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Background: Statistical evidence shows that nursing students prefer a professional career in hospital settings, leading to a lack of career interest in non-hospital settings such as community and residential aged care facilities. The lack of preference for non-hospital settings has persisted over several decades and presents a need for different approaches that may reveal new information to better understand the individual factors that influence specialty choices and preferences from the students' viewpoints. Purpose: The aims of this study were to (1) explore individual factors that impact the nursing specialty choices of final-year nursing students and (2) explore how these factors influence the final-year nursing students' career decision-making process. Method: A narrative inquiry approach using semi-structured interviews was carried out with purposively sampled nursing students (n = 12) who had undertaken a final-year clinical placement(s). Data was analysed using two main steps. First, the interviews were restoried and then analysed using the three-dimensional framework. Subsequently, thematic analysis was applied to generate themes. Results: Data analysis generated three main themes: demographic factors, social factors, and career goals. Participants' characteristics and interactions with other individuals and systems influenced their nursing specialty preferences and professional career plans. Conclusion: Nursing students' career interests are influenced by individual factors external to their nursing education, such as their age, gender, and life experiences. These student characteristics and experiences facilitated or inhibited a career in some nursing specialties, with the students gauging their ability to practice in a specialty during their CPs. Nursing education should expose and inform students about the core skills, career opportunities, and how to advance their careers in the different nursing specialties. Most importantly, final-year students may n

Background: One in four newly graduated registered nurses leave their employment positions within the first year. To reduce this attrition, nursing stakeholders could focus on the final year of nursing education because students at this stage make professional career plans, including their practice destination for the graduate year and their commitment to the profession. Previous studies provide evidence of nursing students' career preferences and specialty choices. However, there is a dearth of data that focuses on the students' career decision-making process. Aim: This study examined the self-efficacy or confidence of final-year nursing students in making career decisions and the factors that influence their career decision-making process. Setting and participants: Final year pre-registration nursing students (N = 222) at two public universities in Western Australia. Methods: An online survey was used to collect cross-sectional data. The Career Decision Self-Efficacy Scale – Short Form was used to investigate nursing students' confidence in making career decisions. Career decision-making self-efficacy refers to the confidence to successfully complete career decision-making tasks. Descriptive statistics were used to describe the participants' characteristics. The chi-square test was used to assess the significance of the difference between categorical data, and binary logistic regression was used to determine the odds of the factors that predict career decision self-efficacy. Results: Forty-seven percent of participants who answered all Career Decision Self-Efficacy Scale – Short Form questions had good confidence in making career decisions. Factors such as the setting of the final clinical placement, the intention to be employed in the specialisation or organisation of their final placement and the students' assessment of their clinical experience were associated with career decision-making confidence. Conclusions: Most participants had low confidence in making ca

Background: Clinical placements (CPs) in the final year of nursing education largely impact nursing students’ professional development by exposing them to nursing realities. Nursing students also use placement exposure to identify suitable career opportunities for their upcoming professional life. However, there is limited evidence on how final-year CPs may attract pre-registration nursing students into different nursing specialties, including hospital and non-hospital settings. Aim: To explore the influence of CPs in the final year of nursing education on pre-registration student nurses’ career decisions. Method: A narrative inquiry approach was utilised. A purposeful sample of 12 final-year students from two Western Australian public universities participated in the study. Data were collected through semi-structured individual interviews. This article follows the Consolidated Criteria for Reporting Qualitative Research. Findings: The final-year CPs mainly influenced nursing students’ career decisions in three ways: they helped them create new career paths, and some students refined their career plans while others reaffirmed their career choices. Four main themes were generated, including nature of the clinical environment, ward or unit culture, preceptorship, and career progression. Conclusion: The final year of study is crucial for nursing students as they make career plans in preparation for the transition to their professional roles. The students make short- and long-term career plans at this stage, which may influence their commitment to nursing. Implication for practice: The outcome of this study may assist stakeholders in nursing education and health care in developing policies for CPs and students’ career guidance. These policies may encourage pre-registration nurses to develop career interests in the less-preferable nursing specialties such as community nursing and residential aged care.

Aims: This study had three objectives: 1) to determine final-year nursing students' career preferences and long-term career plans; 2) to investigate factors influencing nursing students' specialty choices following their final-year clinical placement(s); and 3) to understand how final-year clinical placements can be used to develop the career interests of nursing students to different nursing specialties. Background: Clinical placement provides an insightful experience that may influence students to feel inclined to work in certain specialties. Therefore, each clinical placement should promote students' learning and enhance positive experiences that could develop their career interests and encourage them to seek employment in the specialty on graduation. Design: A cross-sectional online survey. Methods: The survey was structured using the Career Decision Self-Efficacy Scale – Short Form. The questionnaire was distributed to final-year nursing students (N = 222) at two public universities in Western Australia. This study specifically reports on the Goal selection and Planning domains of the Career Decision Self-Efficacy Scale – Short Form, which were explored through additional questions prompting participants to explain their career preferences and reasons for their nursing specialty choices. Results: Most participants, fifty-three percent, had low confidence in making career decisions. The Goal Selection and Planning questions measured the students' confidence in choosing a suitable practice destination and preparing for their professional careers. Overall, participants prefer employment in hospital settings both in the short- and long-term aspects of their nursing career. The factors influencing the students' career decisions were classified into three main categories: the clinical environment, educational factors and individual factors. Conclusions: The nursing curriculum may encourage nursing students to work in some specialties over others. This study provides

