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Aims and objectives: To explore recently graduated perioperative nurses' experiences of interprofessional simulation-based learning during postgraduate education and investigate whether and how this learning approach contributed to the development of their professional competence in meeting acute clinical situations. Background: Perioperative nursing requires specialised education that offers professional development to ensure high-quality nursing care and patient safety in acute situations. Interprofessional simulation-based learning exposes students to acute situations in a safe environment without the risk of harming the patient, and it prepares postgraduate nursing students for clinical practice. Despite extensive research regarding simulation-based learning, there is a lack of knowledge on what impact such training has on perioperative nursing students after graduation. Design: An explorative qualitative design was used, and this study is reported in accordance with the COREQ guidelines. Method: Between March 2019–November 2020, 16 perioperative nurses participated in semi-structured individual interviews three to five months after their graduation from five different educational institutions. During their postgraduate education, they had participated in interprofessional simulation-based learning that included acute clinical situations. A phenomenological hermeneutical analysis was applied to the data involving three steps: naïve reading, structural analysis and comprehensive understanding. Results: During the naïve reading, three themes emerged: competence in handling acute situations, competence in interprofessional teamwork and professional identity development. Conclusion: Interprofessional simulation-based learning in perioperative nursing education developed relevant and important competence, including professional identity development, among perioperative nursing students. As recent graduates, their professional competence was transferred to clinical

Purpose: Nurses provide care at each phase of the complex perioperative pathway and are well placed to identify areas of care requiring investigation in randomised controlled trials. Yet, currently, the scope of nurse-led randomised controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomised controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation. Methods: This scoping review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted in PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials, with a date range of 2014–2019. Sources of unpublished literature included Open Grey, ProQuest Dissertation and Theses, Clinical Trials.gov and the Australian and New Zealand Clinical Trials Registry. After title and abstract checking, full-text retrieval and data extraction, studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Randomised Controlled Trials. Data were synthesised according to the main objectives. Key information was tabulated. Results: From the 86 included studies, key areas where nurses have led randomised controlled trials include patient or caregiver anxiety, post- operative pain relief, surgical site infection prevention, patient and caregiver knowledge, perioperative hypothermia prevention and post-operative nausea and vomiting in addition to other diverse outcomes. Issues impacting upon quality (including poorly reported randomisation) and gaps for future investigation (including a focus on vulnerable populations) are evident. Conclusion: Nurse-led randomised controlled trials in the perioperative setting have focused on key areas of perioperative care. Yet

PURPOSE: To examine nursing knowledge and confidence of peripheral intravenous catheter insertion and maintenance in pediatric patients. DESIGN AND METHODS: An online survey using validated questionnaires was conducted in ten (tertiary and district) hospitals in Indonesia from May to September 2020. Multivariable general linear models were used to investigate associations between nurses' characteristics and knowledge and confidence on the catheter insertion and maintenance score. RESULTS: A total of 413 out of 458 pediatric nurses completed the survey (a response rate of 90%). The mean score of the nurse knowledge on insertion was 18.9(±3.3) (maximum score: 21), and the maintenance score was 6.5(±2.0) (maximum score: 12). The median score of the nurse insertion and maintenance confidence was quite high: 44 (IQR = 7) out of 50 and 37 (IQR = 4) out of 45, respectively. Initial patient assessment, catheter securement, site assessment and management of complications are areas where nurse knowledge and confidence are still lacking. Adjusted analysis indicates that training and work experience were significantly associated with the knowledge and confidence score (p < 0.05). CONCLUSION: Pediatric nurses were largely confident in their skills but this was not reflected in their knowledge scores. Training and experience were important predictors for nursing knowledge and confidence in catheter insertion and maintenance.PRACTICE IMPLICATIONS: The results provide nursing and hospital managers and educational institutions to understand areas of intravenous catheter insertion and maintenance in which nurses lack of knowledge and confidence as well as to formulate tailored and ongoing training to improve nurse knowledge, confidence, practices and optimize patients' care.

Aim: This study aimed to investigate workplace bullying and explore correlations between bullying, burnout and resilience amongst perioperative nurses in Australia. Background: Workplace bullying in perioperative nursing involves verbal, physical and psychological violence. However, no prior studies have measured Australian perioperative nurses' experiences of workplace bullying nor sought to understand if there is a relationship with burnout and resilience. Methods: A descriptive correlational study was conducted utilizing an online survey incorporating four validated instruments. Descriptive statistics and regression models analysed workplace bullying, burnout and resilience. Results: Over half of perioperative nurses (n = 158/257, 61%) were exposed to workplace bullying. Consequences included fatigue and exhaustion (n = 129/192, 67%), anxiety (n = 123/192, 64%) and sleeplessness (n = 121/192, 63%). Organisational processes (r =.458, p <.001), bullying acts (r =.289, p <.001) and avoidance and withdrawal at work (r =.440, p =.001) increased burnout. Psychosocial distress (r = −.216, p <.001) was associated with decreased resilience. Conclusions: Workplace bullying is a persistent issue with negative impacts upon burnout, resilience and well-being. Implications for Nursing Management: The psychological well-being of employees can be prioritized by establishing and maintaining an organisational climate of psychosocial safety, thereby inhibiting the potential of bullying to manifest and positively influencing employee well-being to help promote workplace engagement, productivity and reduced burnout.

