Showing papers in "Australian Journal of Advanced Nursing in 2020"

Roles of rural and remote registered nurses in Australia: An integrative review

Abstract: Objective:The aim of this review is to explore the multifaceted roles of registered nursing practice in rural and remote areas of Australia. Background:People in rural and remote Australia have less access to healthcare than their metropolitan counterparts. They are also burdened with higher rates of chronic disease and premature mortality. These areas also have less doctors and allied health professionals than metropolitan areas, with the core workforce being registered nurses. One strategy to address the health workforce disparities, is to promote registered nurses to work to their full scope and in advanced generalist roles. An understanding of the current roles of the registered nurse is therefore required to assist in determining how their scope could be extended, and to inform appropriate educational planning. Study design and methods:An integrative review of literature was used to obtain articles from online databases relevant to nursing from 1995 to 2017. Data was quality appraised, extracted, and thematically analysed. Results:Registered nurses in rural and remote Australia work in diverse contexts that have a major influence on the roles they undertake. They are already required to be multi-skilled and to practice at an advanced level, including undertaking some aspects of the health professional role traditionally the domain of medical practitioners. These registered nurses often feel unprepared for the breadth and complexity of this role. Discussion:To enable registered nurses to be adequately prepared for rural and remote practice, educational programs need to be flexible, accessible and affordable. The registered nurse’s existing experience and expertise should be recognised, and educational pathways structured to enable the nurse to expand their practice according to the context in which they work and the needs of the community. Conclusion:Registered nurses in rural and remote areas function as advanced generalists. Greater understanding of these roles is necessary to inform the development of ‘fit for purpose’ educational models. Implications for research, policy and practice:Future research is needed to focus on evaluation of existing models of rural and remote nursing practice and in particular the role of the nurse as doctor substitute. The findings of this study highlight the potential expanded contribution of registered nurses in these areas, which is an important factor for consideration by policy makers. In practice, supportive frameworks are required to ensure registered nurses are able to function to their full capacity in their unique context. What is already known about the topic?– People living in rural and remote areas are subjected to inequities in respect of health and access to healthcare services.– Registered nurses working in rural and remote areas are essential for addressing healthcare needs that would otherwise be unmet.– Nurses practicing in these areas require an advanced skills-set in order to function effectively in their role. What this paper adds.– This paper examines the multifaceted role of the registered nurse working in rural and remote areas of Australia as described in the literature.– Four main themes were identified: roles shaped by context; doctor substitute; multi-skilled and advanced practice; and feeling unprepared.– Understanding the complexity of the registered nurse role in rural and remote areas enables the development of policy, practice and educational approaches to support nurses in functioning to their full capacity. https://doi.org/10.37464/2020.371.5

The mental health impact of COVID-19

Abstract: The impact of COVID-19 has and will be wide-ranging, with implications for people’s health and wellbeing way beyond the direct effects of an infectious respiratory illness. Due to the very real threat of the virus to the health of individuals, government responses to gain control and slow the spread of SARS-CoV-2 in order to protect health care sector capacity has resulted in virtually unprecedented limitations on people’s personal, social, and working lives as well as widespread and lasting economic impacts. Many countries already faced significant challenges related to mental ill health prior to the pandemic. COVID-19 has brought with it new threats to the mental health and wellbeing of people with pre-exiting mental ill health, the health care, maternity care, and aged care workforces, and people in the community with no prior experience or risk factors for mental ill health. Mental health is and will be a pressing issue for a vast number of people across many segments of society and addressing it will take action and cooperation across many contexts and between diverse groups. Now more than ever we need to work collaboratively to help one another – especially our most vulnerable community members who often lack the voice, resources, and platforms to help themselves.

Registered nurses as role models for healthy lifestyles

Abstract: Objective: The aim of this paper is to report on registered nurses’ adherence to current Australian health behaviour recommendations. Barriers and facilitators to healthy lifestyles, and their attitudes towards being role models and promoting healthy lifestyles to their patients. Background: It is widely accepted that a healthy diet, limiting alcohol consumption, abstinence from smoking and regular physical exercise are important components of healthy lifestyles and play a significant role in preventing chronic diseases. Nurses are well situated to contribute to providing health and patient education regarding modifiable health risk factors, however their own adherence to health behaviours may impact this. Study design and methods: The research is a mixed methods study of 123 registered nurses from both public and private organisations in Regional Queensland. Data for this paper were generated from an online survey which is the first of two phases in the broader study. Results: Four health risk factors were examined; diet, smoking, physical exercise and alcohol consumption. BMI was also calculated and considered as a fifth risk factor. Of this sample, 13% of participants met the guidelines for fruit and vegetable intake, 5.2% smoked, and only 24.2% exercised enough to be classed sufficiently active for their health. Of the 93.62% of participants whom consumed alcohol, 69.3% consumed more than 2 standard drinks/day. The most common barriers to adhering to healthy lifestyles were shift work, long working hours and family commitments. Conclusion: Many nurses are not adhering to healthy lifestyle recommendations. It is recommended that the health and wellbeing of our health professionals, especially nurses be considered. Providing support and resources to enable them to care for themselves, may in turn allow them to better care for patients. Implications for research, policy, and practice: Research is needed into strategies to enable registered nurses’ better work/life balance. To make a real difference to health outcomes, nurses own health and health education needs to be made a priority that is supported and implemented at multiple points: by policymakers, within nursing practice, nursing curriculum, and in healthcare institutions. Nurses need to be supported in the provision health education to their patients with better resources, education and time allocation. Future research should include studies conducted in different regions or ideally a large nationally representative sample.

