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This study explored the impact of an innovative approach to clinical supervision for mental health nurses which integrates Safewards, named Group Reflective integrated Practice with Safewards–GRiP-S. Qualitative data was collected through 10 individual semi-structured interviews with nursing staff who had participated within the clinical supervision approach. Interviews provided insights into the nursing staff’s perception and experience of the clinical supervision approach. Through interpretive phenomenological analysis six themes emerged (i) illuminating embodied practice of Safewards, (ii) building confidence through empowering connections, (iii) creating a culture of positive change, (iv) identifying internal motivation for and external barriers to supervision engagement, (v) navigating a global pandemic, and (vi) the transformative role of reflection. Findings demonstrated that the GRiP-S approach assisted mental health nurses’ adoption of Safewards interventions in practice, while supporting the development of a cohesive staff team. The impact of COVID-19 within the study setting was addressed and nurses identified how the Safewards model assisted in navigating challenges during this time. Findings further supported prior research on the role of the supervisor and supervisee relationship. This study supports the integration of Safewards within reflective clinical supervision for mental health nursing staff to assist in Safewards fidelity and nursing staff personal and professional development.

Primary care is crucial to the health of people with mental illness. However, there is limited information on their reported engagement in this setting. This study surveyed 100 people with mental illness who had a general practitioner or a general practitioner and a case manager from a tertiary mental health service to determine their engagement level with their GP and what interventions they received to manage their health. Forty-four per cent had their psychotropic medications primarily prescribed by their GP, and 58% reported visiting their GP for physical health problems. Ninety-four point nine percent of participants aged 50 years and over had not received government age-recommended preventive health checks. Only 62% of participants reported being screened by their GP for psychotropic side effects. Primary care plays a crucial role in providing physical and mental health care, but service users report gaps in service. The findings suggest a need to support primary care professionals further to coordinate care across primary and secondary care settings.

Re-engineer clinical teaching through innovative approaches such as virtual reality (VR) and Serious Gaming (SG) may increase patient safety. While several studies have focused on the experiences and perceptions of learners about VR and SG, few have if any have focused on the instructors. We reviewed and appraised published evidence to establish the experiences and intention to adopt VR and SG in clinical teaching. Relevant articles were sourced from five databases (PubMed/Medline, Informit, +A Education, ProQuest-ERIC, and CINHAL-EBSCO host). Experiences of clinical trainers were reported using the technological, pedagogical, and content knowledge (TPACK) model. The intention to adopt VR and SG was synthesized using the Technology Adoption Model (TAM). Clinical trainers had a positive attitude towards VR and SG. Those with longer professional experience were less likely to adopt VR and SG, while more experienced trainers were more likely to benefit from VR and SG. VR and SG are practical pedagogies for clinical instruction, but training is required for novice users. Cost-benefit analysis of VR and SG as clinical training approaches is needed.

Background: While nurse-sensitive outcomes (NSOs) are well established in numerous health settings, to date there is no indicator suite of NSOs for inpatient mental health settings. Aim: To assess the relationship between nursing variables and patient outcomes in acute inpatient mental health settings to determine which outcomes can be used as indicators of the quality of nursing care. Methods: Databases accessed were CINAHL, MEDLINE, PsycINFO and EMBASE, last searched in May 2022. The review followed the 2020 PRISMA checklist for systematic reviews. Papers published between 1995 and 2022, conducted in acute mental health care units were included. The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool. A meta-analysis was not possible because of the large number of variables and measurement inconsistencies. Results: A total of 57 studies were reviewed. Studies were categorised according to whether they found a significant or non-significant relationship between nurse variables and patient outcomes. Seven outcomes—aggression, seclusion, restraint, absconding, pro-re-nata medications, special observations and self-harm—were identified. For each outcome, there were significant findings for several nurse variables indicating that all included outcomes could be used as NSOs. However, evidence for aggression, seclusion and restraint use as suitable NSOs was more robust than the evidence for self-harm, absconding, pro-re-nata medications and special observations. Conclusion: All the seven outcomes can all be used to develop an NSO indicator suite in mental health inpatient settings. More work is needed to establish high-quality studies to clearly demonstrate the relationship between these outcome measures and changes in nurse variables such as nurse staffing, skill mix, work environment, nurse education and nurse experience. Patient and Public Contribution: Patient or public contribution was not possible because o