Background: International nursing students in Australia are faced with additional stress and challenges during clinical placements due to language and cultural differences. These factors can significantly impact their learning experience and personal wellbeing. Aim: This study aimed to explore the clinical facilitators’ perspectives of the experiences of international nursing students and the potential strategies for improving their learning experiences during clinical placements. Methods: An exploratory qualitative study was designed. Semistructured interviews with 14 participants were conducted and analysed using thematic analysis. Findings: The findings were categorised into two categories. (1) Clinical facilitators’ perspectives on the international nursing students’ experiences during the clinical placements, and (2) Clinical facilitators’ perspectives on strategies for improving the learning experience of international nursing students. Category 1 consisted of three themes: (i) Reduce self-confidence when communicating in English, (ii) Lowered perceived self-efficacy, and (iii) Looking for a sense of belonging. Category 2 consisted of five themes: (i) Nurture a supportive environment, (ii) Use validating and understanding communications, (iii) Promote acceptance of the cultural and language diversities, (iv) Use strength-based approaches, and (v) Create opportunities for transcultural socialisation. Discussion: Clinical facilitators are well-positioned to support international nursing students to achieve positive learning experiences during clinical placements. More support from the university and hospital may be needed to enable clinical facilitators to effectively implement the identified potential strategies. Conclusion: The study findings provided the background for future research to upskill clinical facilitators and support them to facilitate positive experiences for international nursing students during clinical placements.

Background: International nursing students in Australia are faced with additional stress and challenges during clinical placements due to language and cultural differences. These factors can significantly impact their learning experience and personal wellbeing. Aim: This study aimed to explore the clinical facilitators’ perspectives of the experiences of international nursing students and the potential strategies for improving their learning experiences during clinical placements. Methods: An exploratory qualitative study was designed. Semi-structured interviews with 14 participants were conducted and analysed using thematic analysis. Findings: The findings were categorised into two categories. (1) Clinical facilitators’ perspectives on the international nursing students’ experiences during the clinical placements, and (2) Clinical facilitators’ perspectives on strategies for improving the learning experience of international nursing students. Category 1 consisted of three themes: (i) Reduced self-confidence when communicating in English, (ii) Lowered perceived self-efficacy, and (iii) Looking for a sense of belonging. Category 2 consisted of five themes: (i) Nurture a supportive environment, (ii) Use validating and understanding communications, (iii) Promote acceptance of the cultural and language diversities, (iv) Use strength-based approaches, and (v) Create opportunities for transcultural socialisation. Discussion: Clinical facilitators are well-positioned to support international nursing students to achieve positive learning experiences during clinical placements. More support from the university and hospital may be needed to enable clinical facilitators to effectively implement the identified potential strategies. Conclusion: The study findings provided the background for future research to upskill clinical facilitators and support them to facilitate positive experiences for international nursing students during clinical placements.

Background: Mandatory placement-based work-integrated learning (WIL) poses challenges for nursing students who work whilst studying. The financial burden of WIL links to other known direct and indirect challenges, yet no Australian study has quantified the financial challenges resulting from attending mandatory WIL placements. Placement-based WIL costs may preclude some students from completing WIL, which may impact student attrition and the future health workforce. Aim: To investigate Australian nursing students’ financial challenges related to mandatory WIL. Methods: An online cross-sectional survey conducted with nursing students from nine Australian universities across five Australian states. The 28-question survey investigated the location of, and travels to, the most recent WIL placement; and students’ employment, accommodation, financial support, expenses and debts, and financial strain pertaining to WIL placements. Results: Overall, 2,359 students participated. The majority were employed (84%); 65% of these reported that they were unable to work during WIL, affecting their employment. One-third incurred a financial liability from their placement, 79% reported financial hardship, and 73% found their placement stressful due to financial strain. Financial issues affected 62% of students’ health and wellbeing. Discussion: Financial pressures related to WIL impact nursing students. While students have strategies to reduce these pressures, universities can also better manage their placement preferencing and support of students to reduce financial impacts of placement-based WIL on students. Conclusions: Nursing students face substantial financial challenges related to placement-based WIL. Scholarship programs and other forms of support are required to assist nursing students to undertake WIL.

Background: Nurse navigators are an emerging workforce providing care to people with multiple chronic conditions. The role of the navigators is to identify patients requiring support in negotiating their health care. Purpose: A critical discourse analysis was used to examine qualitative data collected from nurse navigators and consenting navigated patients to identify key indicators of how nurse navigators do their work and where the success of their work is most evident. Discussion: Nurse navigators help patients who have lost trust in the health system to re-engage with their interdisciplinary health care team. This re-engagement is the final step in a journey of addressing unmet needs, essential to hospital avoidance. Conclusion: Nurse navigators provide a continuum of authentic and holistic care. To acknowledge the true value of nurse navigators, their performance indicators need to embrace the value-added care they provide.

Objectives: Mixed methods were used to evaluate a group self-management education intervention to address type 1 diabetes (T1D)-specific barriers to physical activity (PA). We evaluated the acceptability of study resources and procedures. Methods: Consenting participants from a quantitative evaluation (n=70) were invited to participate in 1 of 5 focus groups. Interviews explored the acceptability of procedures across the randomized controlled trial schedule, acceptability of the intervention/control workshops and resources and the perceived effectiveness of the intervention/control on participant outcomes. The use and helpfulness of intervention take-home resources, Facebook data and fidelity coding were also examined to inform other aspects of intervention acceptability. Results: Twenty-one focus group participants from control or intervention arms participated in 1 of the 5 focus groups. Participants were 46±10 years of age; about half were female and had been living with T1D for 23±16 years. Study procedures were widely accepted; however, randomization and some aspects of the questionnaire were of concern to a small number of participants. Group education was acceptable and preferred, but participants expressed ambivalence toward the private Facebook group. Control participants indicated that basic information on PA guidelines and hypoglycemia risk are not currently being provided in standard care. Fidelity assessment confirmed the intervention was delivered consistently and was facilitated using behaviours and communication skills based on Social Cognitive Theory. Conclusions: Future definitive evaluation of this promising intervention should utilize a blinded randomized controlled trial study design. Alterations to the control workshop are required to better reflect standard care in Australia. Our qualitative findings suggest that group education can be an acceptable and preferred method of education in T1D management for PA. © 2021 Canadian Diabetes Associatio

