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As COVID-19 spread across Australia, our research team undertook a rapid research project to capture the experiences of nurses working in primary healthcare during the pandemic. We were hearing stories of nurses losing their jobs, not having enough personal protective equipment, and concerns for patient care. We wanted to provide a voice for nurses working in primary healthcare who were otherwise invisible in the policy decision making and rapid changes occurring in health services. This research sought to quantify and document the workforce, professional and personal issues facing primary healthcare nurses to inform government, policy makers, and local managers both during the time of crisis and in the longer term.

Background: Rising health care burden has increased demand for general practice nurses. Exploring final-year nursing students’ perceived levels of confidence, interest and intention to work in this area can inform preparation and recruitment of new graduates into this workforce. Aim: To explore final-year nursing students’ confidence, interest and intention to work in general practice. Methods: Final-year nursing students from five universities situated in New South Wales, Australia were surveyed between March and June 2019. The survey comprised investigator-developed questions and validated tools adapted for use in general practice. Findings: Of the 355 included responses, 34.1% respondents had a clinical placement in general practice. Work experience was a significant predictor of confidence in working as a Registered or General Practice Nurse. Being enrolled as an international student, general practice placement experience and high confidence to work in general practice were significant predictors of interest and intention to work in this setting. Analysis showed a strong positive relationship between interest and intention to work in general practice, and a small but positive relationship between confidence and intention to work in general practice. Discussion: Despite generally positive views around their confidence, interest and intention to work in general practice, some respondents indicated uncertainties around these, and the usefulness of their undergraduate preparation towards PHC employment. This may be attributable to the inconsistent exposure to general practice nursing within Australian undergraduate nursing programs. Conclusion: Increasing students’ theoretical and clinical exposure to general practice enhances confidence and interest to pursue a career in this setting.

Aim/objective: This paper sought to investigate the perceptions of final-year nursing students regarding general practice nursing as a new graduate career path. Background: General practice nurses have become increasingly important in providing community-based care, in response to the growing burden of chronic conditions and the ageing population. To sustain this workforce, there is a need to optimise strategies to promote a consistent supply of new graduate nurses. Design: This qualitative descriptive study was undertaken within a sequential explanatory mixed methods project. Methods: Data were collected through semi-structured telephone interviews with sixteen final-year nursing students from five Australian universities. Interviews were analysed using thematic analysis. Results: Four main themes were identified, namely; a) general practice is not a priority career path, b) opportunities for skills development and consolidation, c) perceptions of employment conditions, and d) transition support is limited. Conclusion: To meet current workforce needs in areas with increasing demand, nurse educators need to support undergraduate nursing students to explore a wide range of career pathways following graduation. Informed career choices and well-structured educational preparation during undergraduate education may be an effective strategy in building a sustainable future workforce in settings such as general practice.

Aim: To explore final-year nursing students’ perceptions of general practice nursing. Background: The need for general practice nurses has increased due to growing demands for health care in the community. This demand is exacerbated by a shortage in the general practice nursing workforce. Understanding final-year nursing students’ perceptions of general practice nursing is important as these may influence career choices. Design: Qualitative descriptive study within a mixed methods project. Methods: Telephone interviews were conducted with sixteen final-year nursing students. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Reporting follows the COREQ checklist. Results: Perceptions of general practice nursing varied between participants and related to three main themes; ways of working; a broad role to meet diverse health needs; and relationships with patients. General practice nurses were seen to have stable and collaborative working relationships, with their role ranging from supporting general practitioners to being autonomous professionals. The nurse's broad role was associated with diverse presentations and was considered interesting and challenging. Participants perceived that general practice nurses had more time to spend with patients, and this helped establish trust, and facilitated patient-centred care. Conclusion: Participants’ perceptions of general practice nursing varied, with some students recognising the diversity of the role and others perceiving it as limited. These views were often impacted by others experiences rather than personal experience. These variations underscore the need for students to receive greater exposure to general practice nursing. Review of undergraduate curricula to increase focus on preparing nursing students to work in general practice may help shape students’ interest to seek employment in this setting. Relevance to clinical practice: Students perceptions of a clinical setting can in

Being admitted to an acute mental health unit can lead to feelings of shame, and loss of personhood for some consumers. Promoting safety for consumers is a function of acute mental health units. This paper explores how consumers' personhood influences their perception and experience of safety in acute mental health units. Semi‐structured interviews were conducted with 15 participants who had previously been admitted to an acute mental health unit. Thematic analysis was used to analyse the data. Participants perceived safety as being intrinsically linked to their personhood. When participants' innate worth was affirmed in their interactions with staff, participants felt safe. Three subthemes were identified: 'Seen as an equal', 'Being respected', and 'Able to make choices'. These findings can be used to inform nursing practices that enhance consumers' sense of personhood and, in so doing, promote consumers' safety and recovery in acute mental health units.

Aims and objectives To explore how nurses influence the perceptions and experience of safety among consumers who have been admitted to an acute mental health unit. Background Safety is a priority in acute mental health inpatient units, yet consumers do not always experience acute units as safe. Despite being primary stakeholders, little is known about what safety means for consumers in acute mental health units. Design A qualitative descriptive study informed by naturalistic enquiry was conducted and is reported using the COREQ checklist. Methods Fifteen consumers with experience of mental illness participated in semi‐structured individual interviews. These interviews explored what safety meant for them during their acute mental health unit admissions. Thematic analysis was used to analyse the data. Findings: The theme Influence of Nurses reflected that the way nurses engaged in acute mental health units had a profound impact on participants’ sense of safety. Three sub‐themes emerged: i) Availability: “It’s about nurses spending time with you” ii) Being responsive: “They would listen if you had a concern” iii) Caring: “Little acts of kindness”. Conclusions These findings challenge the dominant discourse around safety in mental health organisations, in which nursing practice is often oriented toward the management of risk, rather than the promotion of safety. The findings demonstrate that, through their clinical practice, nurses can enhance consumers’ feelings of safety in the acute mental health unit. Relevance to clinical practice: Nurses play a key role in providing care within acute mental health units. It is vital that the behaviours and actions nurses can enact in order to promote feelings of safety among consumers in this setting are enabled at individual, unit and organisational levels.

