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Computer-based virtual simulation in nursing is a rapidly developing field. A summary of current research could benefit nursing faculty who are incorporating this pedagogy into online teaching due to social distancing requirements. This umbrella review aimed to explore the use and effectiveness of virtual simulations in prelicensure nursing education. Our umbrella review approach was informed by The Johanna Briggs Institute guidelines. The 18 included reviews captured the experiences of over 7600 nursing students who engaged with five different virtual (screen-based) simulation modalities. Results indicated that virtual simulations can be effective in developing nursing students' knowledge and psychomotor and psychosocial skills, for example, in medication administration and communication. There was no study that showed a conclusive benefit of virtual simulations for developing clinical reasoning. Students enjoyed virtual simulations, claiming they were accessible, fun, and engaging ways to learn. Many benefits of virtual simulations and some technological challenges were identified in a mapped model. In the future, more rigorous and experimental studies are needed to confirm effects on learning outcomes. Nursing curriculum designers need to define the place and purposes of the pedagogy to ensure that knowledge and skills learned during virtual simulations can be applied to real-world, patient-centered care.

Refereed/Peer-reviewed

Virtual simulation is an interactive teaching and learning strategy used in undergraduate nursing student education, especially since the onset of the COVID-19 pandemic. Few published studies have reviewed the impact of virtual simulation as a strategy for teaching nursing students the elements of evidence-based practice.To describe types of virtual simulation that are relevant to nursing student education and examine how these modalities are applied to teach elements of evidence-based practice.A rapid review of literature was conducted to discern the use and impact of virtual simulation. Thirty-seven studies published between 2017 and May 2021 that addressed nursing students' educational outcomes were reviewed and summarized as a narrative analysis.Virtual simulation and virtual reality simulation engage learners in role-plays via a computer screen or hand-held phone. Various levels of realism and immersion were apparent across different modalities and with the utilization of educational games. Most studies related to the teaching of best practice evidence-based clinical nursing topics. Twenty primary studies reported objective measures of students' improvement such as knowledge, performance, better documentation, or communication accuracy. Sixteen studies that measured knowledge identified significant knowledge gains. All studies endorsed virtual simulation as a teaching method.Virtual simulation approaches offer an innovative and feasible option for teaching nursing students. Such approaches should be included in undergraduate nursing curricula. While it is apparent that evidence-based practice guidelines inform the design of the virtual simulation scenarios, the effectiveness of the modality for teaching specific elements of evidence-based practice to nursing students is not yet confirmed. Nursing curricula need to include ways of teaching nursing students to search for and critically appraise trustworthy sources of knowledge for clinical practice.

Background Anxiety and depression affects many pregnant women. Massage may be beneficial for supporting mental wellbeing during this time. The aim of this study was to assess the feasibility and acceptability of a partner-delivered relaxation massage program for pregnant women, and its impact on symptoms of antenatal anxiety, stress and depression. Methods A feasibility randomised controlled trial was conducted to compare partner-delivered relaxation massage (intervention) with self-directed stress management (control). Women attended an initial workshop at 28–32 weeks gestation followed by completion of a self-directed massage or stress management program. Qualitative data about the feasibility and acceptability (primary outcomes) were collected via online participant diaries and post-birth interviews. Anxiety, depression and stress symptoms (secondary outcomes) were assessed using the Depression and Anxiety Stress Scale (DASS-21). Birth outcomes were collected at the post- birth interview. Results A total of 14 women/partner dyads in the massage group and 13 women in the self-directed stress management group, attended the initial workshops. When interviewed, participants from both groups reported that the programs were feasible and acceptable. Women’s mean scores on all subscales of the DASS-21significantly decreased over time in both the intervention and the control group. Conclusion Pregnant women found the partner-delivered massage program to be feasible and acceptable. Both programs decreased women’s symptoms of anxiety, depression and stress with no significant differences identified between the two groups. An adequately powered experimental study with a large representative sample is needed to determine whether partner-delivered relaxation massage reduces pregnant women’s symptoms of anxiety, depression and stress.

Refereed/Peer-reviewed Objectives This review intended to synthesise existing evidence on the application of transformative learning theory in nursing education. Design An umbrella review, or review of reviews. Data sources Six databases were systematically searched: CINAHL, Cochrane Reviews, Ebscohost, OVID, ProQuest Central, and PubMed. The structured framework of PCC: Population/Concept/Context was employed to identify relevant literature, published in English between 2012 and March 1st, 2022. Review methods Elements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided this review. A modified version of the Johanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Synthesis was applied to determine final inclusions. Results Sixteen (16) reviews were included. Most reviews were scoping reviews. Nursing featured in 10 of the 16, medicine in half (8/16) and various allied health disciplines were reported in seven reviews. Studies reported on differing scholarly approaches to transformative learning theory. Curricula design and evaluation, developing leadership skills and a professional identity were common applications. Critical reflection and learning experiences that challenge students' and professionals' existing ideologies also featured. Few reviews reported on studies of models and tools for educators to guide them in applying the theory in lesson design and teaching practice. Conclusion Applying transformative learning theory in curriculum design, program evaluation and healthcare professional education can be beneficial. There were reported successes and some critiques. Researchers should design more rigorous studies to evaluate the theory in practice and to develop and test frameworks that guide educators in teaching with transformative learning theory.