In this article, we discuss the origins, epistemology, and forms of Yarning as derived from the literature, and its use in research and clinical contexts. Drawing on three Yarns, the article addresses the extent to which non-Indigenous researchers and clinicians rightfully use and adapt this information-gathering method, or alternatively, may engage in yet another form of what can be described as post-colonialist behavior. Furthermore, we argue that while non-Indigenous researchers can use Yarning as an interview technique, this does not necessarily mean they engage in Indigenous methodologies. As we note, respectfully interviewing Aboriginal and Torres Strait Islander peoples can be a challenge for non-Indigenous researchers. The difficulties go beyond differences in language to reveal radically different expectations about how relationships shape information giving. Yarning as a method for addressing cross-cultural clinical and research differences goes some way to ameliorating these barriers, but also highlights the post-colonial tensions.

OBJECTIVE: The objective of this review is to explore the research on factors that influence international undergraduate nursing students' experiences and perceptions of their learning environment. INTRODUCTION: International nursing students bring valuable cultural and economic opportunities to universities and health care. It is important that their clinical learning experiences are positive. Factors that influence nursing students' experiences may include cultural and communication differences, diversity related to health care systems, learning and teaching strategies, and programs to improve communication. International nursing students' experiences and perceptions are reported in terms of expressed confidence, perceived competence, and levels of satisfaction. A scoping review is required to identify what is known and to identify the knowledge gaps in this area. INCLUSION CRITERIA: International nursing students are those who are enrolled in an undergraduate nursing program in a higher-education institution in a country other than their own. International students studying vocational nursing and exchange students will be excluded. The learning environment is considered to be one in which any person who may influence patient care learns. Primary research, both qualitative and quantitative methods, published since 1995 in any language that the research team can translate will be included. METHODS: This review follows the JBI methodology for scoping reviews. Data extraction will include the factors influencing students' experiences and the concepts that were explored. Data analysis will include frequencies of concepts and associations between them. Results will be presented in tabular form and mind maps. SCOPING REVIEW REGISTRATION NUMBER: Open Science Framework (osf.io/r4v6q).

Aim: To understand the impact and causes of 'Failure to Attend' (FTA) labelling, of patients with chronic conditions. Background: Nurse navigators are registered nurses employed by public hospitals in Queensland, Australia, to coordinate the care of patients with multiple chronic conditions, who frequently miss hospital appointments. The role of the nurse navigator is to improve care management of these patients. Evidence for this is measured through improvement in patient self-management of their conditions, a reduction in preventable hospital admissions and compliance with attendance at outpatient clinics. Failure to attend (FTA) is one measure of hospital utilisation, identifying outpatient appointments that are cancelled or not attended. Method: The cohort for this study was patients with multiple chronic conditions, and nurse navigators coordinating their care. Data describing the concept of FTA were thematically analysed twelve months into this three year evaluation. Results: Although the patient is blamed for failing to attend appointments, the reasons appear to be a mixture of systems error/miscommunication between the patient and the health services or social reasons impacting on patient's capacity to attend. Themes emerging from the data were: access barriers; failure to recognise personal stigma of FTA; and bridging the gap. Conclusion: The nurse navigators demonstrate their pivotal role in engaging with outpatient services to reduce FTAs whilst helping patients to become confident in dealing with multiple appointments. There are many reasons why a patient is unable to attend a scheduled appointment. The phrase 'Failure to Attend' has distinctly negative connotations and can lead to a sense of blame and shame for those with complex chronic needs. We propose the use of the neutral phrase “appointment did not proceed” to replace FTA. Implications for Nursing management: This article advocates for further consideration of collaborative models that engage the

To identify and map barriers and facilitators of physical activity (PA) in adults living with type 1 diabetes (T1D) in any care setting or environment. A scoping review was conducted in accordance with the PRISMA-ScR guidelines to address the aim of this review. Exclusion/inclusion criteria were determined a priori. Articles captured in the search were subject to title and abstract screening before full-text articles were assessed for eligibility against the exclusion/inclusion criteria. Included articles underwent critical appraisal before being charted, mapped, and discussed. Forty-six articles were included in the final synthesis. Most commonly, articles reported cross-sectional survey studies (46%), then qualitative designs (17%), and opinion or text (17%). Experimental studies accounted for 13% of included articles. Hypoglycaemia/fear of hypoglycaemia was the most commonly reported barrier and patient education the most commonly discussed facilitator. Quality appraisal revealed methodological issues among included articles. Higher quality research with theoretically sound behaviour-change interventions combined with targeted patient education is needed to address hypoglycaemia/fear of hypoglycaemia as a barrier to PA. Novelty: Hypoglycaemia and fear of hypoglycaemia were the most commonly reported barriers to PA in adults with T1D. Powered randomised controlled trials are required to establish efficacy of behaviour change interventions targeting these barriers to PA.

OBJECTIVE: The objective of this review is to identify and map the literature that describes the individual and environmental factors that influence nurses and midwives to stay in or leave their discipline within the first three years of practice. INTRODUCTION: The turnover rate of newcomers within their first three years of nursing and midwifery is higher than in later years and is contributing to a worldwide shortage. Both individual and environmental factors, often in combination, contribute to this attrition. Many studies demonstrate the associations of factors with turnover or intention to stay; however, the scope of factors has not been documented. INCLUSION CRITERIA: Newcomers are defined as registered nurses and registered midwives within the first three years of entering their discipline. Quantitative and qualitative studies and systematic reviews that explore individual or environmental factors that influence the decision to leave or to remain in nursing and midwifery in any context will be considered. Factors may include coping, anxiety, mindfulness, practice environment, or combinations such as resilience, satisfaction, and burnout. Articles must have been peer reviewed. Literature published since 1974 in English will be considered. Newcomers who have completed skills-based training will be excluded. METHODS: The JBI method for scoping reviews will be followed. An extensive search of multiple databases and gray literature will be undertaken. Retrieval of full-text studies and data extraction will be performed independently by two reviewers. Data extracted will be synthesized and results reported using a mind map, tables, and narrative form.

