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Internationally, the adoption of technology into residential aged care settings has been slow and fraught with multiple challenges for residents, staff and service providers. The aim of this study was to evaluate the acceptability, efficiency, and quality of health information system implementation into aged care.Three-stage, mixed-methods participatory action research, concurrent with the natural experiment of a co-designed health information system implementation into a 169-bed aged care home in Australia. Data were collected pre-, during, and post implementation between 2019 and 2021. Qualitative data included focus groups, interviews, and observations. Quantitative data included work observations, pedometers, record audits, incident reports and staff and resident surveys. There were 162 participants composed of 65 aged care residents, 90 staff, and 7 managers/consultants.Improved work efficiency included reduced staff time searching for information (6%); reduced nurse time on documentation (20.4% to 6.4%), and 25% less steps. Documentation improvement included resident assessments (68% to 96%); resident-focused goals (56% to 88%) and evaluations (31% to 88%). The staff reported being better equipped to manage the 'delicacies of dignity'.Implementation of a health information system into a residential aged care facility was associated with improved resident-focused care and staff efficiency.Technology can support nurses and care staff to spend more time with residents in residential aged care homes, improve the quality of resident care, and assist meeting regulatory reporting requirements. Flexible and tailored co-design strategies can enhance both effectiveness and success of technology implementation into residential aged care.

The analysis presented here describes the care needs of older adults with and without cognitive impairment. To describe the health characteristics of older adults with and without cognitive impairment who receive home care or Aged Residential Care services in New Zealand.A descriptive analysis of the initial interRAI assessment for adults older than 55 years was undertaken. Data were grouped by level of assessed cognitive impairment. The population proportions for each level of the following scales were calculated: Changes in Health, End-stage Disease, Signs, and Symptoms Scale (CHESS), pain, pressure injury risk, Activities of Daily Living (ADL), depression screening, and body mass index (BMI).The analysis included 93,680 assessments. The mean age was 83 years (SD = 8.7) a positive association was observed between age and cognitive impairment (p 0.01). People with cognitive impairment were less likely to have been recently hospitalised or to have attended ED (p 0.01). Significant associations with effect sizes ≥3 were observed for cognitive impairment and ADL (p 0.01, γ = 0.63), pain (p 0.01, γ = -0.32), and risk of pressure injury (p 0.01, Cramer's V = 0.271).The results reinforce a need to be alert to the differential care needs of older adults with moderate/severe cognitive impairment. The findings may act as a trigger for practitioners to focus assessment on aspects of care that, due to context, may otherwise be underassessed or untreated.

To explore if and how Parkinson's disease dance class participation and public performance contributes to perceptions of wellbeing.A qualitative design using audio-recorded one-on-one semi-structured interviews with five class participants and three teachers/volunteers from two metropolitan Dance for Wellbeing class locations. Data were inductively thematically analysed by three researchers.Five themes illustrated the experience of dance class and performance for people with Parkinson's Disease: 1) 'the enabling learning environment'; 2) 'physical benefits from class participation; 3) 'mental/psychological benefits from class participation'; 4) 'social benefits from class participation; 5) 'sense of self and life engagement from class participation'. Themes 4 and 5 in particular were considered to be 'magnified by public performance', providing an opportunity for solidarity within the group and a supportive avenue for "coming out" and living publicly with the PD diagnosis.Dance performance magnifies health and wellbeing experiences of people with Parkinson's disease when part of an enabling, inclusive and emotionally and physically safe learning dance class environment. Elements of holistic benefits, as well as the fun and playful nature of the experience may be important elements to consider for motivation, recruitment and retention in this population.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals should consider the use of dance class as an art-based activity that has a holistic therapeutic benefit.Flexible and fun environments are constructive for dancers to sustain attendance and interest.Rehabilitation professionals can be cognisant of the impact of public dance performance as 'coming out' with Parkinson's Disease.

Background: Misconceptions about men in nursing may influence recruitment and retention, further perpetuating the gender diversity imbalance in the nursing workforce. Identifying misconceptions and implementing early intervention strategies to address these deep-rooted stereotypes remain challenging but is considered critical to support students who are commencing a nursing career. Objective: To develop and evaluate the psychometric properties of the ‘Gender Misconceptions of meN in nursIng (GEMINI) Scale. Design: Cross-sectional survey. Methods: Pre-registration nursing students enrolled in undergraduate nursing programmes across 16 nursing institutions in Australia were surveyed from July to September 2021. The17-item self-report GEMINI Scale measured the gender misconceptions of men in nursing. Results: Of the 1410 completed surveys, data from 683 (45%) women were used for exploratory factor analysis showing a one factor structure, while data from 727 men (47%)were used for confirmatory factor analysis of the 17-item GEMINI Scale, which showed a good model fit. The scale demonstrated high internal consistency (Cronbach’s alpha of0.892). Men were found to have higher gender misconceptions (p < 0.001) while respondents who: (a) identified nursing as their first career choice (p = 0.002); (b) were in their final year of programme enrolment (p = 0.016); and (c) engaged in health-related paid work (p = 0.002) had lower gender misconceptions. Conclusion: The GEMINI Scale is a robust, valid, reliable, and easy to administer tool to assess misconceptions about men in nursing, which may potentially influence academic performance and retention. Identifying and addressing specific elements of misconceptions could inform targeted strategies to support retention and decrease attrition among these students. Impact statement: Genderism harms nursing, as well as the men and women working in the profession. Recruitment and retention of men into nursing is needed to cultivate male role models and diversify the workforce, however this is impeded by negative portrayals in popular culture and misconceptions entrenched in society Refereed/Peer-reviewed