Background The quality of nursing clinical placements has been found to vary. Placement evaluation tools for nursing students are available but lack contemporary reviews of clinical settings. Therefore, the aim of this study was to develop a feasible, valid and reliable clinical placement evaluation tool applicable to nursing student placements in Australia. Methods An exploratory mixed methods co-design project. Phase 1 included a literature review; expert rating of potential question items and Nominal Group Technique meetings with a range of stakeholders for item development. Phase 2 included on-line pilot testing of the Placement Evaluation Tool (PET) with 1263 nursing students, across all year levels at six Australian Universities and one further education college in 2019–20, to confirm validity, reliability and feasibility. Results The PET included 19-items (rated on a 5-point agreement scale) and one global satisfaction rating (a 10-point scale). Placements were generally positively rated. The total scale score (19 items) revealed a median student rating of 81 points from a maximum of 95 and a median global satisfaction rating of 9/10. Criterion validity was confirmed by item correlation: Intra-class Correlation Co-efficient ICC = .709; scale total to global score r = .722; and items to total score ranging from .609 to .832. Strong concurrent validity was demonstrated with the Clinical Learning Environment and Supervision Scale (r = .834). Internal reliability was identified and confirmed in two subscale factors: Clinical Environment (Cronbach’s alpha = .94) and Learning Support (alpha = .96). Based on the short time taken to complete the survey (median 3.5 min) and students’ comments, the tool was deemed applicable and feasible. Conclusions The PET was found to be valid, reliable and feasible. Use of the tool as a quality assurance measure is likely to improve education and practice in clinical environments. Further international evaluation of the instrument is required to fully determine its psychometric properties.

Background Measuring the impact of patient safety interventions is challenging. This article aims to illustrate a “gold standard” model of program evaluation incorporating examples from two patient deterioration programs. Methods Australian nurses were trained in primary responses to emergencies in four hospitals using either face-to-face (F2F) or screen-based simulation versions of a simulation program. Evaluation outcomes were measured using Kirkpatrick's evaluation hierarchy covering participant ‘reaction’, ‘learning’, ‘behaviour’ change and ‘results’—based on 1,564 pre–post intervention vital signs chart reviews. Results Seventy-four nurses participated. Reaction—participant confidence/competence ratings and Learning improved significantly in both modalities (p Conclusions Kirkpatrick's evaluation model enables a suitable template for gold standard education evaluations.

Background Little is known about the clinical impact of simulation-based education (SBE) for hospital nurses. Method Scoping review methodology was used to examine the impact of nurse SBE programs within six patient safety domains. Results Twenty-six articles described over 20 education topics. Based on Kirkpatrick's four levels of evaluation, programs prioritized superficial levels of evaluation: Level 1—Reaction, Level 2—Learning. Only seven studies measured Level 3—Behavior change (nurses' performance) or Level 4—Results (impact on patient care). Conclusion(s) Nurses' CPD programs should include both short-term evaluations and longitudinal measures to detect practice improvements that may advance patient safety.

The purpose of this review was to identify the role and contribution of community-based nurse-led wound care as a service delivery model. Centres increasingly respond proactively to assess and manage wounds at all stages - not only chronic wound care. We conducted an integrative review of literature, searching five databases, 2007-2018. Based on inclusion and exclusion criteria, we systematically approached article selection and all three authors collaborated to chart the study variables, evaluate data, and synthesise results. Eighteen studies were included, representing a range of care models internationally. The findings showed a need for nurse-led clinics to provide evidence-based care using best practice guidelines for all wound types. Wound care practices should be standardised across the particular service and be integrated with higher levels of resources such as investigative services and surgical units. A multi-disciplinary approach was likely to achieve better patient outcomes, while patient-centred care with strong patient engagement was likely to assist patients' compliance with treatment. High-quality community-based wound services should include nursing leadership based on a hub-and-spoke model. This is ideally patient-centred, evidence-based, and underpinned by a commitment to developing innovations in terms of treatment modalities, accessibility, and patient engagement.

Aims This paper has two aims : first, to explain the concept of empathy derived from an integrative review of contemporary nursing literature; and second, to profile a new conceptual model that can be used to inform the teaching of empathy. Background Empathy is fundamental to therapeutic communication and integral to quality patient care. However, the lack of agreement on the definition or conceptualisation of empathy in the nursing literature can make teaching and evaluating this skill challenging and inconsistent. Design Integrative review of literature. Data sources Publications from January 2000 to July 2018 in Ovid Medline, Scopus, CINAHLPlus, PsycINFO, and PubMed. Review methods As no integrative review checklists are currently available, a PRISMA checklist was adapted to guide this review. A two-stage approach was used to explore the concept of empathy. Key definitions and attributes of empathy were identified from 11 primary studies and tabulated to allow for display and comparison. Next, the definitions and attributes of empathy drawn from a purposeful sample of 18 nursing education studies were examined, tabulated and summarised. Finally, the two samples were integrated and synthesised to form a cohesive summary, which was then illustrated with teaching and learning exemplars. Results Despite the lack of consensus on the definitions of empathy evident in the literature, recurring attributes and elements of empathy were evident, leading to the development of a new empathy model. Conclusion Patterns of consistency in the attributes of empathy that emerged from the review provided the basis for a new conceptual model, termed "The Empathy Continuum." Relevance to clinical practice Each of the stages in the Empathy Continuum can be used to teach learners the meaning, attributes and application of empathy in practice. The model will be relevant to nurse educators as well as educators from other disciplines.