© 2020 Australian College of Midwives Background: Supporting women to continue breastfeeding is a global challenge. The Milky Way Program is an effective face to face intervention to increase breastfeeding rates up to six months postpartum. The sustainability and access to the Milky Way Program could be enhanced by transforming it into a mobile application allowing women to access relevant information from their own place at a convenient time. Aim: To explore the process of transforming the Milky Way Program into an acceptable and usable mobile health application. Method: Stakeholders including multidisciplinary researchers and end-users designed the application based on the Milky Way Program by using Persuasive System Design principles. A mixed-method approach was used in the development and evaluation process. Seven women were recruited through convenience sampling to pilot test the application. The women's feedback was collected through an online survey six weeks after birth and individual interviews at four months postpartum. Findings: Women in the pilot study reported that the breastfeeding application was well designed, easy to use, interactive, reassuring and evidence-based with credible sources of information. Conclusion: The Persuasive System Design model combined with end-user engagement can feasibly inform the development of an acceptable and usable mobile health application for breastfeeding based on a proven clinical intervention. Further rigorous testing is required to evaluate the effectiveness of the application on breastfeeding initiation and duration.

Background Pandemics and epidemics are a public health emergencies that can result in substantial deaths and socio-economic disruption. Nurses play a key role in the public health response to such crises, delivering direct patient care and risk of exposure to the infectious disease. The experience of providing nursing care in this context has the potential to have significant short and long term consequences for individuals, society and the nursing profession. Objectives To synthesize and present the best available evidence on the experiences of nurses working in acute hospital settings during a pandemic. Design This review was conducted using the Joanna Briggs Institute methodology for systematic reviews. Data sources A structured search using CINAHL, MEDLINE, EMBASE, PubMed, Google Scholar, Cochrane Library, MedNar, ProQuest and Index to Theses was conducted. Review methods All studies describing nurses’ experiences were included regardless of methodology. Themes and narrative statements were extracted from included papers using the SUMARI data extraction tool from Joanna Briggs Institute. Results Thirteen qualitative studies were included in the review. The experiences of 348 nurses generated a total of 116 findings, which formed seven categories based on similarity of meaning. Three synthesized findings were generated from the categories: (i) Supportive nursing teams providing quality care; (ii) Acknowledging the physical and emotional impact; and (iii) Responsiveness of systematised organizational reaction. Conclusions Nurses are pivotal to the health care response to infectious disease pandemics and epidemics. This systematic review emphasises that nurses’ require Governments, policy makers and nursing groups to actively engage in supporting nurses, both during and following a pandemic or epidemic. Without this, nurses are likely to experience substantial psychological issues that can lead to burnout and loss from the nursing workforce.

Purpose: The COVID-19 pandemic has presented an international health crisis of a scope not seen in our lifetime. While much attention has been paid to health workers in critical care and acute areas, nurses working outside of hospitals are also significantly affected. This study sought to investigate the experience of nurses working in Australian primary healthcare during the COVID-19 pandemic. In particular, it sought to understand the implications on their employment status, role, and access to personal protective equipment. Design and Methods: Nurses employed in primary healthcare across Australia were invited to participate in a cross-sectional online survey through social media and professional organizations. The survey tool was composed of demographics, and of questions about the nurses’ employment, work role, and access to personal protective equipment. Findings: Of the 637 responses received, nearly half (43.7%) reported a decrease in hours and threatened or actual loss of employment. While most respondents felt that they had sufficient knowledge about COVID-19, they expressed concern about work-related risks to themselves and their family. Most respondents described never or only sometimes having sufficient personal protective equipment in their workplace. Just over half of respondents (54.8%) felt well supported by their employer. A third of respondents (34%) perceived that care provided in their workplace was significantly or slightly worse than before the pandemic. Conclusions: This is the first study of primary healthcare nurses’ experiences during the COVID-19 pandemic. The study findings highlighted a concerning level of insecurity around primary healthcare nursing employment, as well as issues with the availability of personal protective equipment for these nurses. The perception that the pandemic has resulted in reduced quality of care needs further exploration to ensure that those with chronic conditions are supported to maintain and promote health

Aim To identify Australian primary healthcare nurses immediate support needs during the COVID‐19 pandemic. Background COVID‐19 has had widespread implications for primary healthcare nurses. Supporting these nurses’ capacity to deliver quality care ensures that ongoing health needs can be met. Methods Primary healthcare nurses were recruited to an online survey via social media and professional organisations in April 2020. Results Six‐hundred and thirty‐seven responses were included in analysis. Participants provided 1213 statements about perceived supports required to provide quality clinical care. From these, seven key categories emerged, namely; personal protective equipment, communication, funding, industrial issues, self‐care, workplace factors and valuing nurses. Conclusion A number of key issues relating to personal health and safety, care quality, and job security need to be addressed to support primary healthcare nurses during the COVID‐19 pandemic. Addressing these support issues can assist in retaining nurses and optimising the role of primary healthcare nurses during a pandemic. Implications for nursing management Responding to the needs of primary healthcare nurses has the potential to facilitate their role in providing community based healthcare. This knowledge can guide the provision of support for primary healthcare nurses during the current pandemic, as well as informing planning for future health crises across the health service.