Purpose: Perioperative hypothermia prevention requires regular, accurate, and consistent temperature monitoring. Zero-heat-flux (ZHF) thermometry offers a non-invasive, measurement method that can be applied across all surgical phases. The purpose of this study was to measure agreement between the zero-heat-flux device and esophageal monitoring, sensitivity, and specificity to detect hypothermia and patient acceptability amongst patients undergoing upper and lower limb orthopedic surgery. Patients and Methods: This prospective, observational study utilized Bland–Altman analysis and Lin’s concordance coefficient to measure agreement between devices, sensitivity and specificity to detect hypothermia and assessed patient acceptability amongst 30 patients between December 2018 and June 2019. Results: Bias was observed between devices via Bland Altman, with bias dependent on actual temperature. The mean difference ranged from −0.16°C at 34.9°C (where the mean of ZHF was lower than the esophageal device) to 0.46°C at 37.25°C (where the mean of ZHF was higher than esophageal device), with 95% limits of agreement (max) upper LOA = 0.80 to 1.41, lower LOA = −1.12 to −0.50. Seventy-five percentage of zero-heat-flux measurements were within 0.5°C of esophageal readings. Patient acceptability was high; 96% (n=27) stated that the device was comfortable. Conclusion: ZHF device achieved lesser measurement accuracy with core (esophageal) temperature compared to earlier findings. Nonetheless, due to continuous capability, non-invasiveness and patient reported acceptability, the device warrants further evaluation. Title Registration: The study was registered at www.ANZCTR.org.au (reference: ACTRN12619000842167).

Introduction: Blood transfusions are a risk factor for increased morbidity, mortality, and length of hospital stay. Patient blood management guidelines provide guidance to reduce risk and improve patient outcomes. They outline steps to help prevent transfusions and considerations for when deciding to transfuse. One recommendation to prevent unnecessary transfusion is to optimize patients using Pre-operative Anemia and Iron Deficiency Screening, Evaluation and Management Pathways (PAIDSEM-P). The uptake of these recommendations is highly variable, and an effective approach to implementing them in a tailored and context-specific manner remains elusive. Method and Design: A mixed-methods, interventional study, using a type two-hybrid effectiveness-implementation design, will evaluate the impact of a change package to improve the uptake of PAIDSEM-P. The change package consists of the intervention (PAIDSEM-P) supported by theoretically informed implementation strategies. Pre- and post-implementation, retrospective health record reviews will determine the effect of the change package on provider outcomes, including compliance with guideline recommendations as measured by the proportion of patients who have the appropriate tests performed, and, if required, appropriate treatment and/or referrals. Patient outcomes will be measured by checking for any difference in the proportion of patients with anemia on the day of surgery and the proportion of patients who receive a blood transfusion during the peri-operative period. An economic evaluation will be conducted to compare health outcomes and costs. The feasibility, acceptability and appropriateness of the PAIDSEM-P will be assessed using a quantitative, validated survey to measure implementation outcomes. Discussion: Testing of implementation theory is required to advance understanding of what works, in what context, and the impact on implementation success. This study aims to evaluate the impact of a theoretically i

Aim: To explore perioperative nursing students' experiences of interprofessional simulation-based learning to gain a deeper understanding of how this educational tool can be used to support students' learning and enable them to achieve the intended learning outcomes. Background: Despite extensive research, it remains unclear what and how participants learn from interprofessional simulation-based learning. There is a need to specify how interprofessional simulation-based learning should be organised to support and promote learning processes, especially for postgraduate learners. In particular, there seems to be little evidence in the existing literature in the field of educating perioperative nurses, where advanced technical skills and high-quality nursing care are required. Design: The study's qualitative and explorative design is reported in accordance with the COREQ guideline. Method: Between May–October 2019, thirty-four perioperative nursing students from four educational institutions participated in six focus group interviews, with four to eight students in each. All participants had previous experience of interprofessional simulation-based learning in acute settings. Data were transcribed verbatim and were then subjected to phenomenological hermeneutical analysis involving three steps: naïve reading, structural analysis and comprehensive understanding. Results: Three themes were identified the following: customised interprofessional simulation-based learning; reality of the experience of interprofessional simulation-based learning; and preparedness for clinical practice. Conclusion: Customised interprofessional simulation-based learning was found to be of value to the participants and reflected their feeling of mental preparedness entering interprofessional simulation-based learning. Furthermore, participants' experience of reality when using the tool was a key theme that also impacted how prepared participants felt for clinical practice. Relevance to clini