Background Bibliometrics involves statistical analyses of publication data, particularly citation analysis, to determine popularity/impact of articles and authors. Methods Citation analysis was conducted on the "top 100" cited nursing simulation articles in the Scopus database in April 2019. Results The median number of article citations was 84 (mean = 100.4; range, 53-557). Citations were steadily accumulated after publication; the majority between year four and year seven. Two-thirds of the articles were led by authors from the United States. Conclusions This report on bibliometric mapping helps to graphically illustrate the evolution of simulation articles in the field of nursing.

Introduction and aims Treatment of opioid dependence through opioid replacement therapy is widely recognised as effective. Nonetheless, while there has been a community-based program in the state of Victoria for over two decades, consumer experiences have received little attention. This study aimed to describe the experiences of opioid replacement therapy consumers living in rural and regional areas of the state. Design and methods A qualitative design employed an interpretative phenomenological approach. Sixteen consumers were interviewed. Thematic analysis was conducted by the researchers to examine the phenomena of consumers' experiences and findings were verified by a stakeholder group. Results Findings centred on themes of consumers' experience of becoming recipients; consumer perceptions of pharmacists and pharmacy settings and psychosocial impacts on consumers. A majority of participants believed opioid replacement therapy brought increased normality to their life, however systemic and psychosocial barriers impacted on well-being. The pharmacy setting itself as a public dosing space commonly provoked feelings of stigma and discrimination among consumers. Other barriers prominently reported were restrictions on number of takeaways, cost of dispensing and lack of access to medical practitioners and allied supports. Discussion and conclusions There were psychosocial impacts on opioid replacement therapy consumers relating to financial and social burdens, stigma and discrimination. Access to medical care and a choice of pharmacy appeared to be restricted in rural regions. The findings suggest a need to address, in particular, the financial and dispensing point burdens experienced by consumers to facilitate program retention.

Aims and objectives: To extract, examine and report the highest available levels of evidence from healthcare disciplines in the use of simulation-based education as substitution for clinical placement in prelicensure programmes. Background: Simulation is widely employed across prelicensure health professional education to create safe, realistic clinical learning experiences for students. Whether simulation can be employed to substitute for actual clinical placement, and if so, in what proportion, replacement ratio and duration, is unclear. Methods: A systematic review and quality appraisal of primary studies related to prelicensure students in all health disciplines, guided by the PRISMA checklist. Results: Ten primary studies were included, representing 2,370 students from three health disciplines in four countries. Eight studies were experimental and quasi-experimental and methodological quality was assessed as moderate to high with good to very good inter-rater agreement. Direct substitution of simulation for clinical practice ranged from 5% to 50%. With one exception, replacement ratios were 1:1 and duration of replacement ranged from 21 hr–2 years. Levels of evaluation included measures of reaction, knowledge and behaviour transfer; no negative outcomes were reported. We appraised practicalities for design of substitution, design limitations and knowledge transfer to accreditation standards for prelicensure programmes. Conclusions: This review synthesised highest levels and quality of available evidence for substitution of simulation for clinical placement in health professional education. Included studies were heterogenous in simulation interventions (proportion, ratio and duration) and in the evaluation of outcomes. Future studies should incorporate standardised simulation curricula, widen the health professions represented and strengthen experimental designs. Relevance to clinical practice: Current evidence for clinical educational preparation does not appear to be translated into programme accreditation standards governing clinical practice experience for prelicensure programmes in relevant jurisdictions. Overall, a stronger evidence base is necessary to inform future curricula and policy development, to strengthen clinical practice in health.

© 2019 Elsevier Ltd Objective: The objective of this systematic review was to identify, critically appraise and synthesize evidence for the effectiveness of empathy interventions in undergraduate nursing education. Design: A systematic review of literature. Data Sources: A three-stage systematic search of six electronic databases was conducted. Review Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses guided the review. English language articles published between 2000 and 2018 were eligible. Methodological rigour was examined using the Medical Education Research Study Quality Instrument. Changes in empathy were assessed using Cohen's effect size correlation (r) and reported as effective when the variance was >0.2 standard deviations (r ≥ 0.2). Results: Of 23 included studies, four were experimental and four were case-control studies. Of these, the mean effect size was r = 0.45 and three were regarded as effective empathy interventions. Although 10 of 13 single group studies demonstrated a significant change in empathy between pre-test and post-test (p < 0.05), effect sizes were often low (mean r = 0.26). Six single-group studies reported an intervention effect of r > 0.2. The most effective empathy education involved immersive and experiential simulation-based interventions. Simulation modalities ranged from role plays, manikin-based scenarios, to 3D e-simulations and point-of-view simulations where students wore a hemiparesis suit\ Conclusions: Nine of 23 empathy education studies in undergraduate nurse education demonstrated practical improvements in empathy. The most effective interventions were immersive and experiential simulations that focused on vulnerable patient groups and provided opportunities for guided reflection. We noted the research designs were limited in terms of levels of evidence and use of subjective measures. Larger experimental studies are required to provide higher levels of evidence to identify unequivocal outcomes in terms of empathy research. Future studies should consider transfer to practice and longer-term changes in empathy as study outcomes.