The Safewards model is used across various mental health settings to reduce incidents of conflict and containment and its efficacy in reducing the use of seclusion and restraint, improving patients' experiences of care, and enhancing safety within clinical settings is well documented (Bowers, Journal of Psychiatric & Mental Health Nursing, 21, 2014, 499). However, there are barriers to successful implementation, including level of staff buy-in (Baumgardt et al., Frontiers in Psychiatry, 10, 2019, 340; Price et al., Mental Health Practice, 19, 2016, 14). This mixed-method study assessed the impact of adopting a Safewards model within a clinical supervision framework in an approach, named Group Reflective integrated Practice with Safewards (GRiP-S), which integrates Safewards theory within the clinical supervision framework. Both quantitative and qualitative data were collected using the questions derived from the Manchester Clinical Supervision Scale −26© (Winstanley & White, The Wiley International Handbook of Clinical Supervision. John Wiley & Sons Ltd, 2014). A total of 67 surveys and eight interviews were completed by nursing staff. Overall, the results showed that the GRiP-S approach improves the implementation of Safewards and nurses' clinical practice. Nursing staff satisfaction with clinical supervision and Safewards improved post GRiP-S pre-GRIP-S- 69.54 (SD 16.059); post-GRIP-S 71.47 (SD 13.978). The survey also identified nursing staff's perception of GRiP-S in the restorative and formative domains of clinical supervision improved. The restorative mean score pre-GRiP-S was 28.43 (SD 5.988) and post-GRiP-S 29.29 (SD 3.951). The formative mean score pre-GRiP-S was 20.10 (SD 5.617) and post-GRiP-S 20.63 (SD 13.978). The qualitative results further explained the satisfaction levels and the changes seen in perception domains. The GRiP-S approach reported (i) improved therapeutic relationships and patient centred care, (ii) improved staff communication and teamw

Aim: To synthesise evidence related to risk factors of falls among younger mental health inpatients age ≤ 65 years old. Background: Hospitalised patients with mental illness are at increased risk of falling. Specific risk factors for falls for younger inpatients are poorly understood. Design: Systematic review. Methods: Medline, CINAHL, APA PsycINFO, Scopus and Web of Science were searched for studies published in English till December 2022. The review followed the 2020 PRISMA checklist. Odds ratios and P values of significant risk fall factors and the frequency of factors related to circumstances of falls were extracted. Results: Nine studies were included and 95 risk factors, across seven categories were extracted. These categories included socio-demographic, fall-related factors, functional status, health and mental status, psychiatric diagnosis and assessment, medication, and staff related factors. Factors related to medication, health and mental status are most reported. Majority of the patients sustained minor or no injury from the fall and circumstances of fall vary across studies. Conclusion: Factors strongly associated with risk of falls were dizziness, use of psychotropics and antihypertensive drugs. A meta-analysis of risk factors was not possible due to different dependent variables studied, controlled confounding variables and control groups used. Relevance to clinical practice: Fall prevention is relevant to all patients in mental health settings. Approaches to fall risk assessment and management need to be better tailored to younger mental health patients in the psychiatric setting. Patient and public contribution: Patient or public contribution was not possible because of the study design.