COVID-19 and residential aged care in Australia

Abstract: The aged care sector requires transformation The havoc wreaked by the COVID-19 pandemic globally and nationally may create an environment where the required changes are lost to other priorities Australia’s success with the emergency response and management of COVID-19 pandemic are in a large part due to inherent underlying geographic and population factors When reflecting on this pandemic we must objectively examine the domains of governance, workforce, models of care, evaluation and finally, resources and infrastructure The COVID-19 pandemic highlighted major gaps in each domain A prudent approach is required if we are to guard against the high COVID-19 case fatality rate of residents in aged care homes and to progress with much needed long-term changes

A national survey of nurses who care for people with intellectual and developmental disability

Abstract: Objective: To describe the roles that Australian nurses play, the breadth of skills that they deploy, and the range of contexts in which they practice Study design and methods: This cross-sectional study used a descriptive survey where data were collected online using Qualtrics© Survey respondents were nurses whose primary role was caring for people with intellectual and developmental disability In addition to demographic data, the main outcome measures were: nursing roles, practice and context Results: Complete responses were collected from 101 nurses; 78 females and 22 males completed the survey, the majority of whom (n=70) were from New South Wales The major focus of care was direct assessment and care, followed by supervision of support workers, education, and advocacy for people with intellectual and developmental disability Physical healthcare was consistent across body systems, as it was for all adaptive behaviour domains Support for mental illness was more likely to be for depression and anxiety Nurses liaise with a multitude of health and social agencies as part of their nursing practice Discussion: This is the first study to capture the roles, practice and contexts of these Australian nurses Nurses caring for people with IDD play a variety of roles and engage in a vast array of practice related to the physical and social needs of people with intellectual and developmental disability across the whole of the lifespan and in multiple, disparate contexts Conclusion: It is important for the ongoing care of people with intellectual and developmental disability that the value added by this nursing workforce not be overlooked as disability and health policies evolve Implications for research, policy and practice: This cross sectional study lays the groundwork for further research about these Australian nurses, in particular more focussed research about the economic benefits of disability services employing nurses, description and effect of nursing interventions specific to people with intellectual and developmental disability, as well as theoretical work to conceptualise new, National Disability Insurance Scheme-ready, models of nursing care for people with intellectual and developmental disability What is already known about the topic?• In the Australian context, little is known about the contemporary roles and practice of nurses who care for people with intellectual and developmental disabilityWhat this paper adds:• This paper offers a detailed and modern insight into the roles and nursing practice of this marginalised group of nurses Although all nurses offer physical nursing care, unique to these nurses is the breadth and depth of social, behavioural, emotional and adaptive behaviour support across the lifespan

Nursing student evaluations of the quality of mentoring support in individual, dual and group mentoring approach during clinical training: A prospective cohort study

Abstract: Objective: To examine how Bachelor of Science nursing students evaluate the quality of mentoring support during clinical training using three different types of mentoring approaches. Background: The mentoring approach and the mentor–student relationship are important factors that determine nursing students’ satisfaction with their clinical experience. However, there are significant differences in the approaches to mentoring in nursing, and there is no global consensus around a universal form of mentorship. Study design and methods: The participants were first-year Bachelor of Science students (n = 86) divided into three groups exposed to three different mentoring approaches: Group 1 = dual (two mentors/ group of students); Group 2 = individual (one mentor/ one student); Group 3 = group (one mentor/group of students). The validated Mentor Support Evaluation Questionnaire (MSEQ) was used to assess the quality of mentoring support. Results: Students from Group 2 reported a significantly higher level of mentoring support quality (P < 0.01; M = 4.8; SD = 0.32) in comparison to students from Group 1 (M = 4.1; SD = 0.66) and students from Group 3 (M = 3.32; SD = 1.71). Discussion: Nursing students exposed to different mentoring approaches vary in their reported quality of mentoring support. The highest quality of mentoring support was reported by students in the individual approach, and the lowest quality of mentoring support was reported by students mentored in a group of four to six students by a single mentor. In the individual approach, the students highlighted the continuous availability of the mentor, recognition of personal study needs, respect, safety, appreciation, and patience. Conclusion: The approach to mentoring is an important factor that affects students’ satisfaction with their clinical experience, and in return it influences achievement of final learning outcomes and professional development of students. Implications for research, policy, and practice: The results of this study emphasize the importance individualizing the mentorship process in order to increase students’ satisfaction and lead to more successful acquisition of knowledge, skills, and attitudes. These results also indicate the need to continuously monitor student evaluations of the quality of mentoring support and their overall satisfaction with the mentoring approach during clinical training. A future qualitative, longitudinal, mixed-methods study is recommended in order to investigate and describe the specific and (in)direct causes of student (dis)satisfaction in the mentor–student relationship. What is already known about the topic? There are different types of mentor approaches in nursing education. Comparisons of students’ perceptions of mentor–student relationships in different mentoring approaches, such as individual, dual, or group mentoring, represent an under-researched area. What this paper adds: Findings from this study provide evidence to better understanding the specific advantages and disadvantages of mentor–student relationships in individual, dual, and group approaches from the students’ point of view.