Clinical simulation is an essential component of health professional education. Digital technologies can provide students with near-reality, interactive virtual simulation learning experiences on static and mobile appliances. Clarification is needed, however, regarding the various types of virtual simulation and the different program components. We drew on published literature to define virtual simulation modalities and to offer definitive terminology to clarify the nomenclature and composition of virtual simulation. Reporting should include description of ‘Fidelity’, ‘Immersion’, and ‘Patient’ to add clarity and utility to research in the field.

Refereed/Peer-reviewed Background: There is unprecedented increase in use of simulation-based education in healthcare settings. The key driver is improving quality and safety in healthcare. To date, there is limited understanding of the degree to which this goal has been achieved. Aim: This scoping review aimed to explore the extent to which simulation-based education in healthcare has addressed and impacted contemporary patient safety priorities. Methods: Systematic searches of literature (2007-2016) were based on each of 10 patient safety priorities articulated in Australia's National Safety and Quality Health Service Standards and New Zealand's Health, Quality and Safety Indicators and markers. Included primary studies evaluated transferability to practice and/or behavioural change and improved patient outcomes, based on Kirkpatrick's training evaluation model Level 3 and Level 4. Findings: Fifteen papers met inclusion criteria. Studies aligned with four of ten National Safety and Quality Health Service Standards: (3). Preventing and controlling healthcare associated infections; (4). Medication safety; (6). Clinical handover; (9). Recognising and responding to clinical deterioration. The studies were indicative of potential for simulation-based education to have a significant impact on patient safety. Discussion: Studies that qualify as translational science, demonstrating changes in clinician behaviours and improved patient outcomes, are emerging. Little evidence from Australian and New Zealand contexts suggests that outcomes of simulation-based education in this region are not commensurate with the significant government investments. Conclusion: Translational studies, despite being difficult to design and conduct, should form part of a thematic, sustained and cumulative program of simulation-based research to identify translational science.

Bibliometrics is an emerging science in nursing. Quantitative methods were used to conduct a bibliometric analysis of highly cited virtual simulation nursing education articles to describe rank order, breadth of topics and authorship patterns.A desktop analysis of publication performance was conducted using the Scopus database as the source of article citation data.The top 100 cited articles clustered over 14-years, 2008 to 2021. Citations per paper ranged from 88 to a low of 3 (median 18, mean 22.1) and in the top 10 studies, from 88 to 41. The citation trajectory was moderately correlated with article maturity (r = -.384, p ≤0.001). Article citations in subsequent publications commenced the first year after publication and three-year-old papers reached the mean citation rate of 22. Nurse Education Today was the most cited journal. There was no significant impact of article type (72% primary research, 17% literature reviews, 11% descriptive papers) (p = 0.755). International representation was strong, as first authors in 21 countries were cited - many (43%) from USA. One highly cited author (M. Verkuyl) from Canada led six papers, with six other authors each leading two studies. Virtual simulation modalities included virtual simulation, virtual reality simulation, 3D virtual reality simulation, virtual games and virtual worlds. The top 10 articles offer a diverse resource for faculty and educators who wish to consider using virtual simulation.Virtual simulation studies in nursing education cover an emerging field of research that has relatively low citation rates. Nursing researchers and faculty need to understand the usefulness and limitations of bibliometric analysis as this methodology can make a unique contribution to research, policy, and funding decisions, and enable productivity assessments of faculty staff and departments.

This review aimed to synthesise evidence from experimental studies of the application of digital serious games in developing nursing clinical competence.Systematic review and meta-analysis.Eight databases were searched for randomized controlled trials and quasi-experimental studies published in English from 2000 to 2021.Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted in this review. Quality appraisal was conducted using Cochrane's Risk of Bias tool and the Joanna Brigg's Institute Critical Appraisal Tool for Quasi-Experimental Designs. A narrative synthesis of studies, and a meta-analysis and subgroup analysis, was performed on the study outcomes.22 experimental studies including 13 randomized controlled trials and nine quasi-experimental studies were included. Of these, 19 studies examined nursing students and three examined qualified nurses. These studies applied serious games to develop nursing competencies in management of nursing care, clinical reasoning skills, procedural skills, legal practice and quality improvement. Compared with control groups, serious games improved knowledge (SMD = 1.30, 95% CI [0.75, 1.86]) and skills (SMD = 0.38, 95% CI [0.17, 0.60]). Subgroup analysis for both knowledge and skills outcomes demonstrated that serious games were more effective than control groups with either no intervention or other educational interventions. A large effect size (SMD = 1.13, 95% CI [0.91, 1.34]) was found in favour of serious games for improving knowledge scores in management of nursing care.The reviewed studies identified a broad application of digital serious games for developing nursing competencies. The knowledge and skills performance outcomes supported the use of serious games, which were found to be superior to conventional educational interventions. More serious games are required to be incorporated into undergraduate and continuing nursing education for workplace training, with more rigorous studies examining the effect of serious games in improving the quality and safety of clinical nursing practice.