© 2020 John Wiley & Sons Ltd Aims: To explore how general practice nurses (GPNs) communicate lifestyle risk reduction with patients presenting for chronic disease consultations. Design: Qualitative content analysis of video observations. Methods: The audio of 14 video-recorded GPN chronic disease management (CDM) consultations were transcribed verbatim. Deductive content analysis was undertaken using the exploring, guiding, and choosing model, an adaptation of steps used in motivational interviewing (MI). Data collection occurred between August 2017 - March 2018. Results: General practice nurses demonstrated relational skills including the use of open-ended questions, content reflections, and affirmations. However, greater use of collaborative agenda setting, double-sided reflections, summarizing patient priorities, and ‘importance and confidence scales’ could enhance discussions about lifestyle risk reduction. Conclusion: Although GPNs were using some MI techniques, there was room for skill development. Enhancing GPNs’ MI skills has the potential to optimize their effectiveness in communicating about lifestyle risk reduction and the reduction of chronic disease. Ongoing professional development in MI skills and lifestyle risk communication needs to be supported by nurses, workplaces, and educational providers. Impact: This study has identified GPNs’ strengths and challenges in relation to lifestyle risk communication. Fostering these skills has the potential to reduce risk of lifestyle attributable chronic disease.

Increasingly, middle-aged people are demonstrating lifestyle risk factors that increase their risk of developing chronic disease. Reducing lifestyle risk in middle age can significantly reduce future morbidity and mortality and improve quality of life. Understanding peoples’ perceptions of health support is important to inform health professionals and policymakers regarding strategies to support lifestyle risk reduction. This paper seeks to explore middle-aged Australians’ perceptions of support for lifestyle risk reduction. Thirty-four middle-aged Australians were interviewed using a semi-structured interview schedule. Interviews were audio-recorded, transcribed and analysed using thematic analysis. The overarching theme ‘support for healthy lifestyles’ comprised three subthemes. ‘Engagement with general practice’ highlighted gender differences in why people attend and what impacts their access to general practice. ‘Providing information’ emphasised participants’ experiences of lifestyle risk communication in general practice. Finally, ‘Sources of support’ revealed participants’ current health advice-seeking behaviours. Findings highlight a need for general practices to better engage middle-aged people in behaviour change and educate them about the role of general practice in prevention and health promotion. Consistent messaging across the community and strategies that focus on gender-specific concerns are likely to ensure that middle-aged people are able to make informed choices about seeking support for lifestyle risk reduction.

Aim: This systematic review seeks to synthesise randomised controlled trials reporting the impact of interventions delivered by nurses in primary care to enhance blood pressure control and minimise lifestyle risk factors in hypertensive patients. Background: Given the growing demand for chronic care management, there has been a rapid increase in the primary care nursing workforce and emerging diversity in their roles. The primary care nurse's role has evolved to work in collaboration with general practitioners to manage patients with chronic conditions like hypertension. Despite the nurse's role in lifestyle modification and behaviour change, there is limited evidence exploring the impact of primary care nurse-initiated interventions for lifestyle modification in those with hypertension. Design/methods: A systematic review of randomised controlled trials will be conducted. Electronic databases will be searched from January 2000 to January 2019, using a structured search strategy. Two reviewers will review title and abstract, screen full-text papers and extract data. The Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) will be used to appraise study quality. Data will be synthesised using either meta-analysis or narrative synthesis depending on the heterogeneity of included studies. Discussion: This review will assist in understanding the evidence available on the impact of general practice nurse interventions to manage hypertension. The findings will assist in informing effective nurse-directed interventions for controlling hypertension and will identify gaps in the literature for future research to address.

Purpose The nursing workforce in Australian general practice has increased exponentially in size over recent years to meet the growing demand for health care. Nurses are more likely to remain working if they are satisfied with their jobs. Satisfaction is impacted by a complex range of factors, including the environment, workplace relationships, and the nurses’ role. Therefore, satisfaction data cannot be generalized across disparate clinical settings. This study sought to investigate the job satisfaction and turnover intentions of nurses working in Australian general practice. Design and Methods A cross‐sectional online survey of nurses employed in general practices across Australia was conducted using convenience and snowball sampling techniques. The survey tool contained a 29‐item job satisfaction scale and 8 items around turnover intention. Findings 786 responses were included in the analysis. Respondents were most satisfied with the work nature aspects of their job and least satisfied with the pay items. While most participants intended to stay in nursing (86%) and general practice (77%) employment, a substantial group were undecided about their future (16%). Those who were dissatisfied with their job or neutral in their satisfaction were more likely to be intending to leave than those who were satisfied with their job. Conclusions This is the first study of job satisfaction and turnover intention reported about nurses working in Australian general practice. It has highlighted that a substantial proportion of the workforce is undecided about their future. Therefore, strategies need to be developed to address the issues raised around job satisfaction to reduce the potential loss of these skilled nurses. Clinical Relevance Those intending to leave general practice nursing are more likely to be dissatisfied in their jobs. Understanding the factors that impact job satisfaction is important to inform strategies that will facilitate retention of nurses in general prac

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a ‘now window’ of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

Aim: This paper seeks to explore general practice nurses' perceptions of interactional factors supporting communication with patients about lifestyle risk. Design: Qualitative descriptive study embedded in a concurrent mixed methods design. Methods: Fifteen Australian general practice nurses were interviewed following video-recorded chronic disease management consultations between August 2017 - March 2018. Results: The theme of 'Interactional Factors' comprised of the subthemes 'Relational factors' and 'Patient factors'. Relational factors referred to communication techniques and methods supporting temporal continuity with patients about lifestyle risk. Patient factors included consumers' motivation, willingness, and readiness to prioritize lifestyle changes. Lack of awareness of the nurses' role was perceived to have an impact on initiation of lifestyle risk conversations. Conclusion: Strategies optimizing continuity of nursing care enhance the capacity for lifestyle risk reduction conversations with patients. Ongoing training in patient-centred communication and increasing patients' awareness of general practice nurses' roles would also better support these discussions. Impact: This research identifies ways the general practice nurses' role in supporting lifestyle risk reduction can be improved. Optimizing the general practice nurses' role in lifestyle risk communication can enhance the behaviour change and chronic disease management.