The organisational socialisation of new graduate nurses and midwives within three months of their entrance into the health workforce

Abstract: Objective: To investigate if the current onboarding process influences the organisational socialisation of new graduate nurses and midwives into the workforce. Background: Positive organisational socialisation experience for new graduate nurses and midwives during their entry into the healthcare environment is an important contributor when building an organisation’s ability to increase workforce capacity. However, few studies have investigated the onboarding processes to promote their organisational socialisation. Study design and methods: A quantitative, descriptive, cross-sectional study design was conducted at a large Local Health District that provides health services to almost one million people in metropolitan, rural and remote locations. Participants were 170 new graduate nurses and midwives who commenced their transition program at 21 acute and community healthcare settings within the District in January and February 2017. Data was collected through a document review of current onboarding processes and by an online survey of new graduates. Data sets were analysed using descriptive statistics and content analysis. Results: The survey response rate was 47% (n= 80). Findings highlight that the onboarding process provided by the District was useful for the new graduate’s transition into the workplace. The findings also indicated that the onboarding process was inconsistent across different contexts in the District and required more relevant and practical components. In addition, the current onboarding did not adequately provide strategies to build relationships for new graduates within their work environments. Discussion: This study provides valuable insight into current onboarding practices in both metropolitan and rural contexts and highlights gaps in this process across the health District. The findings of the study provide insights and future direction for improvements with addressing the inconsistency in the structure and content of orientation programs. The need for more accessible and consistent organisational information and a more structured framework for the organisational wide onboarding process was also identified. Conclusion: Re-design of an onboarding process that is relevant, consistent and enhances relationship-building is imperative to meeting both the professional and organisational needs of new graduate nurses and midwives. Implications for research, policy and practice: The findings of the study imply a need to streamline the onboarding process to provide greater opportunity for new graduates to develop and sustain professional networks and associated workplace relationships regardless of their locations. They also signal a need to develop policies practice and future research to assist a better organisational socialisation, in particular, the allocation of resources, better utilisation of time spent on education and workplace support in the transition into their clinical workplaces. What is already known about the topic? Supporting new graduate nurses and midwives in their first year is important for their transition into the workforce and to increase their retention in the profession. Onboarding processes for new graduates during their transition into the workplace enhances their professional knowledge and confidence, which increases their capacity to provide safe quality healthcare. Few studies have investigated the relationship between the onboarding process and the promotion of organisational socialisation within the first three months of entering the health workforce. What this paper adds? Findings identify the need to improve the onboarding process to better meet the complex needs of the new graduates. Implementation of a tailored onboarding process, especially in rural and specialty areas improves organisational socialisation.

The role of telehealth in supporting mothers and children during the COVID-19 pandemic

Abstract: The role of telehealth in supporting community has become increasingly important during the COVID-19 pandemic as we found this coincidently in delivering the Healthy Beginnings program over the phone. We would urge an action to be taken to integrate telehealth into existing health services.

Community respite service utilisation and dementia care: a review of literature

Abstract: Objective: To explore the detrimental effects of caregiver burden, in relation to caregivers of people with dementia, and highlight caregiver burden as an emerging health care problem. The purpose of the literature review is to inform health care professionals of the barriers to utilizing community respite services by caregivers and discuss the significance of respite services to caregivers of people with dementia. Background: Dementia is one of the leading contributors to burden of disease and disability. Increasing numbers of spouse and family caregivers play crucial roles in providing support for people with dementia enabling them to continue living in the community. Caregiver burden occurs in individuals when the demands of caregiving exceeds their resources. Community respite services are valuable resources which provide individuals a break from their caregiving role. Study design and methods: The literature review will draw attention to caregivers of people living with dementia in the community and their utilization of community respite services. The target audience are health care professionals in multidisciplinary community teams composed of clinicians, educators, managers, administrators, and researchers. Seven online databases were accessed to search the following terms of caregiver burden, dementia care and community respite along with specific inclusion criteria. As a result, 26 scholarly articles were reviewed for the purpose of this literature review. Results: There are several community respite services, which help minimize the incidence of caregiver burden, available to caregivers of people with dementia but there are many barriers which affect utilization of these services. Some of these barriers include accessibility of information on respite services, flexibility and affordability of respite services, and the caregiver’s inability to recognize their need for respite services. Discussion: Health care professionals could assist caregivers to better utilize community respite services by performing through assessments on both people with dementia and their caregivers. As a result of these assessments, potential barriers to community respite service utilization could be identified. Implications for research: Further research is required to investigate the specific types of respite service caregivers need and which respite services have been most successful for caregivers. This knowledge can assist HCPs in improving utilization rates of respite services and inform health systems on where to focus the funding of their community resources for PWD and their caregivers. Conclusion: Community respite services are essential to minimizing the incidence of caregiver burden. Health care professionals should recognize these barriers to respite service use and implement strategies to increase service utilization. What is already known about the topic Dementia is an emerging health care problem leading to caregiver burden amongst caregivers. Community respite services help minimize the occurrence of caregiver burden. What this paper adds Contributes to the existing knowledge of caregiver burden amongst Australian health care professionals. Identifies several barriers to caregiver respite service utilization. Emphasizes the significance of respite services to caregivers of people with dementia.