To explore organisation-wide experiences of person-centred care and risk assessment practices using existing healthcare organisation documentation.There is increasing emphasis on multidimensional risk assessments during hospital admission. However, little is known about how nurses use multidimensional assessment documentation in clinical practice to address preventable harms and optimise person-centred care.A qualitative descriptive study reported according to COREQ.Metropolitan tertiary hospital and rehabilitation hospital servicing a population of 550,000. A sample of 111 participants (12 patients, 4 family members/carers, 94 nurses and 1 allied health professional) from a range of wards/clinical locations. Semi-structured interviews and focus groups were conducted at two time points. The audio recording was transcribed, and an inductive thematic analysis was used to provide insight from multiple perspectives.Three main themes emerged: (1) 'What works well in practice' included: efficiency in the structure of the documentation; the Introduction, Situation, Background Assessment, Recommendation (ISBAR) framework and prompting for clinical decision-making were valued by nurses; and direct patient care is always prioritised. (2) 'What does not work well in practice': obtaining the patient's signature on daily care plans; multidisciplinary (MDT) involvement; duplication of paperwork and person-centred goals are not well-captured in care plan documentation. (3) 'Experience of care'; satisfaction of person-centred care; communication in the MDT was important, but sometimes insufficient; patients had variable involvement in their daily care plan; and inadequate integration of care between MDT team which negatively impacted patients.Efficient and streamlined documentation systems should herald feedback from nurses to address their clinical workflow needs and can support, and capture, their decision-making that enables partnership with patients to improve the individualisation of care provision.The integration of effective MDT involvement in clinical documentation was problematic and resulted in unmet supportive care from the patient's perspective.

To evaluate acceptability, efficiency, and quality of a new digital care management system in a residential aged care home (RACH).Improving care quality and efficiency in RACH, while simultaneously upgrading data management, is a priority for communities and governments.Participatory action research with mixed methods data collection was employed to evaluate a digital care management system implemented at a 169-bed RACH. This paper reports qualitative findings of the 2-year evaluation.Qualitative data were collected using focus groups with residents, visitors, nurses, managers, care workers, and consultants; resident/visitor and staff hallway interviews and responses to open-ended questions in online staff surveys. Data were analysed thematically under the four predetermined study objectives. Reporting adhered to COREQ guidelines.325 data captures from 88 participants, over seven data sources were coded. Findings indicate that the system was acceptable to both residents and staff due to perceptions of time-saving and improved quality of care. Increased efficiency was perceived through timeliness as well as reduced time spent retrieving and documenting information. Quality of care was improved through care scheduling individualised to resident needs, with reminders to avoid missed care. Relatives were reassured and activities were scheduled to loved one's preferences. The co-design implementation process was successful through commitment to quality from leadership teams and prioritising the focus on the holistic needs of the residents.A strong emphasis on co-design with care staff in developing and implementing the digital care system contributed to a system that supported nursing and care work, facilitated reporting and documentation, and improved resident care and well-being including identification of missed care.Nurses, carers, administrators, and advocates can support the co-design creation of information systems that suit the workflow of an organisation and keep the focus on individualised models of care provision.

Background Globally, families and communities are impacted by disasters every day. Nurses are integral to assisting in disasters, in the support and enablement of individuals and communities. However, some studies indicate that nurses feel ill-equipped to assist, partially because disaster content is not thoroughly addressed in the undergraduate curriculum. Therefore, nursing schools need to equip undergraduate nursing students with the knowledge and preparation required to assist effectively during and/or following a disaster. Aim To explore priority disaster topic areas aimed at preparing Australian undergraduate nursing students to assist in caring for survivors in the aftermath of disasters. Method This study used an integrative review methodology. Various databases and platforms were searched for literature published between 2000 and 2018 using Medical Subject Heading terms and keywords relating to the undergraduate nursing curriculum. A thematic analysis of the included papers was conducted. Results A total of 10 articles were identified that meet the inclusion criteria. The reviewed studies highlighted that the areas of disaster knowledge, assessment and triage, critical thinking, teamwork, technical skills, mental wellbeing, legal and ethical consideration, and socio-cultural contexts, are relevant for the undergraduate curriculum. Discussion This review highlights disaster education and training topic areas that could be considered for inclusion in Australian undergraduate nursing curricula. The content relating to disaster assistance must be incorporated into nursing schools’ curriculum. Conclusion The incorporation of disaster-related content in the undergraduate nursing curriculum may enhance the disaster preparedness of nursing students and the nursing workforce more broadly.