The rapid uptake of technology is changing the way health professionals provide care to patients and communities. While this presents opportunities to improve, enhance, and positively transform care and treatment, graduates must have the requisite knowledge, skills, and attitudes to make effective use of the technology and data available to them. This research explored nursing students' self-reported digital literacy levels. We undertook a student survey at one university in Australia, utilizing the validated Self-Assessment Nursing Informatics Competencies Scale-SF30 instrument. Overall, 90% of students rated their basic computer knowledge and skills as at least "competent" including performing basic troubleshooting, using the Internet, and conducting online literature searches. However, only 55% of students considered their overall applied computer skills as at least "competent," which included using applications for diagnostic coding and to extract data from clinical data sets. Students have digital literacy in everyday settings; however, their ability to translate this into practice is limited, restricting their access to and use of digital tools in the workplace. Our findings provide the opportunity to address practice issues related to digital literacy and to embed appropriate content in curricula to enable the delivery of improved patient care and the appropriate use of data in various settings.

Background: Simulation-based education is a valuable learning approach for nursing students, yet there is limited focus or reports on graduate entry master's programs. This study explores the effect of simulation on graduate entry master's students' confidence to provide safe patient care. Methods: This study includes a longitudinal, single-site, cohort design that uses the Health Professional Education in Patient Safety Survey to measure nursing students’ (n = 32) confidence before and after simulation and after clinical practice. Results: Overall confidence increased after simulation but was not always sustained after clinical practice. Conclusions: Simulation-based education can build students’ patient safety confidence; however, the dynamic nature of the clinical setting challenges student confidence.

The aim of this study was to determine whether postnatal women whose babies required neonatal intensive care unit (NICU) admission self-reported lower pain scores and required less analgesia than women whose babies remained with them. A prospective matched audit comparing pain scores and analgesia requirements where every woman with a baby admitted to the NICU was matched to 2 women whose babies remained on the ward was undertaken. Matches were based on age, number of previous births, type of birth, episiotomy, and epidural or spinal analgesia use. Data were collected on pain scores and analgesia administered in the first 72 hours postbirth. A total of 150 women were recruited and matched from November 2015 to May 2017. No statistically significant differences were found between the 2 groups for opiate analgesia use (P =.91) or pain scores (P =.89). Regardless of NICU admission, significantly higher pain scores were reported in participants who had episiotomies (P =.03). Birth via cesarean birth resulted in significantly higher pain scores (P <.01) and greater opiate administration (P <.01). This study found no statistically significant difference between pain scores or analgesia use of mothers whose babies required NICU admission and mothers whose babies remained with them.

Nurse resilience is attracting increasing attention in research and practice. Possession of a high level of resilience is cited as being crucial for nurses to succeed professionally and manage workplace stressors. There is no agreed definition of nurse resilience. A concept analysis was undertaken to examine nurse resilience using a priori selected analysis framework. This concept analysis aims to systematically analyse resilience as it relates to nurses and establish a working definition of nurse resilience. Sixty-nine papers met the search criteria for inclusion. Key attributes of nurse resilience were social support, self-efficacy, work–life balance/self-care, humour, optimism, and being realistic. Resilience enables nurses to positively adapt to stressors and adversity. It is a complex and dynamic process which varies over time and context and embodies both individual attributes and external resources. Sustaining nurse resilience requires action and engagement from both individuals and organizations.

Background: Hospitals and other health care providers frequently experience difficulties contacting patients and their carers who live remotely from the town where the health service is located. In 2016 Nurse Navigator positions were introduced into the health services by Queensland Health, to support and navigate the care of people with chronic and complex conditions. One hospital in Far North Queensland initiated an additional free telephone service to provide another means of communication for patients and carers with the NNs and for off-campus health professionals to obtain details about a patient utilising the service. Calls made between 7am and 10pm, seven days per week are answered by a nurse navigator. Aim: To report utilisation of the service by navigated clients and remotely located clinicians compared to use of navigators' individual work numbers and direct health service numbers. We report the reason for calls to the free number and examine features of these calls. Methods: Statistical analysis examined the call reason, duration of calls, setting from where calls originated and stream of calls. Interactions between the reasons for calls and the features of calls, such as contact method, were examined. Results: The major reason for calls was clinical issues and the source of calls was primarily patients and carers. Clinical calls were longer in duration. Shorter calls were mainly non-clinical, made by a health professional. Setting for calls was not related to the reason. The most frequent number used was the individual mobile number of the NN, followed by the hospital landline. Although the free number was utilised by patients and carers, it was not the preferred option. Conclusion: As patients and carers preferred to access their NN directly than via the 1800 number, further research should explore options best suited to this group of patients outside normal business hours.

