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BACKGROUND: Research studies suggest that hospital programmes for young people diagnosed with anorexia nervosa have high readmission rates and limited effectiveness. Nurses caring for these adolescents face a particular set of problems in seeking to establish therapeutic relationships. AIM: This paper reports a study with the original aim of providing rich data on the development of therapeutic relationships between adolescents diagnosed with anorexia and paediatric nurses. However, it was discovered that paediatric nurses were struggling to develop therapeutic alliances with these adolescents. The study was then modified to explore the difficulties and obstacles hindering the formation of therapeutic relationships in this context. METHOD: The study used naturalistic inquiry. The 10 participants were Registered Nurses from the acute wards of an Australian children's hospital with at least 2 years' experience of caring for adolescents with anorexia nervosa. The data were collected using semi-structured interviews that were recorded on audiotape and then thematically analysed both manually and with the aid of the NUD*IST computer package. FINDINGS: Participants described how they struggled to develop therapeutic relationships in this clinical environment. Three themes emerged: (1) 'Struggling for understanding' explores the difficulties nurses experienced in coming to terms with the complexities of a diagnosis of anorexia nervosa and its recovery processes. (2) 'Struggling for control' examines the power struggle between nurses and patients and the mutual distrust that often developed between them as a consequence of this struggle. (3) 'Struggling to develop therapeutic relationships' describes the difficulties some nurses had in establishing therapeutic alliances with these adolescents. CONCLUSION: Recommendations are made for improving the nursing component of hospital treatment programmes for adolescents with anorexia nervosa in the direction of more genuinely therapeutic relationships. [ABSTRACT FROM AUTHOR]

Background: Nurses play a critical role in supporting patients in self-managing their indwelling urinary catheters and preventing avoidable hospital presentations. This study aimed to explore the effectiveness of a co-designed educational approach developed to enhance nurses' ability to provide optimal care for patients with catheters., Aim: The primary aim of this study was to enhance nurses' knowledge and skills in urinary catheterisation, care, and management. The secondary aim was to transform their current catheter management practices to improve patient outcomes., Setting: Nurses (n = 127) from one New South Wales, Australia region participated in the study. These nurses provided healthcare across various community settings. Ethics approval was received from the Local Health District (HREC/2019/ETH12575) and the study was registered in ANZCTR (ACTRN12621000683831)., Methods: A mixed-methods approach was used, collecting data at baseline and after the intervention. Quantitative data were analysed using descriptive statistics, tests for normality, and bivariate analysis with the Wilcoxon Signed Ranks test to identify differences between variables. Qualitative data were analysed using a directed content analysis approach to categorise occurrences of specific phenomena., Results: The composite mean knowledge score increased from 65.03 to 84.30 following the intervention (p < 0.001). In addition, the magnitude of knowledge score improvement in seven out of eight questions following the intervention were: Financial support: 1.1 %; Bladder spasm/urine leakage: 3.3 %; Blockage: 3.5 %; Catheter-Associated Urinary Tract Infection (CAUTI): 4.4 %; Self-management: 6.1 %; Sexuality: 7.9 %; and Urinary catheterisation: 11.3 %. Qualitative findings confirmed that the eLearning module was effective in transforming participants' clinical practice, towards improving patient outcomes., Conclusions: The co-designed eLearning module effectively addressed the learning needs of nurses, enhancing their knowledge and skills in urinary catheter management. Incorporating a theoretical model and contextual approach in the intervention delivery increased relevance, personalisation, and engagement, facilitating the behaviour change required to transform current practices., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the authors., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Aim: This study aims to evaluate the effectiveness of an oral health educational intervention designed for undergraduate nursing students., Background: The role of oral health promotion and screening has been extended to non-dental health professionals, for example, nurses. To prepare the future workforce for these responsibilities, an educational intervention underpinned by Mezirow's Transformative Learning Theory was codesigned and implemented in an Australian undergraduate nursing program., Methods: A concurrent mixed methods design was used to evaluate the educational intervention Semi-structured interviews with second-year nursing students and faculty staff along with pre-post-test surveys (validated tool) were used to assess changes in attitude and confidence among nursing students regarding oral healthcare. Directed Content Analysis and univariate and bivariate analyses were used to analyse the data., Results: Nursing students experienced a positive change in attitude following the educational intervention, which was also observed by faculty staff. This was corroborated by statistically significant improvements in attitude (5.89 versus 6.22, p=0.002) with the main area of improvement being a positive recognition of the role that nurses have in oral health assessment (21% increase). Students demonstrated a positive shift in confidence, which was supported by the quantitative data which showed an increase in mean scores post intervention (4.73 versus 5.26, p<0.001). Marked improvement in confidence was observed around the recognition of periodontitis (24-25% increase) which was the key focus of the educational