Aims and objectives: This study explores nonverbal communication behaviours between general practice nurses and patients during chronic disease consultations. Background: Nonverbal communication is an important aspect of nurse–patient lifestyle risk reduction conversations. Despite the growing role of general practice nurses in lifestyle risk modification when managing chronic disease, few studies have investigated how this communication occurs. Design: Observational study within a concurrent mixed methods project. Methods: Thirty-six consultations by 14 general practice nurses were video-recorded between August 2017 and March 2018. Video analysis used the Nonverbal Accommodation Analysis System. The STROBE checklist was used to guide this paper. Results: Joint convergence of nurse–patient behaviours such as laughing, smiling and eye contact was most common (44%; n = 157). Patient–nurse eye contact time decreased significantly across the consultation, while nurse gesturing increased significantly. No significant relationship between consultation length and convergent to divergent behaviour categorisation or nurse–computer use across the consultation was found. Conclusions: The high levels of convergent behaviours are promising for person-centred care. However, scope exists to enhance nonverbal interactions around lifestyle risk reduction. Supporting nurses with skills and improved environments for lifestyle risk communication has potential to improve therapeutic relationships and patient outcomes. Relevance to clinical practice: These results indicate that nurses support patients through nonverbal interactions during conversations of lifestyle risk reduction. However, there are opportunities to improve this practice for future interventions.

BACKGROUND: Cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, is the leading cause of death and disability globally. A large proportion of mortality occurs in people with prior CHD and effective and scalable strategies are needed to prevent associated deaths and hospitalisations. The aim of this study is to determine if a practice-level collaborative quality improvement program, focused on patients with CHD, reduces the rate of unplanned CVD hospitalisations and major adverse cardiovascular events, and increases the proportion of patients achieving risk factor targets at 24 months. METHODS: Cluster randomised controlled trial (cRCT) to evaluate the effectiveness of a primary care quality improvement program in 50 primary care practices (n~ 10,000 patients) with 24-month follow-up. Eligible practices will be randomised (1:1) to participate in either the intervention (collaborative quality improvement program) or control (standard care) regimens. Outcomes will be assessed based on randomised allocation, according to intention-to-treat. The primary outcome is the proportion of patients with unplanned CVD hospitalisations at 2 years. Secondary outcomes are proportion of patients with major adverse cardiovascular events, proportion of patients who received prescriptions for guideline-recommended medicines, proportion of patients achieving national risk factor targets and proportion with a chronic disease management plan or review. Differences in the proportion of patients who are hospitalised (as well as binary secondary outcomes) will be analysed using log-binomial regression or robust Poisson regression, if necessary. DISCUSSION: Despite extensive research with surrogate outcomes, to the authors' knowledge, this is the first randomised controlled trial to evaluate the effectiveness of a data-driven collaborative quality improvement intervention on hospitalisations, CVD events and cardiovascular risk amongst patients with CHD in the primar

The Department of Health announced an Independent Review of Nursing Education – Educating the Nurse of the Future (the Review) as a measure in the 2018/19 Federal Budget in May 2018. This is the first of 4 literature reviews to inform the Review. The results of these literature reviews prompt and inform discussion about particular issues. This literature review focusses on fitness for purpose, work readiness, and transition to practice. These are important issues for policy development and decision-making about the future of nursing education in Australia.

The Department of Health announced an Independent Review of Nursing Education – Educating the Nurse of the Future (the Review) as a measure in the 2018/19 Federal Budget in May 2018. This is the third of 4 literature reviews to inform the Review. The results of these literature reviews prompt and inform discussion about particular issues. This literature review focusses on clinical skill development. These are important issues for policy development and decision-making about the future of nursing education in Australia.

The Department of Health announced an Independent Review of Nursing Education – Educating the Nurse of the Future (the Review) as a measure in the 2018/19 Federal Budget in May 2018. This is the fouth of 4 literature reviews to inform the Review. The results of these literature reviews prompt and inform discussion about particular issues. This literature review focusses on the future directions in healthcare delivery. These are important issues for policy development and decision-making about the future of nursing education in Australia.

The Department of Health announced an Independent Review of Nursing Education – Educating the Nurse of the Future (the Review) as a measure in the 2018/19 Federal Budget in May 2018. This is the second of 4 literature reviews to inform the Review. The results of these literature reviews prompt and inform discussion about particular issues. This literature review focusses on nursing as a career choice. These are important issues for policy development and decision-making about the future of nursing education in Australia.

The Department of Health announced an Independent Review of Nursing Education – Educating the Nurse of the Future (the Review) as a measure in the 2018/19 Federal Budget in May 2018. This is the second of 4 literature reviews to inform the Review. The results of these literature reviews prompt and inform discussion about particular issues. This literature review focusses on nursing as a career choice. These are important issues for policy development and decision-making about the future of nursing education in Australia.

The Department of Health announced an Independent Review of Nursing Education – Educating the Nurse of the Future (the Review) as a measure in the 2018/19 Federal Budget in May 2018. This is the third of 4 literature reviews to inform the Review. The results of these literature reviews prompt and inform discussion about particular issues. This literature review focusses on clinical skill development. These are important issues for policy development and decision-making about the future of nursing education in Australia.

The Department of Health announced an Independent Review of Nursing Education – Educating the Nurse of the Future (the Review) as a measure in the 2018/19 Federal Budget in May 2018. This is the fouth of 4 literature reviews to inform the Review. The results of these literature reviews prompt and inform discussion about particular issues. This literature review focusses on the future directions in healthcare delivery. These are important issues for policy development and decision-making about the future of nursing education in Australia.

The Department of Health announced an Independent Review of Nursing Education – Educating the Nurse of the Future (the Review) as a measure in the 2018/19 Federal Budget in May 2018. This is the first of 4 literature reviews to inform the Review. The results of these literature reviews prompt and inform discussion about particular issues. This literature review focusses on fitness for purpose, work readiness, and transition to practice. These are important issues for policy development and decision-making about the future of nursing education in Australia.

