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IntroductionHospitalised older adults are prone to functional deterioration, which is more evident in frail older patients and can be further exacerbated by pain. Two interventions that have the potential to prevent progression of frailty and improve patient outcomes in hospitalised older adults but have yet to be subject to clinical trials are nurse-led volunteer support and technology-driven assessment of pain.Methods and analysisThis single-centre, prospective, non-blinded, cluster randomised controlled trial will compare the efficacy of nurse-led volunteer support, technology-driven pain assessment and the combination of the two interventions to usual care for hospitalised older adults. Prior to commencing recruitment, the intervention and control conditions will be randomised across four wards. Recruitment will continue for 12 months. Data will be collected on admission, at discharge and at 30 days post discharge, with additional data collected during hospitalisation comprising records of pain assessment and volunteer support activity. The primary outcome of this study will be the change in frailty between both admission and discharge, and admission and 30 days, and secondary outcomes include length of stay, adverse events, discharge destination, quality of life, depression, cognitive function, functional independence, pain scores, pain management intervention (type and frequency) and unplanned 30-day readmissions. Stakeholder evaluation and an economic analysis of the interventions will also be conducted.Ethics and disseminationEthical approval has been granted by Human Research Ethics Committees at Ramsay Health Care WA|SA (number: 2057) and Edith Cowan University (number: 2021-02210-SAUNDERS). The findings will be disseminated through conference presentations, peer-reviewed publications and social media.Trial registration numberACTRN12620001173987.

To gain a deeper understanding of nurses and midwives' experiences following involvement in a critical incident in a non-critical care area and to explore how they have 'moved-on' from the event.An interpretive descriptive design guided inductive inquiry to interpret the meaning of moving-on.Purposive sampling recruited 10 nurses and midwives. Data collection comprised semi-structured interviews, memos and field notes. Data were concurrently collected and analysed during 2016-2017 with NVivo 11. The thematic analysis enabled a coherent analytical framework evolving emerging themes and transformation of the data into credible interpretive description findings, adhering to the COREQ reporting guidelines.The findings revealed five main themes: Initial emotional and physical response, the aftermath, long-lasting repercussions, workplace support and moving-on.This study shed light on the perceptions of nurses and midwives who lived through the impact of critical incidents. Through their lens, the strategies engaged in to move-on were identified and their call for organizational and collegial support received a voice.

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Background Patients with Class III obesity pose unique challenges to health care staff and organisations. Care requirements of this population are unique and require specialised equipment and knowledge to meet these needs, maintain the quality of care, as well as the safety of patients and staff. Aim To synthesise the evidence on the nursing care of Class III obese patients in acute care settings. Methods A scoping review informed by JBI. CINAHL Plus, Medline, Scopus, Proquest Central, Web of Science and Embase were searched for primary research articles about the nursing management of people classified as Class III obese in acute care. Methodological quality of included studies was assessed; data extracted and synthesised into themes. Results Fourteen studies were included in the review. The synthesis generated three themes: Access to equipment, knowledge and training, patient care, and opportunities to improve care. Conclusions A paucity of high-quality evidence informs the nursing care of people with Class III obesity in acute care. Access to appropriate equipment dominated the findings of this review. Adequate provision of equipment and education on its use are required. Education to promote engagement with patients, adapting clinical practice and promotion of self-care could improve care and outcomes.

Aims To synthesise the existing literature which focuses on the impact of critical incidents on nurses and midwives, and to explore their experiences related to the support they received in the current healthcare environment in order to move-on from the event. Design Systematic review and qualitative synthesis. Data sources The electronic databases CINAHL, MEDLINE, PsycINFO, PubMed, Embase and Nursing and Allied Health (ProQuest) were systematically searched from 2013-2018 and core authors and journals identified in the literature were manually investigated. Review methods Qualitative studies of all research design types written in English were included according to the PRISMA reporting guidelines. The methodological quality of included studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Results A total of 7,520 potential publications were identified. After removal of duplicate citations, study selection and appraisal process, 11 qualitative primary research papers progressed to the meta-synthesis by meta-aggregation. The 179 findings and sub-findings from the included studies were extracted, combined and synthesised into three statements addressing three different aspects within the context of critical incidents: the experiences of the impact, the perceptions of support and the ability to move-on. Conclusion This review illuminated that moving-on after critical incidents is a complex and wearisome journey for nurses and midwives. More attention should to be drawn to second victims within general nursing and midwifery practice to strengthen their ability to navigate the aftermath of critical incidents and reclaim the professional confidence indispensable to remain in the workforce.