Alana Delaforce,1– 3 Jed Duff,1,4 Judy Munday,3– 5 Shannon Farmer,6,7 Kristin Miller,2 Lynne Glover,2 Christopher Corney,2 Cameron Hurst,8 Gareth Ansell,2,9 Naadir Gutta,2,9 Haitham Tuffaha,10 Janet Hardy2,3 1School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia; 2Mater Health Services, South Brisbane, QLD, Australia; 3Mater Research Institute-UQ, South Brisbane, QLD, Australia; 4Centre for Healthcare Transformation/School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia; 5Faculty of Health and Sport Science, The University of Agder, Kristiansand, Norway; 6Department of Haematology, Royal Perth Hospital, Perth, Western Australia, Australia; 7Medical School and Division of Surgery, The University of Western Australia, Perth, Western Australia, Australia; 8QIMR Berghoffer Medical Research Institute, Brisbane, QLD, Australia; 9School of Clinical Medicine - Mater Clinical Unit, The University of Queensland, St Lucia, QLD, Australia; 10Centre for the Business and Economics of Health, The University of Queensland, St Lucia, QLD, AustraliaCorrespondence: Alana Delaforce Level 6, Duncombe Building, Mater Hospital Brisbane, South Brisbane, QLD, 4101, AustraliaTel +61 7 3163 2853Email alana.delaforce@mater.org.auIntroduction: Blood transfusions are a risk factor for increased morbidity, mortality, and length of hospital stay. Patient blood management guidelines provide guidance to reduce risk and improve patient outcomes. They outline steps to help prevent transfusions and considerations for when deciding to transfuse. One recommendation to prevent unnecessary transfusion is to optimize patients using Pre-operative Anemia and Iron Deficiency Screening, Evaluation and Management Pathways (PAIDSEM-P). The uptake of these recommendations is highly variable, and an effective approach to implementing them in a tailored and context-specific manner remains elusive.Method and Design: A mixed-methods, i

Judy Munday,1,2 Niall Higgins,1,3 Lee Jones,1,4 Dimitrios Vagenas,4 André Van Zundert,1,5,6 Samantha Keogh1,3 1School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia; 2Department of Health and Nursing Science, Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway; 3Royal Brisbane and Women’s Hospital, Herston, QLD, Australia; 4Research Methods Group, Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia; 5Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia; 6School of Medicine, The University of Queensland, Brisbane, Australia & Queensland University of Technology, Brisbane, QLD, AustraliaCorrespondence: Judy MundaySchool of Nursing & Centre for Healthcare Transformation, Queensland University of Technology, Rm 529, Level 5, N Block, Kelvin Grove, QLD, 4059, AustraliaTel +61 73138 8209Fax +61 3138 3814Email judy.munday@qut.edu.auPurpose: Perioperative hypothermia prevention requires regular, accurate, and consistent temperature monitoring. Zero-heat-flux (ZHF) thermometry offers a non-invasive, measurement method that can be applied across all surgical phases. The purpose of this study was to measure agreement between the zero-heat-flux device and esophageal monitoring, sensitivity, and specificity to detect hypothermia and patient acceptability amongst patients undergoing upper and lower limb orthopedic surgery.Patients and Methods: This prospective, observational study utilized Bland–Altman analysis and Lin’s concordance coefficient to measure agreement between devices, sensitivity and specificity to detect hypothermia and assessed patient acceptability amongst 30 patients between December 2018 and June 2019.Results: Bias was observed between devices via Bland Altman, with bias dependent

Access to palliative care is recognised internationally as a basic human right. Ensuring adequate clinical knowledge and communication skills to achieve this outside of specialist palliative care settings is therefore essential. Take, for instance, the example of perioperative care...

Alana Delaforce,1,2 Jed Duff,1,3 Judy Munday,3,4 Janet Hardy2 1School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia; 2Mater Health Services, South Brisbane, QLD 4101, Australia; 3School of Nursing/Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, Australia; 4School of Nursing, The University of Agder, Kristiansand, NorwayCorrespondence: Alana Delaforce Email alana.delaforce@mater.org.auIntroduction and aims: Patients undergoing major surgery risk significant blood loss and transfusion, which increases substantially if they have pre-existing anemia. Preoperative Anemia and Iron Deficiency Screening, Evaluation and Management Pathways (PAIDSEM-P) outline recommended blood tests and treatment to optimize patients before surgery. Documented success using PAIDSEM-P to reduce transfusions and improve patient outcomes exists, but the reporting quality of such studies is suboptimal. It remains unclear what implementation strategies best support the implementation of PAIDSEM-P.Method: Maximum variation, purposive sampling was used to recruit a total of 15 participants, including a range of health professionals and patients for semi-structured interviews. Data analysis utilized a deductive approach informed by the Consolidated Framework for Implementation Research (CFIR) for barrier identification and the Expert Recommendations for Implementing Change (ERIC) for reporting recommended implementation strategies. A modified version of the Action, Actor, Context, Target and Time (AACTT) framework assisted with conceptualisation and targeted strategy selection.Results: The analysis revealed five barriers: access to knowledge and information, patient needs and resources, knowledge and beliefs about the intervention, available resources, and networks and communications, which had strong ERIC recommendations, including conduct educational meetings, develop educational materials, distribute educational mate