Background: The diagnosis of a life limiting condition such as motor neurone disease (MND)is a challenging process for all affected by it. There is little research exploring the experience of living with MND. Understanding people's experiences of a diagnosis of MND can help improve diagnosis experiences and relationships with health professionals. Aim: This paper reports on a study exploring the diagnosis experiences of people living with MND, and how these experiences have impacted their lives. Methods: A qualitative descriptive approach was used. Semi-structured interviews were undertaken with six participants diagnosed with MND. Interviews were transcribed verbatim and analysed using thematic analysis. Findings: Four themes emerged, namely Barriers to early diagnosis increase uncertainty; Being treated like a person; Regaining self and control of life; and Support. The results support the need for timely diagnosis to reduce uncertainty and increase trust and interaction with health professionals. Findings also emphasise the importance of early referral to support services and provision of disease specific resources to augment the input of health professionals. Conclusion: The diagnosis period is a crucial and sensitive time for people with MND. These findings highlight how understanding the experiences of those being diagnosed with MND can guide health professionals in their management of the diagnosis process. Improved outcomes for patients may be achieved through enhancing the diagnosis experience.

Background: The general practice nursing workforce in Australia has grown exponentially in the last fifteen years. To understand the contribution and issues relating to this workforce we need to explore the evolution of the nurses' role and the nurses' perceptions of the work that they undertake. Aim: To describe trends in general practice nurse clinical activities, the extent to which GPNs use their knowledge and skills and their satisfaction with the general practice nurse role. Methods: Within a larger mixed methods project, a national cross-sectional survey of Australian primary health care nurses was undertaken. This paper details the survey findings related to the role of nurses working in general practice, the extent to which they use their knowledge and skills and their satisfaction with their role. Data about nurse roles was compared with previous workforce data to elucidate changes over time. Findings: Of the 1166 primary health care nurses who responded to the survey, 950 reported being employed in general practice. Participants reported undertaking activities related to health promotion and chronic disease management more frequently now than previously. They identified a desire to spend the same or less time on administrative activities and more time on health promotion, patient education and patient assessment. Nearly half of participants reported that often they feel that they could do more, or most of the time they don't use their skills to the full extent. Conclusion: Nurses working in general practice are increasingly undertaking activities related to health promotion and chronic disease management. However, these nurses remain underutilised. Having nurses working to their full scope of practice has the potential to increase job satisfaction and nurse retention, as well as improve patient health outcomes.

Nurses are increasingly needed in primary healthcare settings to support community-based healthcare delivery. Programs to facilitate transition of new graduate nurses are well established in acute care however, there are few similar programs reported in settings like general practice. This paper sought to explore the experiences of new graduate registered nurses and their registered nurse mentors in a new graduate program within Australian general practice. New graduates (n = 9) and their mentors participated in interviews before, during and at the conclusion of a 12-month new graduate program. Interviews were digitally audio-recorded and professionally transcribed verbatim before being analysed using thematic analysis. Eighteen new graduate and 10 mentor interviews were conducted, revealing four themes. Preparation and Opportunities describes the influence that pre-registration education had on preparing nurses for general practice employment. Exceeding Expectations highlights the positive experiences within the program. Program Challenges draws attention to the difficulties experienced by participants, and Future Career Intentions explores future career plans. This study highlights that a general practice new graduate nurse program has the potential to build the workforce. However, strengthening undergraduate preparation of nurses around primary health care and addressing funding issues in general practice, are important to promote the success of such programs.

Aims: To examine the usefulness of the annotated exemplar as an academic support strategy, and explore the characteristics of students who were more likely to engage with this academic support tool. Additionally, to identify if there was any influence on the academic performance in the assessment activity among those who engaged with the annotated exemplar. Background: Annotated exemplars have the potential to target students en masse and provide meaningful, task specific comments that guide students prior to assessment submission. Effective strategies to support student learning are needed as nursing students are increasingly entering tertiary studies from non-traditional backgrounds. Design: A cohort study was used to collect administrative data, academic grades and annotated exemplar usage statistics. Setting: A large multi-campus university in NSW, Australia during Spring semester 2016. Participants: Second year undergraduate students enrolled in a single unit in the Bachelor of Nursing Program. Methods: Quantitative data related to marks, grades and usage information; and demographic data and contact details were extracted from the online learning management system and student electronic records. Results: Of the 1120 students enrolled in the unit, 49.5% of students engaged with the annotated exemplar. Students more likely to engage with the tool were older, female, born outside of Australia and had higher hit rates on the online learning management site. Of those who engaged with the annotated exemplar, there was no demonstrated increase in assessment mark. Conclusion: To improve student performance it is essential that feedback is engaging and effective. While, in this study, use of the annotated exemplar was not reflected in student marks, it is unclear how students may have performed without access to the exemplar. Further research is required to explore the reasons why students did not engage with the annotated exemplar and, for those who did, why the inter

Background Non-participatory video research is useful for observing and analysing interactions between clinicians, patients and technology. However, few clinical nursing studies have used non-participatory video observation and there is limited literature describing the approach. Aim To describe a study that used non-participatory video observation in general practice. Discussion The authors' experience of non-participatory video research methods indicates that the acceptability of the technique, workplace organisation and consultation space have implications for preparation and data collection. Strategies for success include engaging stakeholders early on, obtaining contextual knowledge and piloting the approach. Conclusion Non-participatory video observation is valuable in understanding interactions between nurses and patients in a naturalistic setting. Careful planning is essential to ensure alignment between research aims, context and technology. The methods for analysing data must be chosen carefully to ensure the research question is answered. Implications for practice Video observation provides rich data. Careful planning and engagement of participants is required for successful conduct of studies that use the technique.