Background Bullying in nursing is a global problem that has been explored and reported within the literature. There is however, limited literature that deals directly with bullying of nursing students in the clinical setting in New Zealand. Aim This prospective cross-sectional survey investigated New Zealand undergraduate nursing students' experiences of bullying and/or harassment during clinical placement. An electronic survey was conducted between August and October 2017. Findings Responses of 296 Bachelor of Nursing students across the three years of the course were analysed using descriptive and inferential statistics. Forty percent (40%; 118) of students experienced being bullied while on clinical placements. There was a significant increase in the incidence of bullying as students progressed through the degree, with the highest proportion of bullying occurring in the hospital setting. The main perpetrators of bullying were registered nurses, with preceptors, mentors and clinical facilitators being the most cited perpetrators. Experiences of being bullied resulted in feelings of anxiety in students and negatively affected students' clinical learning. Only 27% of respondents who were bullied had self-reported an episode of bullying and respondents indicated they were not satisfied with the outcome, were often uncertain whether any action was taken, and/or felt penalized for reporting bullying. Nursing students are a vulnerable group and these findings have implications for all nurses who work with students during their undergraduate degree.

Objective To measure empathy within the therapeutic relationship between fourth year Traditional Chinese Medicine (TCM) intern practitioners and their patients, who are first-year students within the same program. Methods An observational design was used to examine the interns’ empathic communication, evaluated by first year students ‘mystery shoppers’ using the Consultation and Relational Empathy Measure (CARE). First year TCM students went undercover to experience a clinical treatment (acupuncture) by a fourth-year intern in a public Chinese Medicine clinic attached to a metropolitan university in Sydney, Australia. Results Thirty-nine consultations were assessed by 39 undercover shopper students. The Intern practitioners’ consultation and relational empathy was rated as a mean 76.4% (38.2 points of a possible 50 (median 78%; 39); range 24–50. Significant response differences were found between female and male interns with males rated higher. The underlying elements are presented and discussed. Conclusion The intern practitioners’ level of empathy averaged 76.4% which is consistent with empathy ratings for international studies of healthcare students. Results showed that males were rated higher for empathy than females, indicating further studies examining the specific behaviours that characterise empathy of different genders would be a useful addition to knowledge and assist teaching.

Introduction Clinical placements are a mandatory component of nursing students’ education internationally. Despite clinical education being a key to nursing students’ achievement of nursing competencies, few studies have reviewed students’ narratives to describe their experiences of learning during clinical placement. Such studies may be important in offering a deeper insight into clinical learning experiences than quantitative surveys. Methods A systematic thematic synthesis of qualitative studies between 2010 and June 2020 was conducted. English language studies that offered a thematic analysis of undergraduate nursing students’ experiences of learning during placement were sought. A search was made of five databases PubMed, Ovid Medline, CinahlPlus, SCOPUS, and Google Scholar. The study was guided by the ENTREQ statement for enhancing transparency in reporting the synthesis of qualitative research. Results Twenty-seven qualitative studies were included in the review. A thematic synthesis showed over 100 themes and subthemes across the studies. A cluster analysis revealed positive elements and others that were seen in the studies as a barrier (hindrance) to clinical learning. Positive elements included supportive instructors, close supervision, and belonging (in the team). Unsupportive instructors, a lack of supervision and not being included were seen as a hindrance. Three key overarching themes that could describe a successful placement were revealed as “Preparation,” “Welcomed and wanted” and “Supervision experiences”. A conceptual model of clinical placement elements conducive to nursing students’ learning was developed to enhance understanding of the complexities associated with supervision. The findings and model are presented and discussed. Conclusion The conceptual model presents positive elements that influence students’ clinical placement experiences of learning. This model may provide a framework to guide professional development programs and strategies to support students and supervisors alike, an important step forward in moving beyond the current clinical placement rhetoric.

Objectives To review undergraduate nursing students' perceptions of the quality of their clinical placement experiences by means of surveys conducted using the Clinical Learning Environment Supervision and Nurse Teacher questionnaire. Design Systematic review of English language studies published between 2014 and 2020, in any clinical setting, utilising data collected in the decade 2010 to 2020. Data sources Structured searches were conducted in CinahlPlus, Ovid Medline, Scopus, PubMed and Google Scholar. Review methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses framed the review. Results A total of 111 records were screened, after which 21 studies met criteria for inclusion. Studies were centred on students in Sweden and in 15 other countries. Students' ratings of ‘Experience’ were positive across five scale subdimensions with means 3.0–3.95 of a possible 5 (overall mean 75.4%). ‘Satisfaction’ across seven studies was rated highly (mean 4.16 of 5) 83.2% agreement. The highest rated subdimension was Supervisory relationship, with the Role of the Nurse Teacher rated lower and inconsistently. The underlying elements are discussed. Conclusion Although students' Experience and Satisfaction were rated highly averaging over 75%, there is still room for improvement. Further research is needed to examine how students perceive various components of ‘satisfaction’ within clinical learning environments because this can be seen as the primary measure of program quality. Research using experimental and observational study designs is needed to compare ways of preparing clinical teachers and reporting measurable learning outcomes for models of supervision that are applicable in varied clinical learning environments.