This article explores staff work patterns in an Australian residential aged care facility and the implications for high-quality care. Rarely available minute by minute, time and motion, and ethnographic data demonstrate that nurses and care staff engage in high degrees of multitasking and mental switching between residents. Mental switching occurs up to 18 times per hour (every 3 min); multitasking occurs on average for 37 min/h. Labor process theory is used to examine these outcomes and to explore the concepts of high demand and high commitment as core components of work intensification. These conditions of work result in high levels of cognitive burden and stress on staff in managing the multitasking and mental switching, exacerbated by lack of knowledge about residents associated with labor force casualization. These new interpretations of data in relation to mental and manual labor can contribute to understanding, and, therefore, problem solving, in the aged care sector.

Background Elder abuse is an ongoing issue experienced by older persons in Australia, with instances of neglect, emotional, and physical abuse being reported to the Royal Commission into Aged Care Quality and Safety. Aim The aim of this integrative review was to explore the evidence on the effectiveness of supported decision-making for applying to advocacy in older people and people experiencing elder abuse. Methods A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, across multiple databases including: MEDLINE, CINAHL, PsycInfo, Cochrane Library, Web of Science, Scopus, and Trove. One thousand two hundred-ten articles were screened for relevance using titles and abstracts. Of these, seven met the inclusion criteria. Findings Content analysis informed the development of four themes pertaining to supported decision-making amongst older persons: personal and environmental factors, relationship between decision maker and support person, information and training, and models and frameworks to aid assessment. Discussion Supported decision making presents an important move towards promoting, protecting, and ensuring human rights for people who may have previously been exposed to more paternalistic approaches. Conclusion The review highlighted gaps in the strength of evidence and was therefore not able to offer conclusive advice on of effectiveness of supported decision making in older people experiencing abuse. This review highlights the need for further research to be conducted to identify how best to offer supported decision making to support the autonomy and human rights of the older person.

Aim To explore how parents of children with long-term conditions experience partnership in paediatric and neonatal nursing care and to identify existing partnership barriers and facilitators. Background Parent-nurse partnership is fundamental to paediatric and neonatal nursing. Partnership is characterised by five attributes: parental participation, negotiation, mutual trust and respect, shared roles and decision-making, and communication. Little is known about the parental experiences of partnership nursing specific to children living with a long-term condition. Design A qualitative meta-aggregation review following Joanna Briggs Institute meta-aggregation approach. Methods A comprehensive search was conducted in six electronic databases. Studies were assessed according to the inclusion and exclusion criteria. Qualitative findings with illustrative quotes from included studies were extracted and grouped into categories which informed the synthesised findings. This review has been reported according to the PRISMA guidelines. Findings A total of 4,404 studies were screened, 162 full-text studies were assessed against the inclusion and exclusion criteria, and a total of six studies were included. The meta-aggregation developed three overarching synthesised findings which were as follows: (a) empowering parents to become involved, (b) effective communication to recognise mutual expertise and (c) collaborative nurse-family relationships. Conclusion Parents valued collaboration where both parents and nurses are recognised equally for their skills and expertise. A power struggle existed between parents and nurses when expertise was not recognised. Parents appreciated nurses who empowered them to develop new skills and knowledge in the care of their own child. Relevance to clinical practice Nurses need to recognise the skills and knowledge that parents have surrounding the care requirements of their own children. Collaboration and negotiation are key to successful partnership between nurses and parents. Nurses need to frequently reflect on how they are successfully partnering with both parents and children and ensure all parties in the nurse/parent/child triad feel supported and empowered.

Aim To use expert consensus to develop guidance for nurse leaders implementing e-health tools to support nursing work in hospitals. Background Nurse leaders are increasingly required to make decisions about the selection, development, implementation and optimisation of e-health tools for nursing work in hospitals. Guidance in this rapidly evolving and complex space is limited. Design A two-phase modified Delphi study. Methods Phase one involved in-depth interviews with five nursing informatics experts. Analysis used the qualitative framework method, informed by the Theoretical Domains Framework (TDF), to develop statements for an anonymous online Delphi scoring survey. This was distributed using snowball sampling methods to Australian nurse informatics leaders and experts. Final analysis involved synthesis of qualitative and quantitative data. The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) checklist. Results Ten guidance statements to support nurse leaders to implement e-health tools in hospitals were developed from the synthesis of qualitative interview data and 29 experts' responses to the 55-item Delphi response survey. Conclusion Implementation of e-health tools for nursing work is complex in health settings and requires careful examination of multiple factors and interactions between clinicians, tools, service users and the health organisation. This research proposes ten statements to support nurse leaders with decisions about implementing e-health tools to support nursing work in hospitals. Relevance to clinical practice The ten statements developed by this research provide a resource to assist policy and practice decisions about e-tools to ensure they are suited to supporting nursing work. Nurse leaders can use the ten statements for guidance in the selection, development, implementation and optimisation of e-health tools to ensure suitability and adaptation for nursing work in hospitals.