Unplanned hospital readmission rate is up to 43 % in mental health settings, which is higher than in general health settings. Unplanned readmissions delay the recovery of patients with mental illness and add financial burden on families and healthcare services. There have been efforts to reduce readmissions with a particular interest in identifying patients at higher readmission risk after index admission; however, the results have been inconsistent. This systematic review synthesized risk factors associated with 30-day unplanned hospital readmissions for patients with mental illness. Eleven electronic databases were searched from 2010 to 30 September 2021 using key terms of 'mental illness', 'readmission' and 'risk factors'. Sixteen studies met the selection criteria for this review. Data were synthesized using content analysis and presented in narrative and tabular form because the extracted risk factors could not be pooled statistically due to methodological heterogeneity of the included studies. Consistently cited readmission predictors were patients with lower educational background, unemployment, previous mental illness hospital admission and more than 7 days of the index hospitalization. Results revealed the complexity of identifying unplanned hospital readmission predictors for people with mental illness. Policymakers need to specify the expected standards that written discharge summary must reach general practitioners concurrently at discharge. Hospital clinicians should ensure that discharge summary summaries are distributed to general practitioners for effective ongoing patient care and management. Having an advanced mental health nurse for patients during their transition period needs to be explored to understand how this role could ensure referrals to the general practitioner are eventuated.

Objective The objective of the study was to comprehensively synthesise the components of integrated clinical pathways (ICPs) and post-operative outcomes of patients undergone total hip and knee arthroplasty (THA & TKA) and hip fracture surgeries. Background Previous systematic reviews examined components and effectiveness of ICPs for lower limb joint replacement and hip fracture surgeries. Design and Methods An updated systematic review guided by the Whittemore and Knafl (2005) framework. Electronic databases, Ovid MEDLINE, EBSCOhost-CINAHL, the Cochrane Reviews and Trails, EMBASE and PubMed, were searched from 2007 to 31 January 2021. Due to the heterogeneity of the methods and data collection tools of included studies, pooling of the quantitative data was not possible. Therefore, the included studies were synthesised and presented narratively under subthemes of arthroplasty and hip fracture surgeries. The PRISMA checklist for systematic reviews was used. Results Twenty-four studies met selection criteria with 11 examined ICPs for hip fracture and 13 for the THA and TKA. Twenty-one ICPs were reviewed, and 33 components were extracted. The most frequently included components for hip fracture subgroup were ‘discharge disposition arrangement’ and ‘dedicated personnel and resources’. ‘Exercise plan’ and ‘pain management’ were for the arthroplasty subgroup. A significant reduction in the length of stay and post-operative complications were associated with the ICPs. Results were mixed for the effectiveness of ICPs in reducing unplanned hospital admissions, mortality rates, post-operative complications and hospital costs. Conclusion The number of ICP components varied across studies. This review could not recommend a one size-fits-all ICP that could be adapted for use for patients undergoing hip fracture and joint replacement surgeries. Relevance for clinical practice This review identified research evidence-based components considered as essential for the inclusion in IC

Objective The objective of the study was to comprehensively synthesise the components of integrated clinical pathways (ICPs) and post-operative outcomes of patients undergone total hip and knee arthroplasty (THA & TKA) and hip fracture surgeries. Background Previous systematic reviews examined components and effectiveness of ICPs for lower limb joint replacement and hip fracture surgeries. Design and Methods An updated systematic review guided by the Whittemore and Knafl (2005) framework. Electronic databases, Ovid MEDLINE, EBSCOhost-CINAHL, the Cochrane Reviews and Trails, EMBASE and PubMed, were searched from 2007 to 31 January 2021. Due to the heterogeneity of the methods and data collection tools of included studies, pooling of the quantitative data was not possible. Therefore, the included studies were synthesised and presented narratively under subthemes of arthroplasty and hip fracture surgeries. The PRISMA checklist for systematic reviews was used. Results Twenty-four studies met selection criteria with 11 examined ICPs for hip fracture and 13 for the THA and TKA. Twenty-one ICPs were reviewed, and 33 components were extracted. The most frequently included components for hip fracture subgroup were ‘discharge disposition arrangement’ and ‘dedicated personnel and resources’. ‘Exercise plan’ and ‘pain management’ were for the arthroplasty subgroup. A significant reduction in the length of stay and post-operative complications were associated with the ICPs. Results were mixed for the effectiveness of ICPs in reducing unplanned hospital admissions, mortality rates, post-operative complications and hospital costs. Conclusion The number of ICP components varied across studies. This review could not recommend a one size-fits-all ICP that could be adapted for use for patients undergoing hip fracture and joint replacement surgeries. Relevance for clinical practice This review identified research evidence-based components considered as essential for the inclusion in IC

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.

