level of depression among Indonesian women with gynecological cancer.The quasi-experimental nonequivalent group design involved 50 patients in 2 groups and used convenience sampling. An experimental group (n = 25) received MNI including progressive muscle relaxation and a counseling session; the control group received routine hospital care (n = 25). Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), depression levels by the Beck Depression Inventory-II, and fatigue by the Piper Fatigue Scale (PFS). Pretest data were collected after 3 days of hospital admission; posttest data were gathered after the intervention.The PSQI (P = .000), Beck Depression Inventory-II (P = .008), and PFS (P = .000) changed significantly in the intervention group; the PSQI (P = .000) and PFS (P = .000) in the control group changed significantly. The PSQI (P = .00) and PFS (P = .000) scores differed significantly between the 2 groups before and after the intervention. The effect size of the MNI for difference scores before and after the intervention was medium effect size.The role of nonpharmacological modalities in managing symptoms experienced by patients with cancer is increasingly important to providing holistic care.Gynecology nurses can lead the implementation of MNI to decrease patient fatigue and depression and to increase sleep quality.

Women’s susceptibility to HIV/AIDS infection is related to socio-economic and demographic factors. This study sought to analyze socio-economic and demographic factors related to knowledge and attitude of HIV/AIDS among women aged 15–49 years old in Indonesia. We conducted a secondary data analysis using the 2017 Indonesian Demographic and Health Survey (IDHS). Among 49,627 women, our study analyzed 25,895 women aged 15–49 years familiar with HIV terminology. Multiple logistic regression was utilized to analyze associations between socio-economic and demographic factors with knowledge and attitudes toward HIV/AIDS. Women’s age, education level, wealth quintile, residential area and region, access to information, owning cell phones and autonomy were significantly associated with positive knowledge and attitudes toward HIV/AIDS. These findings revealed that several demographical and social factors contribute to knowledge and attitudes toward HIV/AIDS among women aged 15–49 years in Indonesia.

Academic electronic medical records are useful simulation-based educational tools that assist health professional students develop their skill sets for digital health practice. Despite this, their utilisation in pre-registration nursing curricula is uncommon in Australia and New Zealand.To explore factors surrounding integration of academic electronic medical records into pre-registration nursing curricula in Australia and New Zealand.Exploratory qualitative multiple case studies approach with purposive sampling set within a larger research project.Semi-structured interviews conducted with course leaders from six nursing schools. Data were analysed in an iterative content-driven deductive and inductive process using open-coding and categories. Case analysis involved within case and cross-case analysis.Findings revealed different factors that impacted the utilisation of academic electronic medical records in nursing curricula including factors influencing adoption, barriers and challenges with implementation, enablers for integration and perceived benefits for students' clinical practice preparation. Reasons for not using academic electronic medical records, barriers for implementation, and preparation of students for clinical practice in the absence of these simulation tools were also highlighted.Our findings suggest that use of academic electronic medical records in nursing curricula is still evolving and that their adoption and application within programs is not straightforward. While there are many factors unique to the schools using such resources, factors including decisions around curriculum incorporation, optimising available resources to support students' learning, and developing faculty capability to teach with academic electronic medical records were common considerations. Lack of funding and access to local educational tools were ongoing barriers for adoption. Further research examining curriculum timing and preparation, possibilities of partnerships to share resources, and evaluation in meeting students' needs is necessary.

Chinese-educated nurses are increasingly important to the international labor market. This study aimed to examine how Chinese migrant nurses adapt and evolve professionally while pursuing nursing careers in Australia, using a qualitative descriptive approach. A total of 17 Chinese-educated nurses were recruited by purposive and snowball sampling in Australia during 2017. Data were collected by individual semi-structured interviews and analyzed using thematic analysis. Three central themes and eight subthemes were generated. Perceived differences in nursing involved: work options and flexibility, professional autonomy and independence, and freedom of expressing professional opinions. Elements comprising challenges to adaptation included communication barriers, nursing workload and responsibilities, and collegial relationships. Participants’ professional transition journeys were accompanied by two key areas of self-evolution: Embracing the authentic self and embracing individual differences. Our findings have important implications for migrant-host nursing workforce integration in Australia and internationally.

Entrustable professional activities (EPAs) describe key workplace activities and are increasingly being used for student work-based assessment. An EPA-based work-based assessment tool offers potential to increase understanding of dietetics student skill development and opportunity for standardised work-based student assessment.To determine construct validity and educational impact of an EPA work-based assessment tool for dietetics placement students in clinical settings.Using a time series design, supervisor and student self-assessment data collected from an EPA-based assessment tool from three cohorts of dietetics students and supervisors from 2017-2019 was analyzed.Dietetics students (n = 145) from an accredited dietetic training program in Australia and affiliated metropolitan and rural hospitals.Construct validity was determined through analysis of supervisor evaluation of student performance against EPAs over time. Educational impact was determined through comparing student performance across EPAs to predicted milestones to identify areas of least entrustment.Student performance over time and differences between student self-assessment and supervisor assessment for each EPA were investigated using Wilcoxon signed-rank tests and linear mixed-model analysis. Descriptive statistics summarised student performance against each EPA.Performance significantly increased over time in 35 out of 37 EPAs. Significant differences between supervisor and student self-assessment were evident in 9 out of 37 EPAs. Dietetics student performance varied across EPAs with 88.2% of students achieving entrustment for nutrition management EPAs compared with 100% for professionalism EPAs.The tool's construct validity was established. EPAs identified areas of Nutrition Care Process skills development requiring additional support. Data collected by the tool can inform teaching.