intervention., Conclusion: This is the first time an oral health educational intervention has been implemented and found to be effective in improving the attitude and confidence of nursing students when undertaking oral healthcare activities in Australia. Adopting a transformative approach to teaching oral health is recommended for undergraduate nursing education providers as this learning approach can positively influence practice and behaviour changes., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the authors., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Eating disorder treatment should be underpinned by a recovery-oriented approach, be therapeutic, personalised and trauma informed. Within such models of care, social support is an important factor to explore in terms of its influence in supporting hope for recovery, reducing stigma, and mitigating life stressors. Limited research has been conducted to understand the types of social support that are available to young people formally diagnosed with an eating disorder, their feasibility and acceptability and the positive outcomes. This integrative review sought to explore the positive outcomes of social support or social support programs for young people with eating disorders. An integrative review was conducted based on a search of five electronic databases from inception to 31 March 2023. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools and findings have been narratively synthesised and presented in accordance with the review's aims and questions. Seven studies (total 429 individuals, range 3-160) published between 2001 and 2023 were included in the final synthesis. Overall social support interventions showed promising preliminary evidence as a feasible and acceptable adjunct to treatment for young people with an eating disorder motivated to change, with some clinical improvements in psychopathology. Social support augmented existing relationships, providing a human element of open dialogue, friendship and a sense of hope for recovery. Despite the small number and heterogeneity of the studies, this review has highlighted some promising preliminary benefits. Future treatment for eating disorders should embrace adjunct modalities that enhance psychosocial recovery for young people with eating disorders., (© 2024 The Author(s). International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Aim: To develop and test the psychometric properties of a self-administered scale to assess the knowledge, skills, attitudes and behaviour of nurses to support the self-management of patients living with indwelling urinary catheters., Background: Nurses are pivotal in supporting patients with urinary catheter self-management to prevent potentially avoidable hospital presentations. However, no validated scale is available to assess nurses' attitudes and readiness for this task., Design: A quasi-experimental design was used to collect survey data both at baseline and after the completion of the intervention. A total of 128 participants were recruited from the Western Sydney region (New South Wales, Australia), who were working in community healthcare settings. Research Electronic Data Capture (REDCap™) database was used to manage the survey data collected for data analysis purposes. This study has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN126210 0 0683831) METHODS: Using a three-stage process of concept identification, item construction and pilot testing to develop the Catheter Assessment, Management and Performance (CAMP) scale, followed by factorial and discriminant validity and reliability testing. This 23-item CAMP scale is theoretically informed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model, recognised for its effectiveness in understanding and influencing behaviour change. The scale was distributed to nurses working in three community health care settings to assess their knowledge, attitude and behaviour regarding catheter management and performance., Results: Four factors were identified using scree plot, accounting for 63.36 % of total explained variance, which reflected the four dimensions of the COM-B model. Cronbach's alpha of the overall CAMP scale (0.93) and subscales (0.92, 0.87, 0.85 and 0.86) indicate good internal consistencies. The CAMP scale was able to detect changes in nurses' self-reported behaviour change following educational intervention (85.53 versus 95.98, p < 0.001)., Conclusion: The CAMP scale is valid and reliable scale, capable of assessing nurses' capability, opportunity and motivation to support patients, through delivery of catheter self-management education that can potentially prevent catheter-related complications and avoid hospital presentations. Future research could explore using CAMP scale among non-specialist nurses and in various clinical settings to enhance its effectiveness and generalisability., Competing Interests: Declaration of Competing Interest No conflict of interest has been declared by the authors., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Aim: To explore the experiences of significant others of adult patients with severe burn injury in the Intensive Care Unit. Specifically, this study explored the strategies implemented by significant others and obstacles faced that served to protect or placed them at risk of psychological sequelae during their experience of trauma., Design: A qualitative study using a Narrative Inquiry approach was undertaken., Methods: Individual semi-structured interviews were conducted with 17 participants during 2021-2022, who were a significant other of an adult patient in ICU with severe burn injury. These participants were recruited from the two major severe burns receiving hospitals in New South Wales, Australia. Participants' stories were analysed using a narrative analysis approach informed by Polkinghorne. The COREQ guideline was used in reporting., Results: As each participant navigated the traumatic experience of supporting a loved one with a severe burn injury, they faced unique obstacles to maintaining their own mental health and well-being. They employed strategies that were