Self-harm is a significant health issue, a leading cause of serious injury and is an indicator of psychological distress. Nurses play an important role in providing therapeutic care to people who self-harm. The aim of this study was to explore mental health nurses’ (MHNs) experience of working with people who self-harm. Data were collected using semi-structured interviews and transcribed verbatim from 14 MHNs across Australia. Elo and Kyngäs’ inductive content analysis was used to extract meaning from the data which is reported in accordance with the consolidated criteria for qualitative research guidelines (COREQ). Two categories were identified which captured the MHNs’ experiences of working with people who self-harm: (i) Nurses’ level of preparedness to work with people who self-harm; and (ii) The healthcare system. Several sub-categories were identified. Attitudes, knowledge, skills, and support from others influenced their experience of working with people who self-harm. Clinical and life experience, undergraduate programme preparation and ongoing education all contributed towards developing therapeutic care with this group of patients. Nurses are vital in the care of people who self-harm and an accurate understanding of the functions of self-harm focuses therapeutic interactions to manage psychological distress and reduce further self-harm and lessen the risk of suicide.

Background Cervical cancer is the second most common female reproductive cancer after breast cancer with 84% of the cases in developing countries. A high uptake of human papilloma virus (HPV) vaccination and screening, and early diagnosis leads to a reduction of incidence and mortality rates. Yet uptake of screening is low in Sub-Saharan Africa and there is an increasing number of women presenting for treatment with advanced disease. Nine women in their twenties die from cervical cancer in Kenya every day. This paper presents the biopsychosocial risk factors that impact on cervical cancer knowledge among Kenyan women aged 15 to 24 years. The findings will highlight opportunities for early interventions to prevent the worrying prediction of an exponential increase by 50% of cervical cancer incidences in the younger age group by 2034. Methods Data from the 2014 Kenya Demographic and Health Survey (KDHS) was analysed using complex sample logistic regression to assess biopsychosocial risk factors of knowledge of cervical cancer among young women aged 15 to 24 years (n = 5398). Findings Close to one third of the participants were unaware of cervical cancer with no difference between participants aged 15–19 years (n = 2716) and those aged 20–24 years (n = 2691) (OR = 1; CI = 0.69–1.45). Social predisposing factors, such as lack of education; poverty; living further from a health facility; or never having taken a human immunodeficiency virus (HIV) test, were significantly associated with lack of awareness of cervical cancer (p < 0.001). Young women who did not know where to obtain condoms had an OR of 2.12 (CI 1.72–2.61) for being unaware of cervical cancer. Psychological risk factors, such as low self-efficacy about seeking medical help, and an inability to refuse unsafe sex with husband or partner, perpetuated the low level of awareness about cervical cancer (p < 0.001). Conclusions A considerable proportion of young women in Kenya are unaware of cervical cancer which is

Background Individuals who self-harm may present to emergency departments (EDs) for medical care. As first responders, emergency nurses can have a significant impact on the health outcomes of people who self-harm. This research explored emergency nurses' experiences of working with patients who self-harm. Methods Data were collected using semi-structured interviews and analysed using Elo and Kyngäs' inductive content analysis. Researcher checks ensured consensus of identified categories. Adherence to the research method and inclusion of participant citations added to the trustworthiness of findings. Results Eighteen emergency nurses from across Australia participated in the research. The category "Nurses' level of preparedness to work with people who self-harm" emerged during data analysis with four sub-categories: (1) Nurses' level of comfort to work with people who self-harm; (2) Nursing role; (3) Barriers and facilitators to providing quality care; and (4) Education and training. Conclusions The ED is a challenging environment to provide care to people who present with self-harm. Nurses' level of comfort and attitudes towards caring for people who self-harm improved with knowledge, support and experience. Education and training in the area were important.