Background: End-of-life decision-making for individuals living with a dementia needs to be addressed because as dementia progresses, individuals need support to make decisions about their health care, living arrangements and end-of-life care changes. Advance care directives (ACDs) provide an opportunity for individuals living with a dementia to communicate their wishes about these important issues. Aim: The aim of this study was to understand how Australian registered nurses (RNs) use ACDs for individuals with a dementia living in residential accommodation. Methods: Two hundred and thirty eight RNs working in Australian residential accommodation were recruited via social media, professional organisations and organisations providing residential accomodation. Respondents completed an online survey delivered via Survey Monkey. Findings: 59.7% of respondents reported commencing discussions around ACDs within the first month of individuals living with a dementia relocating to residential accommodation. However, 42.4% never or rarely completed ACDs. Only 59.3% stated that ACDs for individuals living with a dementia were always or often regularly reviewed. 53.8% identified that ACDs were always adhered to when an individuals' circumstances changed. 62.6% felt that understanding among families about ACDs was sometimes, or often, a barrier to using ACDs. Conclusion: The implementation of ACDs in Australian residential accommodation for those living with a dementia remains sub-optimal. This study has demonstrated that ACD documentation and policies describing how they should be used exist, but gaps remain around the practical implementation of ACDs. Strategies to promote communication and collaboration between residential facilities, general practitioners and carers / families could also assist in providing cohesive, high quality care.

Background The ageing population and growing burden of chronic disease has increased demands for primary health care services, necessitating growth of this nursing workforce. Studies have explored strategies in retaining nurses, employment conditions in primary health care, and transitioning of acute care nurses to primary health care employment. Few studies have explored how undergraduate nursing students perceive and are prepared to work in this sector. Aim This review synthesises evidence on the impact of undergraduate curriculum on nursing students' attitudes, perceptions and preparedness to work in primary health care. Design An integrative literature review guided the synthesis of evidence. Data sources Scopus, ScienceDirect, CINAHL and MEDLINE were searched for relevant studies published between 2008 and 2018. Review methods 491 studies were identified from the database searches. Following the removal of duplicates, review of abstracts and keywords against the inclusion and exclusion criteria, 39 papers were subjected to full-text review. Twelve papers, including one thesis, met the inclusion criteria. Using an appraisal system, no paper was excluded based on methodological quality. Results Three themes were identified, namely: impact of curricula; knowledge and attitudes to primary health care; and students' intention to work in primary health care. The preparation of undergraduate nursing students to work in this area is inconsistent as curricula remain acute-care focussed. Negative perceptions about the primary health care nursing role impact intentions of nursing students to work in primary health care. Conclusion This review highlights a need to implement strategies to improve the understanding of undergraduate nurses around the primary health care nursing role. In particular, providing students with skills, knowledge and an understanding of working in this area through curriculum content and structure may provide undergraduates with the desire and confi

There is increasing interest in the use of mixed methods research approaches among health researchers. While mixed methods research has the potential to reveal rich data and deeper understandings of complex phenomena, it needs to be evaluated with the same level of critical appraisal as other methodologies. To date, however, much of the discourse around the critical appraisal of mixed methods research has discussed the challenges and considerations underlying critical appraisal. There has been limited agreement reached on optimal methods of evaluating this body of literature. This chapter will synthesize the literature on critically appraising mixed methods research and provide advice to those reviewing mixed methods papers around considerations in critical appraisal for this type of research.

Background Hypertension is a preventable risk factor for cardiovascular disease, the leading cause of death globally. When hypertension is present with tobacco smoking, poor nutrition, physical inactivity or excessive alcohol consumption, risk of cardiovascular disease is increased. Given the prolonged engagement and ongoing relationship with patients, general practice nurses are ideally situated to actively engage with patients about optimal blood pressure control and lifestyle risk reduction. Objectives This study will test the effectiveness of a nurse-led intervention to reduce blood pressure in adults with hypertension and high cardiovascular risk. Design A multi-site, cluster randomised control trial where the general practice is the unit of randomisation. Methods General Practices (n = 20) will be block randomised to the intervention or usual care group. Adults with hypertension and high cardiovascular risk will be identified through an audit of electronic medical records and invited to attend an assessment visit. Eligible consenting patients will be recruited to the study. The intervention involves three face-to-face consultations and two telephone consultations with the nurse to assess lifestyle risk and develop an action plan. An appointment with the general practitioner will optimise pharmacotherapy. The primary outcome is blood pressure, with secondary outcomes of lifestyle risk factors; smoking, nutrition, alcohol and physical activity body mass index and medication adherence. Patients will have outcome measures evaluated at 6 and 12 months. Discussion ImPress is innovative in its proactive approach of identifying those at greatest risk of cardiovascular disease in combination with the emerging role of the general practice nurse to target care towards improved blood pressure control. If successful, findings from this trial could enhance the nursing role, improve health outcomes, inform health policy and provide an evidence base from which to transform bl

The number of manuscripts published in nursing journals described as "mixed methods" has risen steadily in recent years (Lipscomb, 2008; Simons & Lathlean, 2010). Mixed methods research refers to research which integrates both qualitative and quantitative elements in a single study (Creswell & Plano Clark, 2011; Wisdom, Cavaleri, Onwuegbuzie, & Green, 2012). This is beyond simply the inclusion of open‐ended questions in a survey tool or the collection of demographic data from interview participants, but rather involves the explicit integration of qualitative and quantitative elements in a single study. It is this integration that characterizes the mixed methods approach, as distinct from a "combined approach" whereby qualitative and quantitative elements are used together but not integrated. While the paradigmatic debate of whether qualitative and quantitative elements can be combined has been largely overcome, there remains several issues around the quality of mixed methods research that need to be addressed.

Primary care settings are becoming increasingly complex, as they strive to manage growing multimorbidity and acuity amongst their patient populations and navigate both systems change and evolving workforce trends. As the environment in which primary care professionals work becomes more complex, so too do the problems presenting to health care researchers. To address increasingly complex research problems, researchers must seek innovative methods which capture the multidimensional nature of the phenomena that they investigate. Mixed methods research is one approach to address complex health issues. This approach provides deeper insight into these complex problems than would be achieved if either quantitative or qualitative methods were used alone. However, mixed methods research is more than simply combining quantitative or qualitative techniques within a single study. Mixed methods research is driven by a number of key principles and may be underpinned by different methodological or philosophical considerations. This chapter provides an overview of the key considerations for undertaking mixed methods research in primary care.