Aim: To develop a validated tool to measure nursing and midwifery documentation burden. Background: While an important record of care, documentation can be burdensome for nurses and midwives and may remove them from direct patient care, resulting in decreased job satisfaction, associated with decreased patient satisfaction. The amount of documentation is increasing at a time where staff rationalisation results in decreasing numbers of clinicians at the bedside. No instrument is available to measure staff perceptions of the burden of clinical documentation. Design: Survey development, followed by rwo rounds of content validation (April and May 2019). Methods: Based on the literature a 28 item survey, with items in 6 subscales, representing key areas of documentation burden was developed. Item (I-CVI), subscale (S-CVI/Ave by subscale) and overall content validity indexes (S-CVI/Ave) were calculated following two review rounds by an expert panel of clinical and academic nurses and midwives. Results: Level of agreement for the first iteration of the survey was low, with many items failing to reach the critical I-CVI threshold of 0.78. No subscale reached a S-CVI/Ave above 0.8 and the overall scale only achieved a S-CVI/Ave score of 0.67. Thirteen items were removed, seven were edited and five new items added, based on the expert panel feedback, substantially improving the content validity. All individual items achieved an I-CVI ≥0.78, the S-CVI/Ave was above 0.85 for all subscales and the total S-CVI/Ave was 0.94. Conclusion: The Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey can be considered as content valid, according to the content validity analysis by an expert panel. Impact: The BurDoNsaM survey may be used by nurse leaders and researchers to measure the burden of documentation, providing the opportunity to review practice and implement strategies to decrease documentation burden, potentially improving patient satisfaction with the care receive

Background: Digital capability, that is the ability to live, work, participate and thrive in a digital world, is imperative for nurses because increasingly nurses' work and patient outcomes are influenced by technology. Aim: To evaluate and synthesise the evidence regarding the development of digital capability in nurses and the strategies that support effective integration of digital skills into the workplace. Design: Whittemore and Knafl's methodology, following the preferred reporting items for systematic reviews (PRISMA) guidelines. Data sources: CINAHL, Embase, PsychINFO, Medline (Ovid) and PubMed databases were searched for articles published in English from 2008–2019. Search terms included; digital capabil*, digital literacy, informatics, nursing informatics, health informatics, nurs*, knowledge, knowledge integration, competency, continuing education, nursing skills, workplace and work environment. Review methods: A total of 35 studies were retrieved for quality assessment by two reviewers using standardised critical appraisal instruments from the Joanna Briggs Institute (JBI-MAStARI and JBI-QARI). Minimum essential criteria and scores were agreed prior to appraisal. Results: The 17 studies included comprised quantitative (n = 7), qualitative (n = 8) and mixed methods (n = 2). Integration of digital capability in nurses' workplaces is dependent on user proficiency and competence (theme 1). Nurses use technology to access data at the point of care, specifically accessing evidence to guide care (theme 2a) as well as accessing the medical records (theme 2b). Nurses have several concerns related to the use of technology at point of care (theme 3), some of which can be resolved through investment for implementation (theme 4). Conclusions: There are key attributes of digitally proficient nurses. Nurses with these attributes are more inclined to use digital technology in their work. Involvement of the nurses as end users in the development of digital systems to ens

Objective: The objective of this scoping review is to identify and map barriers to and facilitators of physical activity in adults living with type 1 diabetes. Introduction: Physical activity is crucial to the day-to-day management of type 1 diabetes and in the prevention of diabetes-related complications. Despite these benefits, people living with type 1 diabetes have higher inactivity rates than those in the general population. Identifying barriers and facilitators to physical activity, specific to the type 1 diabetes population, may help explain this discrepancy. Inclusion criteria: This scoping review will include articles describing adults aged 18 years or over, living with type 1 diabetes in any care setting. Included literature will focus on the key concepts under review: Barriers to or facilitators of physical activity participation. Literature examining efficacy of strategies to manage blood glucose levels for physical activity will not be included. Methods: All sources of information will be reviewed, including peer-reviewed, published and unpublished literature. Database search limits will be applied to include articles written in English, involving human participants and published between 1996 and February 2019. Once all records are identified, duplicates will be removed. Remaining records will be subject to title and abstract screening where articles will be excluded if they clearly meet at least one exclusion criteria. All remaining full-text articles will be assessed for eligibility against inclusion and exclusion criteria. Included articles will undergo critical appraisal before being synthesized, charted and discussed.

Introduction It is important to define and promote professionalism because nurses’ conduct is at the heart of maintaining safe patient care and public trust in the profession. Professionalism and being professional are terms used frequently and interchangeably in the nursing literature and policy documents to describe qualities and conduct expected of nurses. However, there is not a shared understanding of the attributes of nursing professionalism. Objectives This article explores three primary questions: (a) How is professionalism defined? (b) What are the attributes of professionalism as described in the literature? (c) What attributes of professionalism related to nursing are captured within the regulatory (licensure) framework of Australia? Methods A scoping review structured this study with articles about professionalism (a key search term) identified through PubMed, CINAHL, and Embase searches. Included articles were published in English between 1960 to 2019. Excluded articles provided no definition or discussion on the attributes of professionalism. Articles were coded using descriptive qualitative data analysis techniques. Attributes were then mapped against the Australian nursing and midwifery Professional Practice Framework, which included codes of conduct and standards of practice. Results Three overarching themes emerged from the data synthesis, each with a number of constituent attributes: (a) inner processes, (b) outer processes, and (c) contextual processes. The themed constituent attributes of professionalism could be found within nursing regulators’ Professional Practice Framework documents. A 21st-century conceptual model of professionalism and its links to the regulatory context is proposed based on the data synthesis findings. Conclusion The proposed contemporary model of professionalism provides a broader contextual perspective of the attributes of professionalism compared to past models. It offers a potential model for other countries to draw f

AIMS: To investigate the impact of shift work on the psychological functioning and resilience of nurses by comparing nurses who work shifts and nurses who work regular hours. DESIGN: A comparative descriptive design using an online self-report questionnaire. METHOD: Data were collected from employed Registered and Enrolled Nurses (N=1369) who were members of the Queensland Nurses and Midwives Union in 2013. The survey included standardised measures of resilience, depression, anxiety, compassion satisfaction, compassion fatigue and intention to leave the profession. RESULTS: Generalised Linear Mixed Model analysis revealed shift workers had significantly lower levels of compassion satisfaction. However, there were no significant differences between the groups on resilience, depression, anxiety, stress, compassion fatigue or intention to leave nursing. CONCLUSION: The findings suggest that shift work is not associated with worse psychological functioning or lower resilience in nurses. However, this study requires replication using a longitudinal design to confirm these findings. This article is protected by copyright. All rights reserved.