Background: The quality of nursing clinical placements has been found to vary. Placement evaluation tools for nursing students are available but lack contemporary reviews of clinical settings. Therefore, the aim of this study was to develop a feasible, valid and reliable clinical placement evaluation tool applicable to nursing student placements in Australia.Methods: An exploratory mixed methods co-design project. Phase 1 included a literature review; expert rating of potential question items and Nominal Group Technique meetings with a range of stakeholders for item development. Phase 2 included on-line pilot testing of the Placement Evaluation Tool (PET) with 1,263 nursing students, across all year levels at six Australian Universities and one further education college in 2019-20, to confirm validity, reliability and feasibility. Results: The PET included 19-items (rated on a 5-point agreement scale) and one global satisfaction rating (a 10-point scale). Placements were generally positively rated. The total scale score (19 items) revealed a median student rating of 81 points from a maximum of 95 and a median global satisfaction rating of 9/10. Criterion validity was confirmed by item correlation: Intra-class Correlation Co-efficient ICC = .709; scale total to global score r = .722; and items to total score ranging from .609 to .832. Strong concurrent validity was demonstrated with the Clinical Learning Environment and Supervision Scale (r= .834). Internal reliability was identified and confirmed in two subscale factors: Clinical Environment (Cronbach’s alpha = .94) and Learning Support (alpha = .96). Based on the short time taken to complete the survey (median 3.5 minutes) and students’ comments, the tool was deemed applicable and feasible. Conclusions: The PET was found to be valid, reliable and feasible. Use of the tool as a quality assurance measure is likely to improve education and practice in clinical environments. Further international evaluation of the instrument is required to fully determine its psychometric properties.

Objective To critically appraise and synthesize the best available evidence on the effectiveness of massage to reduce antenatal women's anxiety and/ or depression. Design Systematic review with meta-analysis Participants, interventions Pregnant women over the age of 18 years who receive massage interventions. Measurements and findings Eight studies were included in the review; seven were randomized controlled trials. Data were collected via pregnant women's self-reported ratings of anxiety or depression using validated tools. Meta-analysis of four studies revealed a moderate effect of massage therapy on women's depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) (MD = -5.95, 95%CI = -8.11 to -3.80, I2 = 0%) compared with usual care. A moderate effect of massage interventions on women's anxiety were also found based on five studies using various measures (SMD = -0.59, 95%CI = -1.06 to -0.12, I2 = 75%) when compared with usual care. However, none of the trials had a low risk of bias. Key conclusions Non-pharmacologic treatments for mental health symptoms are an important option for women to use during pregnancy. As shown in meta-analysed data, massage therapy might be more effective in reducing pregnant women's anxiety and depression than usual care, although the current results may be prone to bias. Further high-quality research is required to fully evaluate the impact of massage therapy on pregnant women's mental health symptoms in the immediate and also longer term. Implications for practice Massage therapy may be an acceptable and feasible approach for pregnant women to employ to reduce their anxiety and depressive symptoms. More research evidence examining the safety and effectiveness of massage is required before practice recommendations can be made.

Objective: To identify communication patterns of Registered Nurses regarding patients’ use of complementary therapies. Methods: A cross-sectional online survey conducted in 2017 recruited Australian Registered Nurses working in any area of nursing. Results: Responses of 614 Registered Nurses were analysed. Patient-initiated discussion of complementary therapies were common for 77% of nurses; nurse-initiated discussions were perceived by 73% (sometimes/almost always/always). Nurses’ personal use of complementary therapies predicted discussion with patients and education-based, oncology, or aged care/rehabilitation nurses were most likely to initiate dialogue. Many (55%) did not ‘recommend’ a particular therapy, although 12% ‘almost always/always’ did so. Four out of five nurses (84%) documented patients’ use and communicated with medical/nursing colleagues about this use. Conversely, 61% ‘never’ or ‘almost never’ communicated with a complementary therapy practitioner. Conclusion: Nurses working in Australia often discuss complementary therapies, however they rarely specifically recommend their use. Their workplace environment and clinical context influenced nurses’ willingness to communicate about complementary therapy use. Practice implications evidence: suggests the need for policy development to promote communication between mainstream healthcare providers and complementary therapy practitioners to support the delivery of safe, high quality patient care. Refereed/Peer-reviewed

To review the literature regarding the value and consumer focus of research on opioid replacement therapy (ORT) programs, relevant to the Australian rural context and community pharmacy. We conducted a narrative review of literature published between 1995 and 2015, searching EBSCOhost, PubMed and Google Scholar. Three authors collaborated to screen and synthesise studies. Effectiveness, cost affordability, diversion and retention benefits were reported from pharmacological or prescribers’ or dispensers’ standpoint. Research was fragmented and evaluated contributions of these individual types of stakeholders with less discussion of consumers, or consumers’ everyday experiences of ORT. No studies took into account consumers’ psychosocial aspects or power discourses. We found ORT as a beneficial treatment for opioid dependence is well researched, although overall Australian program evaluation was lacking. A gap within ORT literature should be addressed by making consumer experiences central in designs for future research and for program evaluation.