likely to protect them on this journey. Psychologically protective factors included taking back control, coexisting in the trauma with the patient and forging a trauma bond. These strategies effectively contained the trauma and protected others (such as children, extended family and friends). While this allowed significant others an element of control, it also effectively isolated them from the support of family and friends., Conclusion: This study shows that significant others may also experience personal trauma and may not recognize this as they focus all their attention on supporting the patient with the burn injury., Implications for Practice: With increased awareness of both protective and risk factors, support can be directed towards enhancing protective factors and addressing risk factors, thereby decreasing their impact and improving support for significant others., Patient or Public Contribution: No patient or public contribution., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aim: To develop and test the psychometric properties of an expanded catheter self-management scale for patients with in-dwelling urinary catheters., Design: A cross-sectional validation study. Despite the utility of the original 13-item catheter self-management scale, this instrument did not include bowel management, general hygiene and drainage bag care, which are fundamental skills in urinary catheter self-management to prevent common problems resulting in unnecessary hospital presentations. The expanded catheter self-management scale was developed with 10 additional items to comprehensively assess all five essential aspects of urinary catheter self-management., Methods: A total of 101 adult community-dwelling patients living with indwelling urinary catheters were recruited from Western Sydney, Australia. Using exploratory factor analysis with Varimax rotation, the number of factors to be extracted from the expanded 23-item expanded catheter self-management scale was determined using a scree plot. The reliability of the overall scale and subscales was measured using Cronbach's alpha. Convergent validity was assessed using Spearman's correlations between clinical characteristics, overall scale and subscales., Results: The 23-item expanded catheter self-management scale yielded a 5-factor solution, labelled as: (i) self-monitoring of catheter function, (ii) proactive, help-seeking behaviour function, (iii) bowel self-care function, (iv) hygiene-related catheter site function and (v) drainage bag care function. Cronbach's alpha of the expanded catheter self-management scale indicating all 23 items contributed to the overall alpha value. Convergent validity results showed a negative correlation between the overall expanded catheter self-management scale and catheter-related problems., Conclusion: The 5-factor structure provided a comprehensive assessment of key aspects of urinary catheter self-management essential to reduce the likelihood of catheter-related hospital presentations., Implications: The expanded catheter self-management scale can be used to assess and monitor effective patient-centred interventions for optimal self-management to prevent catheter-related problems and improve the quality of life of patients., Impact: Many patients start their journey of living with a urinary catheter unexpectedly and are not supported with quality information to care for their catheter. The findings of this study show the correlation between catheter self-management skills and catheter-related problems. The expanded catheter self-management scale (E-CSM) assists with analysing the self-management skills of patients living with a catheter and developing tailored interventions to prevent problems and improve their quality of life. In addition, this screening tool can be included in policies, guidelines, and care plans as a standard for improving catheter management and developing educational resources for patients., Reporting Method: STROBE checklist was used to report all aspects of this study comprehensively and accurately., Patient or Public Contribution: Patients living with indwelling urinary catheter and their carers have participated in surveys, interviews and co-designing interventions. This paper reports the psychometric analysis of the expanded catheter self-management scale (E-CSM) used in the patient survey as part of the main study 'Improving Quality of Life of Patients Living with Indwelling Urinary Catheters: IQ-IDC Study' (Alex et al. in Collegian, 29:405-413, 2021). We greatly value our consumers' contributions and continue to communicate the progress of the study to them. Their contributions will be acknowledged in all publications and presentations. In addition, all participants will be provided the option of receiving the interventions and publications generated from this study., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aims: To examine misconceptions towards men in nursing from the perspective of undergraduate nursing students. Specifically, this study sought to explore contributing factors of misconceptions and attributions of the success of men in nursing., Design: A convergent parallel mixed-method study., Methods: A national survey was conducted (July-September 2021). The quantitative data included demographics and responses to the Gender Misconceptions of Men in Nursing (GEMINI) scale. The qualitative data included responses to a provocative statement related to characteristics of men and their career in nursing. The GRAMMS guideline was used in reporting., Results: Undergraduate nursing students (n = 1245) from 16 Australian schools of nursing responded to the survey. Quantitative analysis demonstrated that most students (96%) did not have misconceptions about men in nursing. Those who did were more likely to be men, born overseas, not in health-related employment and did not have nursing as their first choice. Four broad overarching main themes were generated in response to the statement that suggested men do not have the right attributes for nursing: (1) 'This is a very misandristic viewpoint'; (2) 'Compassion and intelligence are