Aim. The aim of this study was to assess student nurses’ knowledge of and attitudes towards pressure injury prevention evidence-based guidelines. Background. Pressure injuries are a substantial problem in many healthcare settings causing major harm to patients, and generating major economic costs for health service providers. Nurses have a crucial role in the prevention of pressure injuries across all health care settings. Design. A multi-centered, cross-sectional study was conducted using a paper-based questionnaire with undergraduate nursing students enrolled in seven universities with campuses across five Australian states (Queensland, New South Wales, Western Australia, Victoria and Tasmania). Methods. Data were collected from nursing students using two validated instruments (Pressure Ulcer Knowledge Assessment Instrument and Attitude Toward Pressure Ulcer Prevention Instrument), to measure students’ pressure injury prevention knowledge and attitudes. Results. Students reported relatively low pressure injury prevention knowledge scores (51%), and high attitude scores (78%). Critical issues in this study were nursing students’ lack of knowledge about preventative strategies to reduce the amount and duration of pressure/shear, and lower confidence in their capability to prevent pressure injury. Level of education and exposure to working in a greater number of different clinical units were significantly related to pressure injury prevention knowledge and attitude scores. Conclusion. The study findings highlight the need to implement a comprehensive approach to increasing Australian nursing students’ pressure injury prevention and management knowledge, as well as ensuring that these students have adequate experiences in clinical units, with a high focus on pressure injury prevention to raise their personal capability.

© 2018 Elsevier Ltd Aim: The aim of this study was to assess student nurses’ knowledge of and attitudes towards pressure injury prevention evidence-based guidelines. Background: Pressure injuries are a substantial problem in many healthcare settings causing major harm to patients, and generating major economic costs for health service providers. Nurses have a crucial role in the prevention of pressure injuries across all health care settings. Design: A multi-centered, cross-sectional study was conducted using a paper-based questionnaire with undergraduate nursing students enrolled in seven universities with campuses across five Australian states (Queensland, New South Wales, Western Australia, Victoria and Tasmania). Methods: Data were collected from nursing students using two validated instrume nts (Pressure Ulcer Knowledge Assessment Instrument and Attitude Toward Pressure Ulcer Prevention Instrument), to measure students’ pressure injury prevention knowledge and attitudes. Results: Students reported relatively low pressure injury prevention knowledge scores (51%), and high attitude scores (78%). Critical issues in this study were nursing students’ lack of knowledge about preventative strategies to reduce the amount and duration of pressure/shear, and lower confidence in their capability to prevent pressure injury. Level of education and exposure to working in a greater number of different clinical units were significantly related to pressure injury prevention knowledge and attitude scores. Conclusion: The study findings highlight the need to implement a comprehensive approach to increasing Australian nursing students’ pressure injury prevention and management knowledge, as well as ensuring that these students have adequate experiences in clinical units, with a high focus on pressure injury prevention to raise their personal capability.

AIMS AND OBJECTIVES: To determine the prevalence and pattern of use of peripheral intravenous cannulae in hospital wards. BACKGROUND: Peripheral intravenous cannulae are commonly used in acute health care to directly access the bloodstream for the administration of medications, intravenous fluids and blood products. Peripheral intravenous cannulae are associated with multiple adverse events including hospital-acquired bloodstream infection, thrombophlebitis and pain/discomfort. Administration of intravenous fluids is associated with impaired mobility and nocturia which may increase falls risk in the older people. DESIGN: Observational, point prevalence study. METHODS: Three private hospitals comprising a total of 1,230 beds participated in the study. Nurses recorded the presence of a peripheral intravenous cannulae, duration of insertion, state of the dressing and whether the peripheral intravenous cannulae was accessed in the previous 24 hr and for what purpose. Nurses were also asked whether they would replace the peripheral intravenous cannulae should it fail. RESULTS: Approximately one-quarter of patients had a peripheral intravenous cannulae, the majority of which had been present for <24 hr. The major use of the peripheral intravenous cannulae was antibiotic administration. Administration of intravenous fluids occurred in the presence of normal oral fluid intake. Nurses would not replace one-third of peripheral intravenous cannulae in the event of failure. A majority of patients were at increased falls risk, and one-third of these were receiving intravenous fluids. CONCLUSIONS: There is room for improvement in the utilisation of peripheral intravenous cannulae, particularly in removal and associated use of intravenous fluids. Alternative strategies for medication administration and timely switch to the oral route may reduce the risks associated with intravenous fluids. RELEVANCE TO CLINICAL PRACTICE: Vigilance is required in the use of peripheral intravenou

© 2018, Slack Incorporated. All rights reserved. It is essential that nurses and midwives can understand and critically evaluate research to ensure the delivery of high-quality evidence-based care. Journal clubs are an educational method that helps to develop research capacity and assist with bridging the gap between research and clinical practice. To maintain competence and remain current with the latest evidence, a commitment to continuing professional education is required. This article describes how a successful journal club led to clinical nurses identifying a gap in their own practice, which resulted in a research project being conducted by the members of the journal club.

© 2008 Oncology Nursing Society. All rights reserved. OBJECTIVES: To understand what, if any, differences exist in the perception of a breast care nurse (BCN) consultation between women who experienced a preoperative, face-to-face counseling and education opportunity with a BCN, and those who required a telephone consultation or were unable to experience a preoperative BCN consultation. SAMPLE & SETTING: A convenience sample of women in a private hospital in Western Australia who had breast surgery for breast cancer, BRCA gene mutation, or breast cancer risk reduction, and who experienced face-to-face contact, telephone contact, or no preoperative contact with a BCN. METHODS & VARIABLES: A single-center, mixed-methods, descriptive study comparing timing and mode of consultation. RESULTS: Women who experienced a timely face-to-face consultation with a BCN in the preoperative period reported that they received superior education and emotional and practical support than women who experienced a telephone consultation or postoperative consultation with a BCN. IMPLICATIONS FOR NURSING: When a patient’s circumstances allow, a consultation with a BCN in the preoperative period should be offered. Ideally, this consultation should be conducted face-to-face to provide the education and psychosocial and practical support that patients undergoing breast surgery require. When this is not possible, a telephone consultation should be offered, as opposed to waiting until after surgery.