The rapid and ongoing growth in information technology has created many applications for health and wellbeing, including breastfeeding. However, due to a lack of rigorous evaluation of these applications, midwives and other health professionals are unable to recommend any specific breastfeeding application in supporting women towards long-term breastfeeding as a global challenge. Only half of women in developed countries continue any form of breastfeeding for six months. The aim of this study was to evaluate the existing breastfeeding applications based on the Persuasive System Design model. An online search was conducted of the Apple Store in May 2017. The search strategy included the following keywords: breastfeeding, lactation and breast milk. After being checked against the inclusion criteria, each application was assessed based on the four Persuasive System Design Principles. Data from each application was then compared for each element of the design model. Eleven applications met the inclusion criteria and were included in the review. Primary task support and system credibility support principles were addressed at acceptable level in all of the included apps. However, dialogue support and social support principles and their features like praise, reward and social networking were not identified in many of the applications. This review demonstrates the lack of dialogue support and social support principles that could augment human to computer dialogue. There is a need for designing a breastfeeding app that can persuade women to engage and continue breastfeeding based on a full Persuasive System Design model, thus promoting long term breastfeeding.

Primary care settings are becoming increasingly complex, as they strive to manage growing multimorbidity and acuity amongst their patient populations and navigate both systems change and evolving workforce trends. As the environment in which primary care professionals work becomes more complex, so too do the problems presenting to health care researchers. To address increasingly complex research problems, researchers must seek innovative methods which capture the multidimensional nature of the phenomena that they investigate. Mixed methods research is one approach to address complex health issues. This approach provides deeper insight into these complex problems than would be achieved if either quantitative or qualitative methods were used alone. However, mixed methods research is more than simply combining quantitative or qualitative techniques within a single study. Mixed methods research is driven by a number of key principles and may be underpinned by different methodological or philosophical considerations. This chapter provides an overview of the key considerations for undertaking mixed methods research in primary care.

There is increasing interest in the use of mixed methods research approaches among health researchers. While mixed methods research has the potential to reveal rich data and deeper understandings of complex phenomena, it needs to be evaluated with the same level of critical appraisal as other methodologies. To date, however, much of the discourse around the critical appraisal of mixed methods research has discussed the challenges and considerations underlying critical appraisal. There has been limited agreement reached on optimal methods of evaluating this body of literature. This chapter will synthesize the literature on critically appraising mixed methods research and provide advice to those reviewing mixed methods papers around considerations in critical appraisal for this type of research.

Background Mental health issues are increasingly prevalent within the community. Many people experiencing mental health issues have established relationships with primary care providers, including general practice nurses (GPNs). With the recent growth of general practice nursing, it is timely to explore the evidence for GPNs to provide mental health interventions for adults with mental illness within their scope of practice. Objective To synthesize the evidence about nurse-delivered interventions in primary care for adults with mental illness. Methods A systematic review of randomized control trials (RCTs) retrieved from the CINAHL, Ovid MEDLINE and EBSCO electronic databases between 1998 and 2017. Results Nine randomized controlled trials were identified, which reported nurse-delivered interventions in primary care for the management of mental health in adults with mental illness. The heterogeneity of interventions and outcomes made comparison of studies difficult. Seven studies demonstrated significant improvement in at least one outcome following the intervention. In some studies, these improvements were sustained well beyond the intervention. Additionally, consumers were satisfied with the interventions and the role of the GPN. Conclusion There is currently limited evidence of the impact of nurse-delivered interventions in primary care for adults with mental illness. Given the significant improvements in symptoms and the acceptability of interventions seen in included studies, there is a need for further robust research exploring the role of the GPN both individually and within the multidisciplinary team. Such research will enable stronger conclusions to be drawn about the impact of nurse-delivered interventions in primary care for adults with mental illness.

Aim: To critically analyse the international literature describing the experiences of nurses working in rural hospitals.Background: Nursing shortages in rural areas is an ongoing issue. Given the significant role nurses play in the delivery of rural health care, a sufficient workforce is essential. However, maintaining this workforce is challenging. Understanding the experiences of nurses working in rural hospitals is essential to inform strategies around job satisfaction and staff retention.Evaluation: An integrative review was conducted. Six primary sources were included related to the experiences of nurses working in rural hospitals.Results: Four themes emerged, namely: (a) Professional Development; (b) Workplace stressors; (c) Teamwork; and (d) Community.Conclusion: There is a need for further research exploring the experiences of nurses working in rural hospitals and its impact on job satisfaction, turnover intention and patient safety.Implications for Nursing Management: This review highlights some key issues impacting nurses' working in rural hospitals. This understanding can be used by nurse managers to inform strategies for recruitment and retention of nurses in these areas.

Background: The growth of the general practice nursing workforce, has created opportunities to enhance activities aimed at lifestyle change to optimise health and reduce risk. While health status and risk levels are amenable to behaviour change, a number of complex interrelated factors influence the general practice nurses' (GPN) role, often resulting in the underutilisation of nurses. This can limit their capacity to respond to patients' needs, including communication regarding lifestyle risk factors and their chronic health conditions. Understanding GPNs' views on lifestyle risk communication and factors influencing this can inform improvement in chronic disease management and effectiveness of lifestyle risk communication by GPNs. Aim: To review the literature examining the experiences and perspectives of GPNs regarding communication with patients about lifestyle risk factors. Method: An integrative literature review was conducted using the methods of Whittemore and Knafl (2005). CINAHL, Scopus, MEDLINE, Cochrane Library and Joanna Briggs Institute of Systematic Reviews were searched for articles published in English from January 2006-October 2016. Peer-reviewed papers reporting primary research which focussed on GPNs' perceptions, attitudes, experiences and/or perspectives of lifestyle risk communication with adults were included. Included papers were assessed for methodological quality and findings extracted for thematic analysis. Results: Fifteen articles were included, yielding four themes; GPNs' views of the nurse-patient relationship, motivational interviewing (MI), barriers to practice, and role parameters. Data revealed GPNs' needs relating to role clarity, maintenance of therapeutic relationships, as well as organisational, government policy and technique support. Conclusion: GPNs are increasingly managing and coordinating care for people with, or at risk of, chronic disease. Lifestyle risk counselling effectively supports chronic disease management and l