The promotion of physical activity (PA) by health professionals is a key strategy to increase PA levels in the population. In this study, we investigated PA promotion, preparedness, and knowledge among university nursing and allied health students and staff, as well as PA resource usage within curricula, before and after an educational intervention. Students and staff from 13 health disciplines at one Australian university were invited to complete an online survey, and a curriculum audits were conducted before and after PA teaching resources were promoted by academic PA champions (n = 14). A total of 299 students and 43 staff responded to the survey pre-intervention, and 363 and 32 responded to the post-intervention, respectively. PA promotion role perception (≥93%) and confidence to provide general PA advice (≥70%) were high throughout the study. Knowledge of PA guidelines was poor (3–10%). Students of physiotherapy, sport and exercise science, as well as more active students, were more likely to be aware of the PA guidelines (p < 0.05). Over 12 months, PA promotion preparedness and knowledge did not change significantly, nor was there a change in the amount of PA content delivered, despite a significant increase in the use of the teaching resources across a number of disciplines (p = 0.007). Future research should be carried out to investigate the implementation of the resources over time and to develop additional strategies for PA promotion and education scaffolded across curricula.

To describe the experiences of nursing care and partnership nursing as expressed by children living with long-term conditions.Children with long-term conditions have higher rates of hospitalisations and adverse events in hospital, yet little is known about their experiences of nursing care. How children perceive partnership in care with their families and nurses is of interest in the achievement of safe and effective care DESIGN: An integrative review following Joanna Briggs Institute protocols for systematic reviews.An integrative review was chosen following Joanna Briggs Institute protocols for systematic reviews. A total of 5150 articles were screened, with 251 full-text publications reviewed. A total of 21 studies were included, three mixed-method studies and 18 qualitative studies. This review has been reported as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Four integrated findings were identified: "Children are aware of their surroundings and needs," "Children value positive communication," "Children want to be recognised as an individual in the triadic relationship, and this can be done through nurses using tailored play;" and "Children seek a shared decision-making process."Children wanted to be seen as an individual in Children and Young People's nursing as well as a child who craves security, fun and comfort, both from their families and nursing staff. Children described observing partnership between nursing staff and parents but felt uninvolved, with some children craving more knowledge and power to better understand their long-term condition.Further research is required on how Children and Young People's nursing staff can better support children and empower them to be active members in the shared decision-making process if the child wishes to be involved.

Background Residential medication management reviews (RMMRs) are the primary strategy enabling collaborative and individualised medication reviews in Australian residential aged care homes (RACHs). Residents with dementia often have complex health needs and care goals, which makes them a useful benchmark of health service efficacy. Objective To analyse perspectives of pharmacists, general practitioners (GPs) and nurses on the suitability and delivery of the current RMMR model for residents with dementia; and to identify scope for improvement in medication review service delivery. Methods Electronic surveys were distributed to the included health professions via professional agencies. Descriptive statistics and non-parametric tests were used to summarise quantitative variables. Qualitative data obtained from open-text responses underwent iterative thematic analysis. Two researchers independently conducted the thematic categorisation; data within responses was inductively coded, then codes were linked to identify emergent themes that described the data content. In a triangulated exploratory mixed method approach, the qualitative findings were used to explain the quantitative findings. Results None of the participants agreed that the current program recommendation of a single RMMR every 24 months was suitable for the residents’ needs. Participants were more likely to use written, rather than verbal, means of communication during RMMRs. RMMRs were perceived to have minimal benefit if there was minimal face-to-face interaction between stakeholders. Individualised medicine management in relation to resident goals of care was the key benefit of RMMRs. Insufficient remuneration was the primary barrier to effective face-to-face collaboration and delivery of individualised resident care. Conclusions Increasing support for stakeholder participation in face-to-face interactions during medication reviews may enable delivery of a more patient-centred service for residents with dementia and improve health professional satisfaction and engagement.

Aim To describe the self-reported experiences of clinicians evaluating a novel Health Information System in an acute care environment. Design The Health Information System was implemented over a one-month period in 2017 into a 26-bed acute medical ward within a 760-bed tertiary teaching hospital in Australia. Methods Data were collected using interviews with 48 multidisciplinary clinicians and 20 patients, and 2 focus groups with 13 nurses, and analysed with a ‘content, context, and process’ evaluation framework. Results Three themes reflecting unanticipated difficulties emerged from the qualitative data: (1) inconsistent expectations; (2) decisional conflict between managers and end-user nurses; and (3) workflow impacts. Conclusions Designers and evaluators of information systems must listen to, prioritise and respond to the needs of the clinicians who provide care.