Recognition for registered nurses supporting students on clinical placement: a grounded theory study

Abstract: Objective: This study examined registered nurses’ perspectives of being supportive of nursing students and providing them with learning opportunities when on clinical placements Background: In Australia, as part of their three-year Bachelors degree, undergraduate nursing students undertake a minimum of 800 hours of clinical placement During these clinical placement hours, nursing students are supervised by registered nurses who are required to be supportive of the students and provide them with learning opportunities Study design and methods: This study used a grounded theory approach In this qualitative study there were fifteen registered nurse participants Thirteen participants were female participants and two were male Participants were individually interviewed Transcripts from these in–depth interviews were analysed using constant comparative analysis Results: The major category, an added extra, emerged from this study An added extra is about registered nurses’ perception that having a student is an added extra to their daily duties The major category an added extra is informed by three emergent themes The first theme was time, the second theme was workload and the third theme was wanting recognition Discussion: Registered nurses perceived that their workloads tend not to be taken into consideration when they have nursing students The literature suggests that nursing students often miss out on learning opportunities when they are on clinical placement because registered nurses do not have additional time to effectively support students’ clinical learning Conclusion: Participants in this study believed being supportive of nursing students and providing them with learning opportunities was an added extra to their daily nursing duties Findings revealed registered nurses want to be recognised for the extra time and effort they dedicate to students’ learning Implications for research, policy, and practice: When allocated nursing students, registered nurses should have their workloads adjusted because being supportive of nursing students and providing them with learning opportunities is time consuming Further research is recommended to determine if patient workloads are being decreased when registered nurses are allocated nursing students What is already known about the topic?• Registered nurses struggle to find the time to support nursing students with their clinical learning• Management tend not to recognise the time and effort registered nurses dedicate to student learningWhat this paper adds:• Registered nurses perceive supervising nursing students as an added extra on top of their alreadyheavy workload• Registered nurses want to be acknowledged for their contribution to student learning

Skin cancer in regional, rural and remote Australia; opportunities for service improvement through technological advances and interdisciplinary care

Abstract: Age standardised skin cancers (melanoma and non-melanoma) continue to increase in Australia, although they are stabilising for those under age 40. People living in regional, rural and remote Australia have higher rates of skin cancer and challenges accessing care. Better targeting of skin protection measures and improved opportunistic screening have been promoted as ways to improve care for these populations as have increased use of information technology and upskilling of primary health care nurses. The Australian Government supports that Optimal Cancer Care Pathways for skin cancers be used as a key resource in exploring best practice models of care for skin cancer patients both for the development of digital platforms and face to face multidisciplinary teams (MDTs). Better use of technology has been a core recommendation of national health and skin cancer organisations for improving prevention and early detection of skin cancer. Skin cancers, as a primarily visual diagnosis are considered one of the prime areas for technological health interventions. The harnessing of artificial intelligence (AI) technology as a tool for early detection and disease management of skin cancers has great potential to reduce the burden of health care costs to the regional, rural and remote community and improve health outcomes.

The effects of a hospital-based perinatal breastfeeding program on exclusive breastfeeding in Taiwan: a quasi-experimental study

Abstract: Objective: To examine if a perinatal breastfeeding program would improve the exclusive breastfeeding rate at a baby-friendly hospital Background: The Ten Steps to Successful Breastfeeding and Baby-Friendly Hospital Initiative have been widely used to improve breastfeeding outcomes worldwide A hospital-based multi-strategy intervention may provide an opportunity to increase breastfeeding in different countries Study design and methods: The study used a quasi-experimental design Data was collected in a Baby Friendly hospital A total of 60 mother-infant dyads were included The experimental group took part in the multi-component perinatal breastfeeding program, while the control group received routine care The multi-strategy program included prenatal breastfeeding education, birth kangaroo mother care (skin-to-skin contact and non-separation practices) at first breastfeed, continuous 24-hour rooming-in, ongoing kangaroo mother care with breastfeeding on cue, and hospital support visits The exclusive breastfeeding rate was measured at hospital discharge, and one-month postpartum Results: The mothers who participated in the intervention had a greater exclusive breastfeeding rate at hospital discharge and one month postpartum than those in the control group In the experimental group, 90% of the infants completed the first feeding within two hours after birth At discharge, 933% of the mothers in the experimental group and 533% in the control group were exclusively breastfeeding At one month postpartum, 833% of the mothers in the experimental group and 367% in the control group were still exclusively breastfeeding Discussion: The intervention program used in the current study is different to previous studies The current intervention not only included prenatal education and postpartum support, but also included birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care with breastfeeding on cue Breastfeeding should be promoted through perinatal comprehensive clinical and social support starting in the prenatal period and continuing through intrapartal, postpartum, and follow-up periods Conclusion: This study was the first study to use a hospital-based multi-strategy intervention including the non-separation of mother-infant dyads and other breastfeeding support for mothers in Taiwan The program was associated with a significant improvement in the exclusive breastfeeding rate at one month postpartum Implication for practice: This study provided initial evidence to support the implementation of mother-infant non-separation practices in improving breastfeeding outcomes Health professionals can be re-educated regarding birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care with breastfeeding on cue without increasing nursing workloads while infants’ fathers and other family members (eg mothers-in-law/mothers’ mothers) can be encouraged to participate in order to achieve family-centred maternity care What is already known about the topic?• Early and exclusive breast feeding and ongoing breast feeding is the optimal form of nutrition for newborn babies and promotes positive infant and mother outcomes• Birth kangaroo mother care plays an important role in providing the optimal atmosphere for a baby’s instinctive reflex ability to breastfeed effectively in order to help infant imprinting and sucklingWhat this paper adds:• The newly developed hospital-based perinatal breastfeeding program has demonstrated effectiveness in promoting exclusive breastfeeding rate at one month postpartum• Including birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care withbreastfeeding on cue in a perinatal breastfeeding program may lead to more positive breastfeeding experiences for new mothers