Nursing management of physical deterioration of patients within acute mental health settings is observed, recorded, and actively managed with the use of standardized Adult Deterioration Detection System (ADDS) charts. Patient deterioration may require the urgent assistance of a hospital rapid response or Medical Emergency Team. A five-and-a-half-year (2011-2016) audit of hospital-wide Medical Emergency Team attendances was conducted in an acute mental health unit of a single large 250 bed regional hospital in Victoria, Australia. Data were extracted from the hospitals' quality and patient safety program, RISKMan, and entered into a statistical data program for analysis. A total of 140 patient records were analysed, and the 'Worried' category (34%, n = 47) was the principle reason for a Medical Emergency Team call in a mental health ward, followed by hypotension (23%, n = 31) and a low Glasgow Coma Score (16%, n = 22). Upon further investigation of the 'Worried' category, the most common conditions recorded were an altered conscious state (22%, n = 9), low oxygen saturation (20%, n = 8), or chest pain (17%, n = 7). Activation of Medical Emergency Team calls predominantly occurred in the daylight morning hours (6am-12md). When data were compared to the general hospital patients, the context of the physiological deterioration of the mental health patients was strikingly similar. Further research is recommended to ascertain the extent and frequency with which staff working in mental health units are performing vital signs monitoring as an essential component of detection of early signs of physiological deterioration.

Aims and objectives To explore service provision for Victorian regional refugee families from the perspective of maternal and child health nurses. Background Increasingly, more families from a refugee background are resettling in regional Victoria. The refugee journey has significant effect on families. Refugee families with infants and young children can be provided with support by maternal and child health services; however, many families experience barriers to ongoing engagement with this service. Design This descriptive study used focus group and questionnaire. A purposive sample of 26 maternal and child health nurses was drawn from six municipalities throughout regional Victoria, where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio-recorded narratives were transcribed, prior to inductive thematic analysis. Methods This descriptive study used focus group and questionnaire. A purposive sample of 26 Maternal and Child Health nurses was drawn from six municipalities throughout regional Victoria where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio-recorded narratives were transcribed verbatim, prior to inductive thematic analysis. Results Participating nurses were experienced nurses, averaging 12 years in the service. Four major themes emerged from thematic analysis: "How to identify women from a refugee background"; "The Maternal and Child Health nurse role when working with families from a refugee background"; "Interpreting issues"; and "Access to other referral agencies." Nurses worked to develop a relationship with families, attending to a complex mix of issues which were complicated by language barriers. Nurses found their role in supporting refugee families required additional time and more home visits. Conclusions To provide best practice, maternal and child health nurses need (i) ongoing professional development; (ii) time, flexibility and creativity to build relationships with refugee families and (iii) better access to services that enhance communication, such as interpreting services and translated resources. Relevance to clinical practice Nurses require ongoing professional development to help them address the multifaceted needs of families of refugee background. With limited resources available in regional areas, accessing further education can be challenging. Distance education models and organisational support could provide nurses with educational opportunities aimed at improving service provision and clinical practice.

Aims and objectives To identify how science should be taught to nursing students, and by whom. Background An understanding of foundational science and its role in supporting safe and effective nursing practice is an important part of student learning. The well documented challenges in teaching this content are compounded by a lack of evidence regarding educational strategies that lead to improved educational outcomes. Design The study employed a cross-sectional design using online surveys. Methods Two surveys were conducted in Australia involving (i) academics who teach science in undergraduate nursing programs and (ii) registered nurses (RNs). Participants were asked to respond to a range of questions around how science should be taught to nurses. There were n=30 and n=1808 respondents respectively. Results Findings indicated a need to better integrate science content throughout nursing curricula. Participants were supportive of a discrete science subject in the foundation year and the integration of science content throughout the remainder of the curriculum. Participants across both surveys were ambivalent about whether the depth of science teaching was adequate for nursing practice. Most nurse academics and RNs thought that nurses should teach science, while non-nursing science teachers were less certain. Conclusions Existing consensus clearly values the delivery of science content as an initial and ongoing priority of learning throughout the undergraduate nursing program. Relevance to practice Improving the ways in which students learn sciences will impact on nursing practice, with the potential to improve patient care.

Aim: This study aimed to evaluate Australian nursing students’ views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET). Background: Clinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences. Design: A survey design was used with a contemporary survey tool– the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed. Methods: A total of 1263 nursing students completed the Placement Evaluation Tool (PET) − 19 items (rated 1–5), one global rating (rated 1–10) − following placement in three Australian States (July 2019−February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall. Results: The total PET mean score was 78.3% with 29.8% being ‘extremely satisfied’ (10 out of 10 – Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p =

Objective:This study explored young university students’ (aged 18–24 years) health literacy, asthma experiences and help-seeking behaviours to inform the development of a web-based asthma education intervention relevant to this age group.Design:Exploratory mixed-methods design incorporateing a health literacy survey and interviews, plus the development of a web-based educational video.Setting:Participants were students at two universities in the state of Victoria, Australia.Method:In total, 20 asthma sufferers were interviewed by trained pairs of university students. Interpretative phenomenology underpinned the narrative analysis and enabled the description of the participants’ lived experience. A branching e-simulation video was developed.Results:A number of key themes were identified: ‘Life with asthma’, including ‘A life of vigilance’ regarding asthma triggers, lifestyle limitations and heightened sensitivities; ‘Asthma management – call Mum’, a lack of knowledge and support systems with substantial ma...