Background: Low response rates to surveys have been a long-standing issue in research. This includes research involving nurses and midwives. To gain representative samples, appropriate measures to maximise response rates need to be used. Aim: To explore ways to maximise response rates from nurses and midwives, using a hospital-wide survey as an example. Discussion: All nurses and midwives at the study hospital were invited to participate in a survey. To encourage participation and elicit an adequate response rate, several strategies were used. A total of 1,000 surveys were distributed and 319 (32%) were returned. All the required age groups, levels of experience and types of nursing registration were represented in the responses and data saturation was achieved. Conclusion: It is important to pay attention to obtaining a representative sample. Further investigation of response rates to surveys by nurses and midwives is warranted. Implications for practice Strategies to maximise response rates from a target population should be used when conducting surveys.

The role of the pastoral practitioner is embedded in many health care services and organizations. Despite this, there is little evidence to describe the impact of this role on patient outcomes, in particular how visits by a pastoral practitioner influence patient healing and recovery. This paper describes a small study that explored the patient experience of pastoral practitioner visits in an acute care facility.

Background: Peripherally inserted central catheters (PICCs) are used to administer chemotherapy to oncology patients. A review o f the literature revealed a gap in the understanding o f the patient experience o f living with a PICC. Aim: To explore patient experience and satisfaction including self-reported adverse events o f PICC use. Methods: A prospective survey was utilised to gain an understanding o f patients' experiences o f living with PICCs. The survey included self-reported pain, comfort and ease o f managing activities o f daily living. Participants were surveyed at two time points over one month. Results: The positive aspects of PICCs included ease o f treatment and little pain being associated with the PICC site. However, PICCs did hinder patients in a number of activities including work, leisure and exercise. Discussion: Little research has been conducted exploring patient experience o f living with a PICC. This small pilot study identifies areas that warrant further investigation to assist with providing patient centred holistic care.

© 2017 Australasian College for Infection Prevention and Control Objectives To explore patient experience, understanding and compliance with using Chlorhexidine Gluconate (CHG) preoperative washes. Methods A cross-sectional survey was conducted over a ten week period with adult inpatients who had undergone a surgical procedure at the study hospital. The survey consisted of 17 questions which participants self-completed. Closed and open-ended questions were i ncluded in the survey to allow both statistical and thematic analysis. Results A 74% (n = 194) sample response rate was attained. The sample obtained was representative of the wider hospital surgical patient population. Although 85% (n = 159) of participants reported they used CHG prior to their surgical procedure only 63% (n = 101) used the wash the recommended two times. Across all age groups in the survey 20% (n = 36) of participants reported they received too little information about CHG washes. Open-ended questions revealed three key themes; lack of information, issues with time or access and inconsistencies across the hospital. Conclusion This project revealed the current experience of patients undergoing surgery in relation to preoperative washing. Lack of information regarding CHG, issues with timing of information and access, as well as inconsistencies between different surgical specialities within the hospital were identified as barriers to participants using CHG. These are areas which could be targeted with a suite of interventions which aim to provide patients with clear, consistent information in a timely manner.

Aim: To synthesize existing research to determine if nurses who work shifts have poorer psychological functioning and resilience than nurses who do not work shifts. Background: Research exploring the impact of shift work on the psychological functioning and resilience of nurses is limited compared with research investigating the impact of shifts on physical outcomes. Design: Integrative literature review. Data Sources: Relevant databases were searched from January 1995-August 2016 using the combination of keywords: nurse, shift work; rotating roster; night shift; resilient; hardiness; coping; well-being; burnout; mental health; occupational stress; compassion fatigue; compassion satisfaction; stress; anxiety; depression. Review Methods: Two authors independently performed the integrative review processes proposed by Whittemore and Knafl and a quality assessment using the mixed-methods appraisal tool by Pluye et al. Results: A total of 37 articles were included in the review (32 quantitative, 4 qualitative and 1 mixed-methods). Approximately half of the studies directly compared nurse shift workers with non-shift workers. Findings were grouped according to the following main outcomes: (1) general psychological well-being/quality of life; (2) Job satisfaction/burnout; (3) Depression, anxiety and stress; and (4) Resilience/coping. We did not find definitive evidence that shift work is associated with poorer psychological functioning in nurses. Overall, the findings suggest that the impact of shift work on nurse psychological functioning is dependent on several contextual and individual factors. Conclusion: More studies are required which directly compare the psychological outcomes and resilience of nurse shift workers with non-shift workers.

Aims and objectives: To compare two methods of calculating interrater agreement while determining content validity of the Paediatric Pain Knowledge and Attitudes Questionnaire for use with Australian nurses. Background: Paediatric pain assessment and management documentation was found to be suboptimal revealing a need to assess paediatric nurses' knowledge and attitude to pain. The Paediatric Pain Knowledge and Attitudes Questionnaire was selected as it had been reported as valid and reliable in the United Kingdom with student nurses. The questionnaire required content validity determination prior to use in the Australian context. Design: A two phase process of expert review. Methods: Ten paediatric nurses completed a relevancy rating of all 68 questionnaire items. In phase two, five pain experts reviewed the items of the questionnaire that scored an unacceptable item level content validity. Item and scale level content validity indices and intraclass correlation coefficients were calculated. Results: In phase one, 31 items received an item level content validity index <0·78 and the scale level content validity index average was 0·80 which were below levels required for acceptable validity. The intraclass correlation coefficient was 0·47. In phase two, 10 items were amended and four items deleted. The revised questionnaire provided a scale level content validity index average <0·90 and an intraclass correlation coefficient of 0·94 demonstrating excellent agreement between raters therefore acceptable content validity. Conclusion: Equivalent outcomes were achieved using the content validity index and the intraclass correlation coefficient.