Patients’ experiences of natalizumab treatment in a home environment: a qualitative study

Abstract: Objective:This study’s objective was to understand the experiences and perspectives of people with multiple sclerosis who received infusions of natalizumab at home instead of the tertiary hospital day unit. Background:Continually returning once every four weeks to an out-patient department to complete an intravenous infusion can be taxing for chronic disease patients. In Australia, acute care patients may be offered hospital in the home service. In-home services are delivered by highly qualified, trained nurses following the infusion protocols similar to that of the hospital. However, this service is not yet offered for chronic disease patients, such as those with relapsing remitting multiple sclerosis. Study design and methods:An exploratorydescriptive study that incorporated face-to-face audio-recorded interviews of people with multiple sclerosis was undertaken as part of a larger study that trialled delivery of natalizumab at home instead of the hospital day unit. The interviews were conducted at the Ambulatory Care Day Unit of a hospital following a period of three natalizumab infusions in participants’ homes. Twelve people with multiple sclerosis (two males and 10 females) aged between 18–56 years participated in this study. Results: A main theme of ‘patient-centredness’ that describes the positive contribution of having patients at the centre of care when delivering home infusions emerged. This encompassed three subthemes: ‘in the comfort of their own home’, ‘convenience for patients and their families’ and ‘saving time and money’. Patient-centred care was an important part of the model of care because it provided flexibility for the participants in managing their home and work-life commitments. Discussion:Although home infusion therapy requires a healthcare team approach, this study’s findings demonstrated that delivering patient-centred home infusions provided satisfaction for people with multiple sclerosis. This enabled natalizumab to be delivered at patients’ preferred time in the convenience of their own home. Conclusion:If models of care are to be truly patientcentred, the convenience of the location of the delivery of safe treatment must be a consideration into the future design of services for those with longterm health issues such as multiple sclerosis. What is already known about this topic?– People with multiple sclerosis come to hospital on a four-weekly basis to receive natalizumab infusions via an out-patient department service. Home infusion programs have been established to stem the increasing demand for acute care hospital beds. What this paper adds.– Home natalizumab infusions were accepted by the participants, particularly because of the convenience involved.– The study contributes to patient-centredness of home infusions, which may improve the health and wellbeing of people with multiple sclerosis. https://doi.org/10.37464/2020.371.4

Implications for bachelor of nursing programs when using student experience survey findings as an indicator of course quality

Abstract: Objective: To discuss the implications of using student experience surveys to improve the quality of teaching and learning within bachelor of nursing programs in Australia. Background: Australia’s recent independent review of nursing education suggests that not all graduates are sufficiently prepared for their registered nurse role, indicating problems with program quality. Student experience surveys are widely used in course development processes. Discussion: A reliance on student experience survey findings for course development may contribute to course changes based on student satisfaction that place overall graduate capability at risk. Because student experience surveys have design limitations, satisfaction only partially aligns with learning and learning outcomes, and students’ subjective beliefs about self, nursing and learning potentially influence their survey responses, the exclusive use of student experience surveys in course development and teacher evaluations is contested. Conclusion: Using student experience survey findings as an indicator of course quality has unacknowledged implications for bachelor of nursing programs. Findings from student experience surveys should be situated within a context of other elements or factors when making curriculum decisions. Teacher and course evaluations based primarily on student satisfaction can have unintended consequences for course content, course delivery, student learning and learning outcomes and ultimately impact on the reputation of the university. What is already known about the topic? Student experience surveys are used widely in higher education in Australia. Universities monitor student satisfaction as an indicator of course quality through student experience surveys. What this paper adds: The relationship between the characteristics of course quality and student satisfaction require further exploration in practice-focused programs such as nursing. The governance of course quality using student experience as a primary indicator may unintentionally limit course development, catering to student preferences rather than focusing on learning experiences that are required for graduate capability.

The non-medical surgical assistant and inequity in the Australian healthcare system