Background The role of eHealth programs to support patients through surgical pathways, including total hip arthroplasty (THA), is rapidly growing and offers the potential to improve patient engagement, self-care, and outcomes. Objective The aim of this study is to compare the effects of an eHealth program (intervention) versus standard care for pre- and postoperative education on patient outcomes for primary THA. Methods A prospective parallel randomized controlled trial with two arms (standard care and standard care plus access to the eHealth education program) was conducted. Participants included those who underwent THA. Outcome measures were collected preadmission, at 6 weeks, and at 3 and 6 months after surgery. The primary outcome was the Hip Dysfunction and Osteoarthritis Outcome Score. Secondary outcomes were a 5-level 5-dimension quality of life measure and the self-efficacy for managing chronic disease scale. Demographic and clinical characteristics were also collected. A satisfaction survey was completed by all participants 6 weeks after surgery, and those in the intervention arm completed an additional survey specific to the eHealth program. Results A total of 99 patients were recruited: 50 in the eHealth program (intervention) and 49 in standard care (control). Clinical improvements were demonstrated in both groups across all time points. Per-protocol analysis demonstrated no differences between the groups for all outcome measures across all time points. Participants in the eHealth program reported that the program was accessible, that they felt comfortable using it, and that the information was helpful. Conclusions This study demonstrated that the eHealth program, in addition to standard care, had no additional benefit to THA recovery compared with standard care alone. The study found that the eHealth program was highly valued by participants, and it supported the preoperative preparation, recovery, and postoperative rehabilitation of participants. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12617001433392; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373657

BACKGROUND The role of eHealth programs to support patients through surgical pathways, including total hip arthroplasty (THA), is rapidly growing and offers the potential to improve patient engagement, self-care, and outcomes. OBJECTIVE The aim of this study is to compare the effects of an eHealth program (intervention) versus standard care for pre- and postoperative education on patient outcomes for primary THA. METHODS A prospective parallel randomized controlled trial with two arms (standard care and standard care plus access to the eHealth education program) was conducted. Participants included those who underwent THA. Outcome measures were collected preadmission, at 6 weeks, and at 3 and 6 months after surgery. The primary outcome was the Hip Dysfunction and Osteoarthritis Outcome Score. Secondary outcomes were a 5-level 5-dimension quality of life measure and the self-efficacy for managing chronic disease scale. Demographic and clinical characteristics were also collected. A satisfaction survey was completed by all participants 6 weeks after surgery, and those in the intervention arm completed an additional survey specific to the eHealth program. RESULTS A total of 99 patients were recruited: 50 in the eHealth program (intervention) and 49 in standard care (control). Clinical improvements were demonstrated in both groups across all time points. Per-protocol analysis demonstrated no differences between the groups for all outcome measures across all time points. Participants in the eHealth program reported that the program was accessible, that they felt comfortable using it, and that the information was helpful. CONCLUSIONS This study demonstrated that the eHealth program, in addition to standard care, had no additional benefit to THA recovery compared with standard care alone. The study found that the eHealth program was highly valued by participants, and it supported the preoperative preparation, recovery, and postoperative rehabilitation of participants. CLINICALTRIAL Australian New Zealand Clinical Trial Registry ACTRN12617001433392; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373657

Background: Obesity is a complex psycho-social construct which is strongly linked with health and well-being. The health and socioeconomic impacts of obesity on individuals and health care systems can be significant. The nursing care of people with Class III obesity needs careful attention to ensure the provision of appropriate care. This scoping review aims to synthesise available evidence on the nursing care of Class III obese patients in acute care settings. Methods : A scoping review informed by the Joanna Briggs Institute approach was undertaken. We searched CINAHL Plus, Medline, Scopus, Proquest Central, Web of Science and Embase databases for primary research articles relating to the nursing management of people classified as Class III obese in acute care settings. The methodological quality of all studies that met the inclusion criteria were assessed and data relating to methods and the findings extracted and synthesised into themes. Results : 3809 records were identified. Thirteen studies met the inclusion criteria and were included in the review. Three themes were generated from the synthesis of the findings: Access, knowledge and training related to equipment; Patient care; and Opportunities to improve care. Conclusions : The need for proactive planning to improve the nursing care provided to people classified as class III obese and admitted to acute care settings is vital. Access to appropriate equipment to support moving and handling and education on equipment use to prevent injury to both patients and staff is necessary. Education and support to promote engagement with patients, adapt nursing care practices and promote self-care have the potential to improve patient care and patient outcomes.