To investigate the association of unfinished nursing care on nurse outcomes.Systematic review in line with National Institute for Health and Care Excellence guideline.CINAHL, the Cochrane Library, Embase, Medline, ProQuest and Scopus databases were searched up until April 2020.Two independent reviewers conducted each stage of the review process: screening eligibility, quality appraisal using Mixed Methods Appraisal Tool; and data extraction. Narrative synthesis compared measurements and outcomes.Nine hospital studies were included, and all but one were cross-sectional multicentre studies with a variety of sampling sizes (136-4169 nurses). Studies had low internal validity implying a high risk of bias. There was also a high potential for bias due to non-response. Only one study explicitly sought to examine nurse outcomes as a primary dependent variable, as most included nurse outcomes as mediating variables. Of the available data, unfinished nursing care was associated with: reduced job satisfaction (5/7 studies); burnout (1/3); and intention-to-leave (2/2). No association was found with turnover (2/2).Unfinished nursing care remains a plausible mediator of negative nurse outcomes, but research is limited to single-country studies and self-reported outcome measures. Given challenges in the sector for nurse satisfaction, recruitment and retention, future research needs to focus on nurse outcomes as a specific aim of inquiry in relation to unfinished nursing care.Unfinished nursing care has previously been demonstrated to be associated with staffing, education and work environments, with negative associations with patient outcomes (patient satisfaction, medication errors, infections, incidents and readmissions). This study offers new evidence that the impact of unfinished nursing care on nurses is under investigated. Policymakers can prioritize the funding of robust observational studies and quasi-experimental studies with a primary aim to understand the impact of unfinished nursing care on nurse outcomes to better inform health workforce sustainability.

To understand the enablers and barriers for delivering fundamental care to hospitalized older patients.Explanatory sequential mixed methods design, with qualitative data used to elaborate quantitative results.Set in one medical and one surgical unit of a tertiary hospital in southeast Queensland, Australia. Observations of nursing practice using the Work Sampling Technique were conducted over two 2-week periods in 2019. Data were analyzed and presented to groups of nurses who appraised the findings of the observations.There were 1176 and 1278 observations of care in the medical unit over two time periods and 1380 and 1398 observations over the same period in the surgical unit. Fundamental care activities were recorded in approximately 26% (i.e. medical) and 22% (i.e. surgical) of all observations. Indirect care was highest, recorded in 41% (i.e. medical) and 43% (i.e. surgical) of observations. Nurses prioritized the completion of reportable activities, which is perceived as a potential enabler of fundamental care. Potential barriers to fundamental care included frequent delays in indirect care and difficulty balancing care requirements across a group of patients when patients have high fundamental care needs.The cultural acceptance of missed nursing care has the potential to erode public confidence in health systems, where assistance with fundamental care is expected. Relational styles of nurse leadership should focus on: (1) making fundamental care important work in the nurses' scope thereby offering an opportunity for organizational change, (2) promoting education, demonstrating the serious implications of missed fundamental care for older patients and (3) investigating work interruptions.Fundamental care is necessary to arrest the risk of functional decline and associated hospital-acquired complications in older patients. However, nurses commonly report fundamental care as missed or omitted care. Understanding the challenges of implementing fundamental care can assist in the development of nurse leadership strategies to improve older patients' care. Fundamental care was observed between 22% (i.e. surgical) and 26% (i.e. medical) of all observations. Nurses explained that they were focused on prioritizing and completing reported activities, experienced frequent delays when delivering indirect care and found balancing care requirements across groups of patients more challenging when patients had fundamental care needs. Clinical nurses working in acute health services with increasing populations of older patients can lead improvements to fundamental care provision through relational leadership styles to demonstrate how this work is in nurses' scope of practice, promote education about the serious implications of missed fundamental care and investigate the root cause of work interruptions.

Objective Research involving people with dementia is vital to appropriately inform policy and practice decisions affecting this population. As dementia-care researchers, we frequently advocate to Human Research Ethics Committees for the right of people with dementia to choose whether to participate in research. This brief report provides some considerations for researchers and ethics committees. Method Descriptive summary of principles that argue for inclusion of people with dementia in research studies. Results Specifically excluding people living with dementia from research because of perceived cognitive impairment is inappropriate in light of human rights principles and the right to contribute to evidence-based care. Conclusion There is a difference between capacity to provide informed consent and ability to provide perspectives that are valid for each individual. Providing the opportunity for a person with dementia to participate in research and offering support to do this is a matter of human rights.

What is known and objective: With the ageing of the population also comes increasing comorbidities and the use of multiple medications and administration methods, along with greater susceptibility to adverse drug reactions. Dosage form modification to facilitate drug administration in older adults can be potentially problematic as altering the original licensed formulation can affect medication safety and efficacy. The reporting of adverse drug reactions and medication incidents is a key strategy in avoiding preventable adverse drug events for aged care residents. This study evaluated the effect of an on‐site clinical pharmacist on reducing inappropriate dosage form modification and staff time spent on medication administration, and optimizing the documentation of drug allergies, adverse drug reactions and medication incidents. Methods: A pilot‐controlled trial was performed in a purposive sample of two residential aged care homes. Both homes belonged to the same organization; the study site had 104 beds and the control site had 100 beds. All permanent residents were eligible for inclusion in the study if written consent was provided. A residential care pharmacist position was implemented at the study site for six months, with a focus on performing medication reviews and quality improvement activities. Observational audits of medication rounds were performed, and documentation relating to allergies, adverse drug reactions, and medication incidents was obtained from both sites before and after the pharmacist trial period. Results: At the study site, there was a significant reduction over the trial in the proportion of inappropriate dosage form modification (from 24% to 0% of all dosage form modifications; P < 0.01). Mean time spent on medication rounds per resident reduced from 4.8 minutes per resident (SD 1.1) to 3.2 minutes per resident (SD 1.7) per round (P < 0.05). The incidence of previous allergy and adverse drug reaction documentation significantly improved from 77% of residents pre‐study to 100% of residents post‐study (P < 0.01). Mean monthly medication incident reports significantly improved from 13.3 (SD 7.4) pre‐study to 25.7 (SD 10.8) post‐study (P < 0.05). There was no change in these outcomes at the control site. What is new and conclusion: Including a pharmacist in a residential aged care home can improve medication administration practices by reducing inappropriate dosage form modification and staff time spent on medication administration rounds, and increasing the documentation of resident allergies, adverse drug reactions and medication incidents. These findings warrant further exploration in a large randomized controlled trial.