Background: Timely and meaningful feedback is essential to promote active learning and student engagement with learning. However, achieving this remains elusive, particularly in undergraduate nursing programs that admit large student cohorts. One strategy to provide meaningful en masse feedback is to provide feed-forward support by using exemplars. To date, there has been limited evaluation of the effectiveness of this feedback strategy. Objective: To review the impact of using exemplars as a feedback strategy to support student academic writing in higher education. Data Sources and Review Method: A systematic search of electronic databases for original research papers published between 2000 and 2017 that used exemplars to support student's academic writing in higher education. An integrative review methodology was utilised to identify emerging themes. Results: Ten papers met the inclusion criteria, revealing four themes; 1) exemplars as a tool for structuring and preparing assessment activities, 2) appraising exemplars provided as a teaching and learning activity, 3) the impact of exemplar use on academic performance, and 4) students' satisfaction of exemplars as a learning tool. Conclusion: Despite the diverse approaches in the use of exemplars, this review highlighted that students value exemplars as a teaching tool. However, the benefits of exemplar use were not always reflected in students' academic performance. Further research is required, particularly in a nursing context, to understand the impact of exemplars on student learning.

Aims and objectives: To explore the experiences of chronic obstructive pulmonary disease (COPD) amongst individuals who have a high frequency of presentations to the Emergency Department and their carers. Background: Patients with COPD are amongst the most frequent attenders in the Emergency Department despite the chronic nature of their condition. Good self-management has previously been identified as a key to maintaining health and reducing COPD exacerbations. There has been limited investigation of those with COPD who frequently attend the Emergency Department. Design: Descriptive qualitative phase of a mixed methods study. Methods: Individuals who had attended an Emergency Department within a single health district at least three times in the previous year for COPD were invited to participate in semistructured face-to-face interviews. A total of 19 individuals consented to participate, of whom 12 were male. Half of the interviews included both those with COPD and carers. Data were audio-recorded and transcribed, before being analysed using thematic analysis. Results: Five main themes emerged from the data, namely (i) a sense of grief, loss and guilt, yet hope for the future; (ii) the impact on carers; (iii) the end point of self-management; (iv) the healthcare experience; and (v) the primary care experience. Conclusion: The experience of individuals with COPD who frequently present to the Emergency Department and their carers highlights the complexity of living with this disease. Providing effective intervention to manage exacerbation requires an understanding of the issues that are faced by patients and their carers. Clear systems and skills for sharing information are essential to decrease avoidable use of the Emergency Department.

Presentation from Australian Primary Health Care Nurses Association National Conference, 10-12 May 2018, Brisbane, Australia

Internationally, the population is ageing and people are living well, longer. In Australia, extended travelling has gained popularity among older Grey Nomads due to time and opportunity post retirement. However, there is limited research available focusing on older Australians' health while travelling. This paper reports the qualitative phase of a larger mixed-method project that explores the experience of Australian Grey Nomads travelling with chronic conditions. Eight Grey Nomads participated in telephone interviews. Data were analysed using inductive thematic analysis. Two themes emerged, namely: continuity of care while travelling and experts on the road. Participants described encountering a fragmented health system, with challenges regarding finding health services; a lack of shared medical records; and difficulties accessing regular medications. Despite these challenges, participants demonstrated health preparedness, an ability to accommodate health on the road, and were all travelling for their health. This study highlights key systems issues that challenge health care while travelling, and identifies opportunities for both usual practices and rural health services to enhance the care provided to this group.

Aim: To explore registered nurses' reflections on transitioning from acute to primary health care employment, and future career intentions. Background: Reforms in primary health care have resulted in increasing demands for a skilled primary health care nursing workforce. To meet shortfalls, acute care nurses are being recruited to primary health care employment, yet little is known about levels of satisfaction and future career intentions. Method: A sequential mixed methods study consisting of a survey and semi-structured interviews with nurses who transition to primary health care. Results: Most reported positive experiences, valuing work/life balance, role diversity and patient/family interactions. Limited orientation and support, loss of acute skills and inequitable remuneration were reported negatively. Many respondents indicated an intention to stay in primary health care (87.3%) and nursing (92.6%) for the foreseeable future, whilst others indicated they may leave primary health care as soon as convenient (29.6%). Conclusion: Our findings provide guidance to managers in seeking strategies to recruit and retain nurses in primary health care employment. Implications for Nursing Management: To maximize recruitment and retention, managers must consider factors influencing job satisfaction amongst transitioning nurses, and the impact that nurses' past experiences may have on future career intentions in primary health care.

Background: To prepare nurses for a role in knowledge generation they need to engage in research training. Bachelor of Nursing (Honours) programs are a first step in this training. Developing a better understanding of current programs, their challenges and outcomes will provide an evidence base to inform curriculum development and policy making. Aim: The aim of this study was to explore current Australian Bachelor of Nursing (Honours) programs in terms of their composition, delivery and number of enrolments/graduates. Methods: Bachelor of Nursing Honours Coordinators or Heads of Schools of Nursing and Midwifery at Australian Universities were emailed an invitation to participate in an online survey. Findings: Of the 19 academics who responded to the survey, 15 (78.9%) reported currently offering a Bachelor of Nursing (Honours) program in their institution. A steady decline in mean enrolments was evident over recent years. There were clear differences in course delivery and assessment tasks between courses. Conclusion: This paper highlights the need to further explore Bachelor of Nursing (Honours) programs across Australia to ensure consistency in outcomes and to explore innovations in course delivery and project development. Such changes should incorporate feedback from students, supervisors, curriculum developers and professional stakeholders to ensure that programs address their various needs.