Objectives To synthesise the current evidence of the implications of postgraduate nursing qualifications on patient and nurse outcomes. Design A systematic review. Data sources Primary research findings. Review methods A systematic search following PRISMA guidelines and the Joanna Briggs Institute's framework was conducted. A structured and comprehensive search of three electronic databases CINAHL, MEDLINE, PsychINFO, search engine Google Scholar, and a manual-search of reference lists was undertaken. The search was limited to articles in English between 2000 and 2019. The combined search yielded 3710 records. Search records were exported to EndNote X8 and duplicates were removed. Inclusion eligibility was assessed by title, abstract and full text. All team members were involved in selecting the studies and assessing methodical quality. Discrepancies were resolved through rigorous discussion between the reviewers. Twenty studies (quantitative and qualitative) were finally selected as suitable for inclusion in the review. A qualitative descriptive synthesis was undertaken to summarise and report the findings. Results This systematic review has shown that the empirical evidence to date does not support nurses' perceptions of the implications of postgraduate education. The findings from this review fell into three major themes: perceived implications of postgraduate study, clinical outcomes and patient satisfaction. Nurses perceived that postgraduate qualifications had improved their knowledge and skills and thus clinical practice, patient outcomes and health services. This perception has not been borne out by measurable outcomes as yet. The literature also suggests that postgraduate education should improve career opportunities and progression for nurses. This is not supported by the nurses' perceptions in the research available to date. It should be noted that these findings predominantly came from qualitative data. A few studies did report descriptive statistical analysis: demographics, knowledge levels, qualifications etc. None conducted any inferential statistical analysis. Conclusion Although the literature suggests that postgraduate nursing qualifications improve outcomes for patients, the level of evidence is weak. Exploration methods are suggested to move beyond examining nurses' perceptions, to empirical measures of the value of postgraduate education on nurse and patient outcomes.

Background: Total hip arthroplasty is an effective surgical procedure commonly used worldwide for patients suffering the disabling effects of osteoarthritis when medical therapy is unsuccessful. Traditionally pre- and postoperative information for patients undergoing a hip arthroplasty has been provided by paper-based methods. Electronic health (eHealth) programs to support individualized patient education on preoperative preparation, in-patient care, and home rehabilitation have the potential to increase patient engagement, enhance patient recovery, and reduce potential postoperative complications. Objective: The aim of this study is to compare the addition of an eHealth program versus standard care for pre- and postoperative education on patient outcomes for primary total hip arthroplasty. Methods: One hundred patients undergoing a primary elective total hip arthroplasty will be recruited from a metropolitan hospital in Western Australia to participate in a 6-month parallel randomized control trial. Participants will be randomized to either the standard care group (n=50) and will be given the education booklet and enrolled to attend a 1-hour education session, or the intervention group (n=50), and will receive the same as the standard care plus access to an eHealth program titled “My Hip Journey.” The eHealth program encourages the patient to log in daily, from 2 weeks prior to surgery to 30 days postsurgery. The information on the platform will be aligned with the patient's individual surgical journey and will include exercises to be completed each day for the duration of the program. The primary outcome measure is the Hip Dysfunction and Osteoarthritis Outcome Score, version LK 2.0. Secondary outcome measures include the EuroQoL EQ-5D-5L, a 5-level 5-dimension quality of life measure, and the Self-Efficacy for Managing Chronic Disease Scale. Data will be collected at pre-admission (presurgery) and at 6 weeks, 3 months, and 6 months postsurgery. A patient satisfaction survey will be completed 6 weeks postsurgery and Web-based analytics will be collected 6 months postsurgery. A cost-effectiveness analysis, using the intention-to-treat principle, will be conducted from the hospital’s perspective. Results: Enrollment in the study commenced in January 2018 with recruitment due for completion towards the end of the year. The first results are expected to be submitted for publication in 2019. Conclusions: The outcomes and cost of using an eHealth program to support a patient’s recovery from a hip arthroplasty will be compared with standard care in this study. If the eHealth program is found to be effective, further implementation across clinical practice could lead to improvement in patient outcomes and other surgical areas could be incorporated. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001433392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373657&isReview=true (Archived by WebCite at http://www.webcitation.org/6yzoTuggx). Registered Report Identifier: RR1-10.2196/9654