This research explored the impact of tablet technology, in the form of Apple iPads, on undergraduate nursing and midwifery students’ learning outcomes. In simulated clinical learning environments, first-year nursing students (n = 30) accessed apps and reference materials on iPads. Third-year nursing students (n = 88) referred to clinical guidelines to aid their decision making when problem solving. First-year midwifery students (n = 25) filmed themselves undertaking a skill and then immediately played back the video file. A total of 45 students completed an online questionnaire that allowed for qualitative comments. Students reported finding the use of iPads easy and that iPads provided point-of-care access to resources, ensuring an evidence-based approach to clinical decision making. iPads reportedly improved student efficiency and time management, while improving their ability to provide patient education. Students who used iPads for the purpose of formative self-assessment appreciated the immediate feedback and opportunity to develop clinical skills.

For this study, we examined the nature of the unique relationships trait-negative affect and compassion satisfaction had with compassion fatigue and its components of secondary traumatic stress and burnout in 273 nurses from 1 metropolitan tertiary acute hospital in Western Australia. Participants completed the Professional Quality of Life Scale (Stamm, 2010), Depression Anxiety Stress Scale (Lovibond & Lovibond, 2004), and the State-Trait Anxiety Inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983). Bivariate correlation and hierarchical regression analyses were performed to examine and investigate 4 hypotheses. The results demonstrate a clear differential pattern of relationships with secondary traumatic stress and burnout for both trait-negative affect and compassion satisfaction. Trait-negative affect was clearly the more important factor in terms of its contribution to overall compassion fatigue and secondary traumatic stress. In contrast, compassion satisfaction's unique protective relationship only related to burnout, and not secondary traumatic stress. The results are therefore consistent with the view that compassion satisfaction may be an important internal resource that protects against burnout, but is not directly influential in protecting against secondary traumatic stress for nurses working in an acute-care hospital environment. With the projected nursing workforce shortages in Australia, it is apparent that a further understanding is warranted of how such personal variables may work as protective and risk factors. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Bereavement and grief are natural processes and the majority of people ?nd their way through their loss. However, a small minority may bene?t from professional assistance and a service that meets their needs. The aim of this study was to evaluate the impact of an Australian Hospital Bereavement Service on the next of kin of deceased patients. The service provides three consecutive tiers of support to palliative care patients and families including information and compassion, non-specialised bereavement support and specialist intervention referral to external agencies on an individual and selective basis. The research used a qualitative approach with semi-structured focus groups and thematic analysis. Major themes identi?ed were personal experience of grief; revisiting the hospital; and bereavement care experiences. We conclude assumptions should not be made about bereavement needs or grieving reactions of individuals. However, a suite of appropriate bereavement services, support groups and feedback opportunities are perceived as helpful by grieving adults. The research also highlighted how dif?cult it is for some family members to return to the hospital following the death of their loved one.

Background: This retrospective study examined the enhancement of practice, knowledge, and skill of delivery suite midwives undertaking the circulating and instrument roles during emergent caesarean sections following a tailored educational program implemented to the benchmark standard. Method: All midwives who attended the educational program were invited to participate (N = 48); a total of 20 responses were received. Descriptive data analysis of the bivariate nominal data was performed. Results: Clinically significant outcomes were noted across all theme areas: knowledge of the Australian College of Operating Room Nurses standards, competence and knowledge of the main roles during a caesarean section, knowledge of policies and procedures, and patient safety. An improved working relationship between the perioperative and delivery ward staff also was identified. Conclusion: An educational program for midwives on the instrument and circulating roles for caesarean sections provides the knowledge and skill development required for clinically safe practice.

Background: Clinical handover ensures continuity of care, providing the opportunity to transfer responsibility and accountability for the care of a patient from nurse to nurse. Aim: The aim of this study was to examine afternoon nursing clinical handover from the perspective of nurses, exploring the quality of information, the interactions and support, the efficiency and the involvement of parents in a private neonatal unit. Methods/Design: An exploratory, descriptive, prospective quantitative survey with qualitative elements was undertaken using The Handover Evaluation Scale (O'Connell, MacDonald, & Kelly, 2008). All nurses working in the Neonatal unit who attend afternoon handover, were invited to participate in the study (N = 22), with N = 16 responses received. Results/Findings: The quantitative and qualitative results indicate that the quality of the information handed over in neonatal care units can be maintained despite intrinsic limitations. Additionally, high levels of support and interaction between nursing staffin this stressful practice environment occur during the handover period. Conclusion: Given the vulnerability of neonates it is important that accurate information is efficiently handed over. In order to do this distractions should be minimised. Finally, parental involvement in handover should be actively encouraged whenever feasible.

Increased bandwidth, broadband network availability and improved functionality have enhanced the accessibility and attractiveness of social media. The use of the Internet by higher education students has markedly increased. Social media are already used widely across the health sector but little is currently known of the use of social media by health profession students in Australia. A cross-sectional study was undertaken to explore health profession students' use of social media and their media preferences for sourcing information. An electronic survey was made available to health profession students at ten participating universities across most Australian states and territories. Respondents were 637 first year students and 451 final year students. The results for first and final year health profession students indicate that online media is the preferred source of information with only 20% of students nominating traditional peer-reviewed journals as a preferred information source. In addition, the results indicate that Facebook® usage was high among all students while use of other types of social media such as Twitter® remains comparatively low. As health profession students engage regularly with social media, and this use is likely to grow rather than diminish, educational institutions are challenged to consider the use of social media as a validated platform for learning and teaching.