Objective: The aim was to explore and compare documentation of the nursing process for patient safety in two nursing documentation systems: paper and digital records. Background: The ‘nursing process’ (assessment, planning, intervention, and evaluation) is recommended by professional nursing registration and health service accreditation bodies as a key component of understanding nurses’ clinical reasoning. Nurses’ responsibility for patient safety must be supported by comprehensive documentation practices. Study design and methods: A retrospective audit of twenty clinical care records (N = 20) randomly selected from a single acute medical ward at a tertiary hospital in Australia; ten from a digital trial that replicated selected paper forms and ten paper records as controls. The audit was conducted by two nurse researchers using a purpose built data extraction tool. Results: Patient age, gender and primary diagnoses were similar for the digital and paper care records. Documentation of the full nursing process was low in both record types, and comprehensiveness of nursing documentation was similar across the paper and digital records. Compared to the paper documents, the digital documents were more often rated as ‘complete’ (p

Background Research on missed nursing care reveals individual and systems failure. Research on infection control missed care is minimal. Aims Investigate nurse perceptions of missed infection control. Design Qualitative in-depth interviews with 11 Australian infection control nurse experts. Methods Participants were asked whether nursing and hospital-wide care tasks fundamental to infection control were missed, and what were the underlying causes and contributing factors for these omissions. Qualitative data was mapped against fundamental nursing practice and Australian infection control guidelines. Findings Omission of infection control care occur at the individual clinician and organisational level. Nurses describe failure to perform standard precautions as well as failure to perform basic care activities. Participants identified a range of institutional and cultural factors which contributed to cascade iatrogenesis resulting in healthcare associated infections for patients. Some factors are outside nurses’ control and include: environmental cleanliness; ward layout; ward culture; resourcing and staffing; integration of infection control into clinical governance; action following audit results; and reviewing evidence base of protocols. Discussion Care occurs in complex and conflicted settings, with prioritisation essential. Potentially harmful practices are generally done with the intention of care. Nurses are key, but not sole performers in the creation of quality infection control. Conclusion Mapping missed care related to infection control against standard frameworks of nursing practice revealed “gaps in the chain of infection” that contribute to “cascade iatrogenesis” with negative outcomes for patients.

Aim: To determine if there are cross-national differences in nurse understandings of the terms: missed care, rationed care and care left undone. Background: Nurse researchers from a number of countries have published studies on missed and rationed care. It is not clear if there are differences in understanding the key terms across various language groups. Design: A mixed method questionnaire was distributed to 26 member countries of a nursing research consortium in 2017. Methods: Forty-five responses to a qualitative questionnaire were received; 80% were nurse researchers. These responses were categorized into language groups and analysed for congruence and differences. Findings: There was congruence across all language groups in interpreting the three terms. Giddens' theory of globalization provides an explanation for this congruence. Conclusion: Shared understandings are explained by the fact that the majority of participants are nurse researchers with knowledge of English and the research literature. Shared understanding within the globalized academic community does not necessarily translate for clinical or nurse managers, nor does it predetermine solutions. Funding text #1 The authors acknowledge the funding of the European Cooperation in Science and Technology and the contribution of the RANCARE consortium as listed below. Funding text #2 This article is based upon work from COST Action RANCARE CA15208, supported by COST (European Cooperation in Science and Technology).

Aim To synthesise international research conducted on dementia-friendly community initiatives. Background The number of people living with dementia is increasing as a result of population ageing. Impairments related to neurological changes, together with environmental challenges, result in disability for people who have dementia. Led by the World Health Organization and Alzheimer's Disease International, initiatives have been undertaken internationally to promote social inclusion for people who have dementia. Communities where people with dementia are able to remain socially included are known as dementia-friendly communities. Design An integrative review of the literature. Methods Scopus, MEDLINE, Web of Science and CINAHL Plus via Ebsco databases were searched for relevant articles. The PRISMA framework guided the article search and screening; reporting is in accordance with the PRISMA guideline. Eight eligible studies were identified. The methodological quality of the eligible studies was evaluated using the MMAT checklist. The matrix method was used to extract, abstract and analyse the data. Results Of the eight studies reviewed, five were from the UK and one each from Australia, New Zealand and Canada. Four major concepts were identified in the literature, and these are characteristics of dementia-friendly communities, facilitators and barriers to community engagement for people with dementia, strategies for developing dementia-friendly communities and challenges encountered when developing dementia-friendly communities. Conclusion People with dementia are at the centre of dementia-friendly initiatives, and these foster social inclusion. Collaborations and partnerships enhance development of dementia-friendly communities; however, lack of resources and difficulty ensuring representation of marginalised groups provide challenges. Relevance to clinical practice An understanding of the impact of marginalisation and inequality on community participation for people with dementia is important for practitioners, enabling them to support those people. Senior nurses with this understanding can ensure services are able to meet the needs of a growing population with dementia.