BACKGROUND Those who experience a critical illness or condition requiring admission to an intensive care unit (ICU) frequently experience physical and psychological complications as a direct result of their critical illness or condition and ICU experience. Complications, if left untreated, can affect the quality of life of survivors and impact health care resources. Explorations of potential interventions to reduce the negative impact of an ICU experience have failed to establish an evidence-based intervention. OBJECTIVE The aim of this study is to evaluate the impact of a Web-based intensive care recovery program on the mental well-being of intensive care survivors and to determine if it is a cost-effective approach. METHODS In total, 162 patients that survived an ICU experience will be recruited and randomized into 1 of 2 groups. The intervention group will receive access to the Web-based intensive care recovery program, ICUTogether, 2 weeks after discharge (n=81), and the control group will receive usual care (n=81). Mental well-being will be measured using the Hospital Anxiety and Depression Scale, The Impact of Events Scale-Revised and the 5-level 5-dimension EuroQoL at 3 time points (2 weeks, 6 months, and 12 months post discharge). Family support will be measured using the Multidimensional Scale of Perceived Social Support at 3 time points. Analysis will be conducted on an intention-to-treat basis using regression modeling. Covariates will include baseline outcome measures, study allocation (intervention or control), age, gender, length of ICU stay, APACHE III score, level of family support, and hospital readmissions. Participants’ evaluation of the mobile website will be sought at 12 months postdischarge. A cost utility analysis conducted at 12 months from a societal perspective will consider costs incurred by individuals as well as health care providers. RESULTS Participant recruitment is currently underway. Recruitment is anticipated to be completed by December 2020. CONCLUSIONS This study will evaluate a novel intervention in a group of ICU survivors. The findings from this study will inform a larger study and wider debate about an appropriate intervention in this population.

Background Those who experience a critical illness or condition requiring admission to an intensive care unit (ICU) frequently experience physical and psychological complications as a direct result of their critical illness or condition and ICU experience. Complications, if left untreated, can affect the quality of life of survivors and impact health care resources. Explorations of potential interventions to reduce the negative impact of an ICU experience have failed to establish an evidence-based intervention. Objective The aim of this study is to evaluate the impact of a Web-based intensive care recovery program on the mental well-being of intensive care survivors and to determine if it is a cost-effective approach. Methods In total, 162 patients that survived an ICU experience will be recruited and randomized into 1 of 2 groups. The intervention group will receive access to the Web-based intensive care recovery program, ICUTogether, 2 weeks after discharge (n=81), and the control group will receive usual care (n=81). Mental well-being will be measured using the Hospital Anxiety and Depression Scale, The Impact of Events Scale-Revised and the 5-level 5-dimension EuroQoL at 3 time points (2 weeks, 6 months, and 12 months post discharge). Family support will be measured using the Multidimensional Scale of Perceived Social Support at 3 time points. Analysis will be conducted on an intention-to-treat basis using regression modeling. Covariates will include baseline outcome measures, study allocation (intervention or control), age, gender, length of ICU stay, APACHE III score, level of family support, and hospital readmissions. Participants’ evaluation of the mobile website will be sought at 12 months postdischarge. A cost utility analysis conducted at 12 months from a societal perspective will consider costs incurred by individuals as well as health care providers. Results Participant recruitment is currently underway. Recruitment is anticipated to be completed by December 2020. Conclusions This study will evaluate a novel intervention in a group of ICU survivors. The findings from this study will inform a larger study and wider debate about an appropriate intervention in this population. International Registered Report Identifier (IRRID) PRR1-10.2196/10935