Abstract: Objectives: The objective of this discussion paper is two-fold. The first is to quantify if the non-medical surgical assistant increases access to surgery by investigating what percentages of cases these clinicians undertake in the private sector surgical units where they work. The second is to examine procedural and distributive justice and how they impact on private sector surgical care. Aim: The aim of this paper is to investigate if the non-medical surgical assistant increases equity via access, for the patient, to private sector surgical care; and if government policy has an impact on equity in the form of access. Background: The private healthcare sector completes approximately two-thirds of all elective surgery in Australia; without this contribution, there would be more pressure on the public healthcare sector. In the private sector, recognition and federal funding of the surgical assistant differs depending on whether this clinician has a medical or non-medical, eg. nursing, qualification. The role of the non-medical surgical assistant is well established internationally and this role has been practiced in Australia for more than 20 years. Discussion: Inequity; as a result of the procedural injustice of government funding policy, impacts the private sector surgical patient causing distributive injustice. This distributive injustice results in an out-of-pocket expense to the patient. Rising outof-pocket expenses has started a trend of patients moving away from private health insurance and into the public sector. The registered nurse and nurse practitioner are qualified to practise as a non-medical surgical assistant and provide increased access to care, and effective care compared to the medical surgical assistant. The nurse practitioner is an eligible provider of Medical Benefits Schedule services but restricted from accessing the intraoperative assisting item numbers. Conclusion: The non-medical surgical assistant; or at least the nurse practitioner as non-medical surgical assistant; require access to the Medical Benefits Schedule intraoperative item numbers. Access would alleviate the out-of-pocket expense incurred by Australian patients when a non-medical surgical assistant assists with their surgery. Lack of access to these item numbers means patients may have their surgery delayed until an appropriately skilled medical surgical assistant is available, or the public healthcare sector can accommodate them. Implications for research, policy and practice: This paper illustrates a need for change in Australian government policy to reflect contemporary, evidencebased practice. What is already known about the topic? • The international literature reports that advanced practice nursing roles increase access to healthcare. • The nurse practitioner role in Australia is now well established, and the Australian literature illustrates increased access to care. • The Medical Benefits Schedule Review Taskforce was formed to investigate a system that is not consistent with contemporary, evidence-based healthcare. What this paper adds: • The nurse practitioner and registered nurse, in the role of non-medical surgical assistant, increase access to private sector surgical care. • Australian government policy limits access to private sector surgical care through its inequitable policies that contravene the spirit of fair trade. • According to peak professional bodies’ policy and position statements, the nurse practitioner and registered nurse are legitimate providers of surgical assisting services.

Happy, Healthy, Ready – working with early childhood non-government organisations for developmental surveillance for vulnerable children

Abstract: Objective: This study sought to improve: (1) knowledge of child development among non-health child and family workers; and (2) identification and referral of children from culturally and linguistically diverse (CALD) backgrounds at developmental risk, by partnering child health services with nongovernment early childhood education and family support services in two suburbs with high numbers of families from CALD backgrounds. Background: Children from CALD backgrounds have increased risk of developmental problems going undetected prior to school entry, thereby missing early intervention. Study design and methods: This was a quality improvement project. The model comprised: (1) co-locating a child and family health nurse CAFHN in a non-health setting or visits by early childhood health staff to undertake developmental surveillance and (2) training non-health staff on child development and New South Wales (NSW) developmental surveillance tools. Evaluation used a mixed methods design analysing qualitative data from parents, early childhood workers, CAFHNs, and paediatricians and de-identified activity data from CAFHNs, and other early childhood health services. Results: Non-health workers increased their referrals of children at developmental risk to CAFHN or other child health providers. In Rockdale, 44% (n=62) and Botany 41% (n=98) of children screened had one or more significant developmental vulnerabilities. CAFHN reported developmental surveillance for families who were not accessing traditional clinic-based services. Discussion: This study tested a model of developmental surveillance and entry into the child and family health system in a non-health setting, thus providing a ‘soft’ entry for parents who might not otherwise engage with these services. Conclusion: The project demonstrated a new way of working for CAFHNs and facilitated identification of developmental risk in children from CALD backgrounds, who would otherwise have been missed. Implications for research, policy, and practice: This relatively small-scale model of practice change has resulted in improved access for a marginalised population, but further research is needed to refine the model and test it for scalability and replicability. What is already known about this topic? Our team undertook a systematic review of outreach developmental surveillance occurring in non-health settings. Eight studies across high, middle and low income countries have been identified with a total of 150,047 children aged 18 months to five years, the majority from low socioeconomic backgrounds. Only one study has been based in Australia10 in a regional area in Victoria which showed increased detection of children who were developmentally vulnerable. No studies have had a specific focus on CALD populations in Australia or have been based in the context of the NSW health and developmental surveillance system. What this paper adds: This paper describes the outcomes of a quality improvement project implemented in Rockdale and Botany – two disadvantaged areas of South Eastern Sydney – to increase access to developmental surveillance and early intervention for children from culturally and linguistically diverse (CALD) backgrounds attending supported playgroups and early childhood education services.

Continuity of care for people with multimorbidity: the development of a model for a nurse-led care coordination service

Abstract: Objective: To collaboratively develop a model of nurse-led care, within a multidisciplinary team and support continuity of care at the primary-secondary interface for people with multimorbidity. Background: Existing models of care are frequently based on a medical model, designed to manage a single disease condition, and thus pose a significant challenge to provide healthcare for people with multimorbidity. Particular design elements for models of care affecting the primary-secondary interface have been previously demonstrated, however, these have not been applied to the development of a nurse-led model of care for people with multimorbidity. Study design and methods: This paper, the first in a series of two, is part of a broader action research study and reports on the development of a model which will subsequently be assessed in terms of feasibility to provide a nurse-led care coordination service for people with multi-morbidity. This paper reports on the first action research cycle and methodology including a literature search, stakeholder engagement forums, validation workshop, team meetings, and professional engagement and validation. Results: Data from two stakeholder forums were sorted into 257 ‘structure, process and outcome’ statements and 86 goal related statements. These were cross referenced with design elements on models of care from the literature and finally aggregated into themes. The aggregated themes were then integrated into a model of care for a nurse–led care coordination service. The model consists of an overarching component, 4 domains and 6 operational areas with underpinning criteria. Conclusion: Through stakeholder consultation, consideration of the strengths of previous models and building blocks, a new nurse-led model of care that provides a pathway for transitional healthcare management at the primary -secondary interface has been developed. Inclusion of governance and culture within the model’s domains enables the approach to be pragmatic and adaptable, contributing to the potential for successful change management and model implementation in the clinical workplace. Further evaluation and refinement of the model is planned and will be reported on, in part 2 of this two-part series. Implications for research, policy, and practice: These findings provide direction for model implementation and further research required regarding nurse-led models of care. The supporting documents, systems, and processes reported, positions the model to support change and guide clinical practitioners and nursing management working at the primary-secondary healthcare interface. The future success of model implementation could provide evidence for health workforce policy and coordinated healthcare management. What is already known about this topic: Particular design elements for models of care affecting the primary-secondary interface have been previously demonstrated. Interventions delivered at the primary-secondary care interface, particularly stepped care and models of shared care are effective for the management of depression. Established model design elements and interventions to improve continuity of care at the primary-secondary interface have not been applied to nurse- led models of care for chronic conditions and still require development within research settings. What this paper adds: A new person-centred nurse-led model of care coordination, with healthcare management activities intended to support and enable development of the person’s agency in their healthcare optimisation. A model with specific domains and criteria with the potential for application to nurse-led services across primary and secondary settings, for a range of patients. Inclusion of governance and culture as domains within the model, to enable the best possibility for change, model implementation and continuity of care between the primary-secondary healthcare interface.