Objectives: The feasibility of pharmacist-led influenza vaccination services in residential aged care homes has not previously been studied. The primary objective of this pilot study was to evaluate the feasibility of this service. The secondary objective was to assess the effect of the service on employee vaccination rates. Methods: An in-house pharmacist-led vaccination service was implemented at a single site in 2017. De-identified employee influenza vaccination records at this site for 2016 and 2017 were compared to assess the change in vaccination rate. Results: The residential care pharmacist administered 37% of all influenza vaccinations to employees (n = 78) in 2017. Between 2016 and 2017, there was a significant improvement in the employee vaccination rate at the site (46.5% vs 69.2%, P Conclusions: It is feasible for pharmacists to administer influenza vaccinations to employees in residential aged care. The flexibility of an in-house pharmacist improves accessibility and can therefore promote uptake of influenza vaccination by employees.

Aims and objectives The aim of this literature review is to synthesise and analyse the literature pertinent to the RN's competence and confidence to undertake the leadership role when working in residential aged care facilities after-hours and to determine any association of leadership with quality resident outcomes. Background Registered nurses (RNs) working in Residential Aged Care Facilities are required to undertake complex management tasks including leading nursing care teams, supervising non-nursing staff and allocating workloads according to residents' care needs, staff skills and experience. Registered nurses plan, assess, manage medication, evaluate each resident's care, liaise with doctors and allied health professionals and are responsible for evidence-based practice in accordance with the Nursing Standards for Practice (2016). Researchers have commented that effective nurse leadership can improve quality of care, improved resident outcomes and reduce adverse events. Design A review of original research papers based on the structured methodology described by Kable, Pich, and Maslin-Prothero (Nurse Education Today, 32, 2012, 878-886). Methods The review was conducted according to the 12-step structured framework by Kable et al. (Nurse Education Today, 32, 2012, 878-886). The search included peer-reviewed papers published between 2002-2017 on RN leadership after-hours, factors contributing to or with relationships to nursing leadership. Nineteen papers were found that researched the impact of leadership in aged care settings. Results The literature review concluded that nursing leadership has been linked to the quality of care and clinical outcomes in the aged care setting. However, RNs in the aged care setting have limited opportunities to develop key leadership competencies and confidence in order to meet the many challenges found in this environment due to lack of access to aged-care-specific leadership education. Minimal publications address the importance of the leadership of after-hours RNs. Results from this literature review will inform future research in this area. Conclusion Nineteen papers identified the leadership required of RNs in aged care settings. However, limited research investigating the association between nursing leadership and clinical outcomes was found. The findings from this literature review suggest that leadership in the aged care setting may be facilitated through specific educational activities such as RN shadowing shifts, continuing professional development, working with peers and by demonstrating and practising leadership competencies. Based on the literature reviewed, a need for more research in this area is required. In a specific manner, research into RN leadership, competence and confidence in aged care facilities after-hours is needed. Relevance to clinical practice Registered nurses working in the aged care setting after-hours need access to leadership education. Better quality of care, improved resident outcomes and reduced adverse events are associated with sound leadership.

Background Hospital acquired infections (HAIs) increase length of hospital stay and lead to poorer clinical outcomes. HAIs are viewed as preventable through risk monitoring and prevention of transmission. These activities are frequently missed. This study explores missed infection control activities through the lens of missed or rationed care. Aim To determine the factors that contribute to infection control activities being missed. Methods Semi-structured interviews were conducted with eleven nurses with infection control expertise. Findings Four major factors were identified as contributing to infection control activities being missed. These are systemic factors such as poor staffing and skillmix which contribute to time constraints and difficulties with identifying signs of infection; environmental factors such as ward layout and access to Personal Protective Equipment (PPE); organisational factors including lack of managerial support and interprofessional relationships; and personal factors, primarily the priority given to infection control by the nurse and knowledge, understanding and application of the principles of infection control. Discussion Policy responses to HAI frequently focus upon surveillance and education however, resourcing, organisational and interprofessional support and hospital layout all contribute to infection control activities being missed. Conclusion Further research is required into the impact of systemic factors upon infection control activities being missed.