BACKGROUND Total hip arthroplasty is an effective surgical procedure commonly used worldwide for patients suffering the disabling effects of osteoarthritis when medical therapy is unsuccessful. Traditionally pre- and postoperative information for patients undergoing a hip arthroplasty has been provided by paper-based methods. Electronic health (eHealth) programs to support individualized patient education on preoperative preparation, in-patient care, and home rehabilitation have the potential to increase patient engagement, enhance patient recovery, and reduce potential postoperative complications. OBJECTIVE The aim of this study is to compare the addition of an eHealth program versus standard care for pre- and postoperative education on patient outcomes for primary total hip arthroplasty. METHODS One hundred patients undergoing a primary elective total hip arthroplasty will be recruited from a metropolitan hospital in Western Australia to participate in a 6-month parallel randomized control trial. Participants will be randomized to either the standard care group (n=50) and will be given the education booklet and enrolled to attend a 1-hour education session, or the intervention group (n=50), and will receive the same as the standard care plus access to an eHealth program titled “My Hip Journey.” The eHealth program encourages the patient to log in daily, from 2 weeks prior to surgery to 30 days postsurgery. The information on the platform will be aligned with the patient's individual surgical journey and will include exercises to be completed each day for the duration of the program. The primary outcome measure is the Hip Dysfunction and Osteoarthritis Outcome Score, version LK 2.0. Secondary outcome measures include the EuroQoL EQ-5D-5L, a 5-level 5-dimension quality of life measure, and the Self-Efficacy for Managing Chronic Disease Scale. Data will be collected at pre-admission (presurgery) and at 6 weeks, 3 months, and 6 months postsurgery. A patient satisfaction survey will be completed 6 weeks postsurgery and Web-based analytics will be collected 6 months postsurgery. A cost-effectiveness analysis, using the intention-to-treat principle, will be conducted from the hospital’s perspective. RESULTS Enrollment in the study commenced in January 2018 with recruitment due for completion towards the end of the year. The first results are expected to be submitted for publication in 2019. CONCLUSIONS The outcomes and cost of using an eHealth program to support a patient’s recovery from a hip arthroplasty will be compared with standard care in this study. If the eHealth program is found to be effective, further implementation across clinical practice could lead to improvement in patient outcomes and other surgical areas could be incorporated. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001433392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373657&isReview=true (Archived by WebCite at http://www.webcitation.org/6yzoTuggx). REGISTERED REPORT IDENTIFIER RR1-10.2196/9654

Background A growing body of evidence has confirmed that intensive care unit survivors encounter myriad of physical and psychological complications during their recovery. The incidence of psychological morbidity in intensive care survivors is increasingly being recognised. The causes of psychological morbidity are multi-factorial but may be associated with a complete lack of, or delusional recall of events in intensive care. Intensive care unit diaries are an initiative designed to enable survivors to help restore factual memories and differentiate those from delusional. Purpose To explore survivors’ and family members’ perceptions and utilisation of diaries following discharge from hospital. Method A single centre qualitative descriptive study was undertaken in a general intensive care unit in Western Australia. Participants were surveyed 3, 6 and 12 months following discharge from hospital. Eighteen participants completed one or more surveys. Findings Many of the participants who completed the surveys read their diaries but few made entries in them following discharge. Reading the diaries evoked mixed emotions for these participants; however they still viewed the diaries as a positive initiative in their recovery. Diaries enabled survivors to fill the memory gaps, make sense of their experience and reinforced the human connection when they were immersed in a technological environment. Conclusion Use of patient diaries was received positively by the participants in this study. Diaries are a simple, cost effective initiative which enabled survivors to piece together the time they had lost, concreted their experience in reality and enabled them to retain a connection with their loved ones whilst immersed in a technological environment.

Objective : Technology has changed our world; changed the way we communicate, the way we do business and the way education is delivered. As a result, undergraduate student cohorts come to university equipped with new technology, and educators need to transform the delivery of the curricula to satisfy a variety of learning styles. Nursing education, in particular, is developing and transforming to incorporate technology into the learning environment. Clinical placement opportunities are often sparse and alternative experiences need to be considered. Across nursing curricula, it has been recognised that technology has the capacity to provide real-life learning experiences that promote student engagement and meet the learning needs of a diverse student cohort. Methods : This paper will discuss the development of a “Virtual World” in an undergraduate nursing program in Western Australia. The Virtual World initiative is designed to support students to understand the holistic, health-centred intent of the curriculum. Results : Initial results have shown that the Virtual World and humanising the curriculum, has increased learner engagement, improved critical thinking and decision-making. It has enhanced and maintained a high level of student satisfaction and self-efficacy as well as assisting the development of graduate nurses who perceive themselves as health advocates, problem-solvers and organisers of care. Research will continue to follow the use of the Virtual World model, incorporating a virtual family and its integration into the undergraduate nursing curriculum. Conclusions : In the current climate of nurse education and due to a reduction in availability of clinical placements, alternative authentic experiences need to be offered. The development of the Virtual World has enabled meaningful participation in a safe and supportive learning environment.