“A protracted struggle” – A qualitative blog study of endometriosis healthcare experiences in Sweden

Abstract: Objective: The aim of this study was to identify and describe endometriosis healthcare experiences based on affected individuals’ blog posts. Background: Endometriosis is a chronic gynaecological disease that often has a negative effect on mental, physical, sexual and social health, resulting in lower quality of life. Endometriosis healthcare experiences have typically been described in terms of normalisation, trivialisation and a lack of knowledge from healthcare professionals. These experiences are often reported via individual interviews or focus group interviews. Studying internet blogs may contribute additional information that might not be disclosed during interviews. Therefore, observing and analysing content from blog posts may present an opportunity to gain additional understanding of how healthcare encounters can be experienced by individuals with endometriosis. Study design and methods: This is an inductive qualitative study based on blog posts. The blog posts were written in Swedish and posted online without passwords. Sixteen blogs written between 2008 and 2019 by people aged 22-34 were included. The bloggers had been diagnosed with endometriosis one to seven years prior to writing the blogs and lived all over Sweden. Data collection was performed in March 2019 using an online search engine. A combination of different research terms was used to find the blogs. After considering the blogs on the basis of inclusion and exclusion criteria, 12 blogs remained, and another four blogs were included via links from one of the blogs. The analysis was conducted using thematic analysis according to Braun and Clarke. Results: The results are presented under one main theme, “A protracted struggle”, and two subthemes, “The response plays a significant role” and “The value of competence”. The bloggers described their healthcare experiences as a long struggle including contact with a large number of different healthcare professionals (HCPs), where the response was significant for their physical and mental health. They emphasised the advantages of person-centredness, competence and continuity in the HCP contact. Conclusions and implications for practice: The results demonstrate that the journey through healthcare was experienced as a prolonged struggle, including normalisation, trivialisation and distrust. The results imply that more improvement work remains to be done within endometriosis healthcare. Taking patients’ complaints seriously and providing prompt and effective investigations and treatment may lead to more positive healthcare experiences. What is already known about the topic? Endometriosis healthcare experiences have typically been described in terms of normalisation, trivialisation and a lack of knowledge from healthcare professionals. Previous qualitative studies on the subject are interview studies, which may be influenced by the presence of researchers. What this paper adds: The care-seeking behaviours involved a wide range of strategies. The descriptions varied from extensive care-seeking from different doctors and clinics, to refraining from seeking care due to a fear of being treated badly. The wording used in the blogs was tougher and more unforgiving, and included mostly negative aspects compared to what has been presented in interview studies. This may be explained by the “diary-like” characteristics of blogs and the free way of presenting narratives in a blog.

Prehospital interventions to prevent hypothermia in trauma patients: a scoping review

Abstract: Objective: The aim of this review is to map the prehospital rewarming measures used to prevent hypothermia among trauma victims Background: Hypothermia is responsible for an increase of the mortality and morbidity in trauma victims and its recognition and early treatment are crucial for the victim’s haemodynamic stabilisation Prehospital interventions are particularly important, especially those that target bleeding control, haemodynamic stability, and safe body temperature Registered nurses may be pivotal to prevention and minimisation of the dangerous effects of hypothermia Study design and methods: A scoping review was used to identify articles from several online databases from 2010 to 2018 Studies in English, Spanish, and Portuguese were included Two reviewers performed data extractions independently Results: Seven studies were considered eligible for this review: two quantitative research studies, one qualitative research study, and four literature reviews Rewarming measures can be divided into two main groups: passive rewarming, which includes the use of blankets, positioning the response unit to act as a windbreak, removing the patients’ wet clothes, drying the patient’s body, and increasing the ambient temperature; and active rewarming which includes the use of heating pads, heated oxygen, warmed intravenous fluids, peritoneal irrigation, arteriovenous rewarming, and haemodialysis Discussion: Active measures reported by the included studies were always used as a complement to the passive measures Active rewarming produced an increase in core temperature, and passive rewarming was responsible for intrinsic heat-generating mechanisms that will counteract heat loss Patients receiving passive warming in addition to active warming measures presented a statistically significant increase in body core temperature as well as an improvement in the discomfort caused by cold Conclusion: Rewarming measures seem to be essential for the prevention of hypothermia and to minimise the discomfort felt by the patient In many countries registered nurses can play important roles in the prehospital context of trauma victim’s assistance Greater understanding of these roles is necessary to the development of better practices Implications for research, policy, and practice: The findings of this study highlight that passive and active rewarming measures must be implemented as soon as possible for trauma victims Many measures are incorporated in trauma relief protocols; however, the lack of consensus on their inclusion results in an undervaluation of this issue, which inevitably compromises the safety and wellbeing of trauma victims In practice, supportive frameworks and an intervention plan (based on heat loss reduction and heat supply) are required to ensure that first responders including registered nurses are able to prevent and treat hypothermia What is already known about the topic?• Hypothermia is a serious threat to trauma victims in the prehospital context and can induce a “vicious cycle” of hypothermia, acidosis, and coagulopathy• To prevent or control the decline of a trauma patient with hypothermia, treatment of hypothermia should ideally begin in the prehospital context• Prehospital nurses must be able to develop advanced practice competence to function effectively in their roleWhat this paper adds:• This paper mapped out what measures can be used by prehospital healthcare workers including nurses• This study identified all the rewarming measures that may improve the health and wellbeing of patients with hypothermia• The combined use of active and passive measures seems to provide better outcomes in the prevention and treatment of hypothermia in trauma victims