Self‐harm is a significant health issue, a leading cause of serious injury and is an indicator of psychological distress. Nurses play an important role in providing therapeutic care to people who self‐harm. The aim of this study was to explore mental health nurses’ (MHNs) experience of working with people who self‐harm. Data were collected using semi‐structured interviews and transcribed verbatim from 14 MHNs across Australia. Elo and Kyngäs’ inductive content analysis was used to extract meaning from the data which is reported in accordance with the consolidated criteria for qualitative research guidelines (COREQ). Two categories were identified which captured the MHNs’ experiences of working with people who self‐harm: (i) Nurses’ level of preparedness to work with people who self‐harm; and (ii) The healthcare system. Several sub‐categories were identified. Attitudes, knowledge, skills, and support from others influenced their experience of working with people who self‐harm. Clinical and life experience, undergraduate programme preparation and ongoing education all contributed towards developing therapeutic care with this group of patients. Nurses are vital in the care of people who self‐harm and an accurate understanding of the functions of self‐harm focuses therapeutic interactions to manage psychological distress and reduce further self‐harm and lessen the risk of suicide.

Non-suicidal self-injury (NSSI) is a major public health concern and is also associated with increased risk of suicide. The type of care people with NSSI receive at the hospital impacts their health outcomes. This study explored emergency department (ED) and mental health nurses’ (MHNs) understanding, attitudes, empathy and confidence to work with people presenting with NSSI. ED and MHNs who belonged to either the College of Emergency Nursing Australasia (CENA) or the Australian College of Mental Health Nurses (ACMHN) were invited to complete an online survey through a group email from their college. One hundred and one nurses (56 ED and 45 MHNs) completed the survey. The results revealed that nurses from both groups had an accurate understanding of NSSI and had positive attitudes about patients who self-injure. However, confidence was higher among MHNs. Greater knowledge of NSSI was correlated with increased confidence, positive attitudes and empathy. For mental health nurses, but not ED nurses, years of clinical practice was associated with nurses’ confidence. In contrast, ED nurses with more than 10 years’ experience were less confident in addressing NSSI than ED nurses with less experience. Issues that affect both ED and MHNs’ knowledge, attitude, empathy and confidence to care for patients who self-injure are multifactorial. Future education and training should focus on therapeutic interactions with people at risk of repeat NSSI. Further, more research is recommended to explore patients’ perspectives of nurses’ attitudes in care for people who self-injure.

Background: Referral of residents with urinary tract infections (UTIs) in residential aged care facilities (RACFs) to hospital are common. However, there is limited information on what influences Registered Nurses’ (RN) decision-making process. Aim: To investigate resident factors that influence RN’s decisions to escalate care. Design: A retrospective cohort approach audited electronic clinical records of residents with UTIs. Methods: Data were extracted from the electronic database and analyzed using descriptive and regression analysis. Approval was obtained from both the RACFs and University Human Research Ethics Committee. Results: There was a higher likelihood of being referred to hospital if residents were female, had had a past fall, had related comorbidity, or had abnormal vital signs. However, being older and having a urinary catheter were protective factors for referral by the RN. Conclusion: Referral of residents with UTIs by RNs to hospital is common in RACFs. Resident characteristics such as abnormal vital signs, past falls, and presence of comorbidity influence referrals by RNs. Nurse Practitioners dedicated to the RACFs could complement the role of a general practitioner. UTI-specific escalation protocols can assist RNs to make decisions about referrals. RNs’ related risk factors also need to be examined to understand other influencing factors.

Objective: Social distancing and hand washing with soap and water have been advocated as the main proactive measures against the spread of coronavirus. We sought to find out what other alternative materials and methods would be used among populations without running water and who may not afford alcohol-based sanitizers. Results: We reviewed studies that reported use of sand, soil, ash, soda ash, seawater, alkaline materials, and sunlight as possible alternatives to handwashing with soap and water. We identified the documented mechanism of actions of these alternative wash methods on both inanimate surfaces and at cellular levels. The consideration of use of these alternative locally available in situations of unavailability of soap and water and alcohol-based sanitizers is timely in the face of coronavirus pandemic. Further randomized studies need to be carried out to evaluate the effectiveness of these alternatives in management of SARS-Cov-2.