Background E-simulation may enable a feasible education solution to the management of deteriorating patients. Method The study involves a pre–post quasi-experimental evaluation of global data on educational outcomes from an e-simulation program. Results Qualified nurses (n = 1,229) and final year nursing students (n = 1,742) were among 5,511 participants from 20 countries who completed the program. Both groups' knowledge and performance improved significantly (p = Conclusion E-simulation may enhance students' preparation for practice and improve qualified nurses' management of deteriorating patients.

Simulation-based learning is an approach recommended for teaching undergraduate health professionals. There is a scarcity of research around interprofessional simulation training for pre-professional students in obstetric emergencies that occur prior to arrival at the maternity ward.The primary aims of the study were to examine whether an interprofessional team-based simulated birth scenario would improve undergraduate paramedic, nursing, and midwifery students' self-efficacy scores and clinical knowledge when managing birth in an unplanned location. The secondary aim was to assess students' satisfaction with the newly developed interprofessional simulation.Quasi-experimental descriptive study with repeated measures.Simulated hospital emergency department.Final year undergraduate paramedic, nursing, and midwifery students.Interprofessional teams of five students managed a simulated unplanned vaginal birth, followed by debriefing. Students completed a satisfaction with simulation survey. Serial surveys of clinical knowledge and self-efficacy were conducted at three time points.Twenty-four students participated in one of five simulation scenarios. Overall, students' self-efficacy and confidence in ability to achieve a successful birth outcome was significantly improved at one month (p0.001) with a magnitude of increase (effect) of 40% (r=0.71) and remained so after a further three months. Clinical knowledge was significantly increased in only one of three student groups: nursing (p=0.04; r=0.311). Students' satisfaction with the simulation experience was high (M=4.65/5).Results from this study indicate that an interprofessional simulation of a birth in an unplanned setting can improve undergraduate paramedic, nursing and midwifery students' confidence working in an interprofessional team. There was a significant improvement in clinical knowledge of the nursing students (who had least content about managing birth in their program). All students were highly satisfied with the interprofessional simulation experience simulation.

Summary Bullying and harassment in nursing are unacceptable behaviours in the workplace. There is a large body of evidence relating this problem, however little of it focuses on the experiences of nursing students. This prospective cross-sectional survey investigated Australian undergraduate nursing students' (N=888) experiences of bullying and/or harassment during clinical placement. Half (50.1%) of the students indicated they had experienced this behaviour in the previous 12 months. Younger students were more likely to be bullied/harassed than older students (p=0.05). Participants identified perpetrators of bullying/harassment as registered nurses (56.6%), patients (37.4%), enrolled nurse's (36.4%), clinical facilitators (25.9%), preceptors (24.6%), nurse managers (22.8%) and other student nurses (11.8%). The majority of students reported that the experience of being bullied/harassed made them feel anxious (71.5%) and depressed (53.6%). Almost a third of students (32.8%) indicated that these experiences negatively affected the standard of care they provided to patients with many (46.9%) reconsidering nursing as their intended career. In the face of workforce attrition in nursing, the findings of this study have implications for education providers, clinical institutions and the profession at large.

A scoping review aims to systematically explore and map the research available from a wide range of sources. The objective of this study was to produce a scoping review checklist to guide future scoping studies to enable rigorous review and critique of phenomena of interest. The methods used included a review of literature, expert consensus group meetings, a modified Delphi survey and, finally, verification against recent scoping study examples. Results showed that the checklist was able to identify key elements of scoping reviews. The 22-item Scoping Review Checklist (SRC), which includes two optional stakeholder consultation items, has been developed using rigorous recommended approaches. The checklist can be used to guide the conduct and critique of scoping studies. Refereed/Peer-reviewed

This paper aims to explore and classify studies of the impact and effectiveness of continuing professional education for registered nurses, using existing reviews of literature. Four healthcare databases were searched for publications from 2010 to July 2019 and electronic keywords searches were conducted. Umbrella review methodology was applied and Kirkpatrick's Four-Level Model of training evaluation was used to synthesise results and explicate the levels of educational impact. Of 16 included reviews, 13 were of simulation-based education activities. Three reviews of experimental studies demonstrated strong positive evidence of education impact on nurses' learning. Objective evidence of transfer of knowledge and skills into practice included improved interprofessional team performance and less time taken to complete clinical tasks. Reports of practice improvements and intention to change practice provided further evidence of impact. A small number of individual studies measured impact on service delivery, reporting positive and neutral results. We conclude that nurses learn and newly acquired knowledge and skills are often transferred into practice. Collection of robust evaluative data after completion of education is limited by practical considerations such as access to learners, resources and time constraints. Further studies of translational impact are needed, specifically, of the impact on patient care.