Nurses documentation of falls prevention in a patient centred care plan in a medical ward

Abstract: Objective: To evaluate the consistency of nurses’ documentation in the falls prevention assessment tool, and to ascertain whether patients identified as high risk of falling had falls preventative strategies implemented. Background: Falls are one of the leading causes of adverse events for patients in the hospital setting. The current practice of implementing falls prevention strategies for patients has not been able to be sustained, which remains a challenge for healthcare providers. Among the falls prevention strategies, falls risk assessment tools have been identified as a crucial element in falls prevention so as the number of falls are minimised. Study design and methods: A retrospective chart audit, with the auditing of falls assessment documentation on the Patient Centred Care Plan. Results: The Patient Centred Care Plan audit revealed that 60.8% of patients (n=508) were identified as high risk of falls by the principal investigator. For the cohort of patients identified by the nurses as having a high risk of falling (53.4%), 53.7% of patients had falls prevention strategies implemented, and only 17.5% of patients were engaged with their falls prevention plan. The strategies that were documented by the nurses on the care plan for the high-risk cohort were not implemented for 16.8% of the patients, and 29.5% of high risk of falls patients did not have documentation on the plan indicating their falls status. Discussion: The findings show that there is a significant gap in the identification of high falls risk patients and the documentation and implementation of falls prevention strategies, between nursing staff records on the Patient Centred Care Plan and the audit conducted by the principal investigator for patients who are identified as high falls risk. As part of the audit patient engagement in their falls prevention plan revealed that patients were not informed of their falls risk status by the nursing staff. Conclusion: The outcome from this audit signifies that not all high falls risk patients were identified as a high falls risk, and most of the high falls risk patients were not engaged in their falls prevention plan. Implications for research, policy and practice: Understanding the current practices of falls prevention and raising nursing staff awareness of the identified variance in the implementation of falls prevention strategies will improve the quality, efficiency of healthcare and the patient safety What is already known about the topic? Nurses’ do not always document patient assessment and associated nursing care. There are multiple factors which impact on nurses’ documenting assessment findings and implementation of nursing care. What this paper adds: At times nurses rely on a falls risk assessment made on the previous day when not able to conduct a current falls assessment. Patients are not engaged in their falls prevention plan, even though they are identified as being of risk of falls. Patients are not aware of the implemented falls prevention strategies which are part of their care.

The importance and value of reporting guidance for scoping reviews : A rehabilitation science example

Abstract: Objective: Scoping reviews use a systematic approach to synthesize a body of knowledge. The use of scoping review methodology is increasingly common. Despite recommendations to guide the conduct of scoping reviews, inconsistencies exist with regards to their methodology and reporting. In this case-study, we reflect on our experience using the PRISMA Extension for Scoping Reviews (PRISMAScR): Checklist and Explanation to improve reporting for a scoping review we initially conducted prior to the release of the PRISMA-ScR reporting guidelines. Study Design and Methods: We evaluated the scoping review against 22 criteria included in the PRISMA-ScR. For each criterion, we provided a rating representing the degree to which we felt the scoping review met the individual criterion in the PRISMAScR. We also provided comments to substantiate our ratings, along with recommended revisions for the scoping review and considerations for future scoping reviews. Results: We identified a number of strengths in the initial reporting of our scoping review , as well as opportunities for improvement. The most substantial areas for zmprovement included the protocol registration, data items and data charting process. Based on our evaluation, we made revisions to the scoping review manuscript to improve our reporting. Conclusion: Our evaluation helps to highlight the value of using reporting guidelines to improve reporting of scoping reviews, while also exposing several challenges. In future, we recommend consulting the guidelines during the initial preparation of the scoping review manuscript rather than retrospectively. What is already known about the topic? The use of scoping review methodology is becoming increasingly common. While recommendations to guide the conduct of scoping reviews have been published, inconsistencies exist in both scoping review methodology and reporting. What this paper adds: Despite some challenges, we found the PRISMAScR to be an effective tool to guide a structured reflection on our scoping review reporting. We encourage authors completing scoping reviews to make use of the PRISMA-ScR to guide their own scoping review reporting.