Objectives: To evaluate outcomes associated with pharmacist-led medication reviews in residential aged care facility (RACF) residents with dementia. Methods: Six scientific databases were searched. All study designs investigating pharmacist-led medication reviews in RACF residents with dementia were considered. The protocol was registered with PROSPERO (CRD42019121681). Results: One randomised controlled trial (RCT) and five observational studies were identified. Two studies reported reductions in medication usage per resident, and one study reported improved appropriateness of psychotropic use following reviews as part of multi-faceted, collaborative interventions. In three studies, reviews undertaken as an isolated intervention or by a visiting pharmacist with minimal collaboration with physicians were associated with low implementation rates of recommendations to alter therapy. Conclusion: Pharmacist-led medication reviews, when conducted collaboratively, may improve the use of medicines in RACF residents with dementia. However, robust conclusions cannot be drawn, largely due to the low quality of evidence available, including only one RCT.

Background: This pilot study aimed to assess whether an on-site pharmacist could influence indicators of quality use of medicines in residential aged care. Methods: A pharmacist was embedded in a residential aged care home for six months. A similar control site received usual care. Polypharmacy, drug burden index, antipsychotic and benzodiazepine use, hospital admission rates and length of stay, and emergency department presentation rates were outcomes used to indicate medication use quality. Data were extracted from participating resident health records. Results: Fifty-eight residents at the study site and 39 residents at the control site were included in the analysis. There was a reduction in the proportion of residents at the study site who had at least one hospital admission at follow-up (28% to 12%, p &lt, 0.01), but no significant difference in other outcomes. Conclusions: This pilot study suggests that a residential care pharmacist may positively influence indicators of medication use quality in aged care, however, further research is needed to expand on these findings.

Despite the increasing number of older people, many with cognitive impairment (CI), in hospitals, there is yet to be an evaluation of hospital-wide interventions improving the management of those with CI. In hospitalized patients with CI, there are likely to be associations between increased complications that impact on outcomes, length of stay, and costs. This prospective study will evaluate the effectiveness of an established hospital CI support program on patient outcomes, patient quality of life, staff awareness of CI, and carer satisfaction. Using a stepped-wedge, continuous-recruitment method, the pre-intervention patient data will provide the control data for usual hospital care. The intervention, the Dementia Care in Hospitals Program, provides hospital-wide CI awareness and support education, and screening for all patients aged 65+, along with a bedside alert, the Cognitive Impairment Identifier. The primary outcome is a reduction in hospital-acquired complications: urinary tract infections, pressure injuries, pneumonia and delirium. Secondary outcome measures include cost effectiveness, patient quality of life, carer satisfaction, staff awareness of CI, and staff perceived impact of care. This large-sample study across four sites offers an opportunity for research evaluation of health service functioning at a whole-of-hospital level, which is important for sustainable change in hospital practice.

Older adults are particularly susceptible to iatrogenic disease and communicable diseases, such as influenza. Prescribing in the residential aged care population is complex, and requires ongoing review to prevent medication misadventure. Pharmacist-led medication review is effective in reducing medication-related problems; however, current funding arrangements specifically exclude pharmacists from routinely participating in resident care. Integrating an on-site clinical pharmacist into residential care teams is an unexplored opportunity to improve quality use of medicines in this setting. The primary objective of this pilot study is to investigate the feasibility of integrating a residential care pharmacist into the existing care team. Secondary outcomes include incidence of pharmacist-led medication review, and incidence of potential medication problems based on validated prescribing measures. This is a cross-sectional, non-randomised controlled trial with a residential care pharmacist trialled at a single facility, and a parallel control site receiving usual care and services only. The results of this hypothesis-generating pilot study will be used to identify clinical outcomes and direct future larger scale investigations into the implementation of the novel residential care pharmacist model to optimise quality use of medicines in a population at high risk of medication misadventure.

Background Hospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established. Method To investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient’s Diagnosis Related Group from hospital discharge data. Results For adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p

The aim of this study was to investigate the implementation of a novel electronic bedside nursing chart in an acute hospital setting. The case study used multiple data sources captured within a real-life clinical ward context. Quantitative findings included significant reductions in nurse-reported missed care (P

Supplemental Digital Content is available in the text., Background. Physical examination of potential organ and tissue donors is standard practice to mitigate risks and optimize outcomes for transplant recipients, but the content and process of the examination has not been investigated. The aim of this study was to determine current practice of performing a physical examination on potential organ and tissue donors in Australia. Methods. An online cross-sectional survey was circulated to all Australian Donor Coordinators (n = 125). Results. There were 75 responses (60% response rate) to the online survey. Respondents perform a mean 10.5 physical examinations per year. Inconsistencies were observed in the approach to the physical examination, inclusive of assessment techniques used to perform the examination such as palpation. Specific staff training and education to perform the examination was reportedly provided to 77% of respondents. There was less variation reported in examination findings classified as higher risk and escalation procedures with the 3 most common findings of injection sites / track marks (86%), suspicious moles (77%), and unexplained scarring (51%), and with 97% seeking a second opinion. Current and previously removed melanomas were the main examination findings that stopped a donation from proceeding, as reported to have occurred by 18 respondents. Conclusions. This study has identified variations in current physical examination practice and provided the evidence to pursue practice improvement. The inconsistencies can be partly attributed to discrepancies in training and education of staff and no standardized national guidelines to clearly outline expected practice.