distributed in men and women equally'; (3) 'Men bring a different quality to nursing' (4) 'Anyone can be whatever they want to be'., Conclusion: Overall, nursing students did not have misconceptions about men in nursing, despite experiencing ongoing social stigma regarding archaic gender norms. The findings from this study indicate that the next-generation nurses were championing to challenge the gender stereotype and support the needs of a gender diverse society., Impact: Attitudes and misconceptions that elicit gender inequalities must be addressed with comprehensive strategies and de-gendered language and imagery within the profession, schools, workplaces and the media. Shifting culture and attitudes towards inclusion, values the diversity in the workforce and supports healthy workplace environments., Patient or Public Contribution: No patient or public contribution., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aim: To explore how nurses and nursing knowledge contributed to the success of an Australian nurse-led medical hotel quarantine facility during the COVID-19 pandemic. The facility was established to accommodate returning travellers who were COVID-19 positive or at risk of becoming positive, to travellers requiring complex care and expanded to community members who could not quarantine at home., Design: This descriptive qualitative study explored how nurses and nursing knowledge in the quarantine facility contributed to the low transmission incidence of COVID-19 infection., Method: Twelve semi-structured interviews were conducted via ZOOM from February to May 2022 with all levels of nursing staff (nurse managers to assistants in nursing) who had worked in the facility for 3 months or more. The nurses were asked to describe their experiences, the challenges they faced and how they overcame them. The data were rich and were analysed using Braun and Clarke's six-step thematic analysis., Results: Four broad themes were generated demonstrating how nurses played a pivotal role in the success of the facility. First: nursing knowledge was evident through the development of policies, which minimized risks to nurses and patients. Second: a community of learning was developed as nurses supported upskilling and capacity building of staff, particularly new graduates with the facility. Third: a supportive management structure promoted teamwork and a positive workplace culture. And finally: the nurses were encouraged to develop techniques that promoted self-care which enabled them to develop resilience., Conclusion: This was a nurse-led service that developed strategies to manage care delivery and overcame unanticipated difficulties in a unique clinical setting., Reporting Method: The quality of the research design was ensured by using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist., Patient or Public Contribution: No patient or public contribution., (© 2023 John Wiley & Sons Ltd.)

Background: Depression in older people living in residential aged care is a serious and highly prevalent health issue, with loneliness and social isolation being major contributors. The COVID-19 pandemic underscored the harm visiting restrictions have on the mental wellbeing of older people in residential aged care. However, there is a need to systematically review the relationship between family visits and depression in this population., Objective: This literature review seeks to explore the association between family visits and depression among those living in residential aged care., Methods: An integrative review was conducted in March 2022, based on a search of seven databases from inception to 2022. Papers were included if the studies were situated in a residential aged care facility and explored the impact of in-person family visits on depression of residents. Those that examined impact of family visits on community-dwelling older people and papers examining virtual family visits were excluded. The quality of the included papers was assessed using appropriate critical appraisal tools. Guided by the aim of this study, the included papers were narratively synthesised and presented thematically (PROSPERO ID CRD42022325895)., Results: Ten papers, published between 1991 and 2022, were included in the final synthesis. Multiple categorisations of frequency of visits and different scales were used to assess depression. Depression among residents in aged care facilities varied from 20 % to 58.7 % with 40 % of studies showing a positive association between the frequency of family visits and lower rate of depression. Three themes influencing the association between family visits and depression in residential aged care were identified. These were: (i) intersection of culture, filial values, and depression; (ii) resident-related factors including whether admission was voluntary and presence of functional impairment; and (iii) non-resident-related factors such as social activities for residents and staff involvement., Conclusion: Family visits ameliorated loneliness and depression among residents in aged care however, other factors such as culture, comorbidities and functional impairment, opportunities for socialisation and the social involvement of facility staff also influenced depression. Whilst the low number of studies reviewed limited comparison and generalisation of results, the review highlighted the broader and crucial role of healthcare staff in facilitating socialisation and promoting mental wellbeing of residents especially those who are not visited by families., Tweetable Abstract: Family visits ameliorate depression in institutionalised older people but may not be the "silver bullet" as depression is multifactorial., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Due in part to medical complications, adults with a pediatric onset spinal cord injury (SCI) are at higher risk of experiencing dissatisfaction with life and lower perceived physical health when compared to their peers with no disability. To support the prevention of medical complications, young people with SCI must successfully transition to adult health care. Health care transition (HCT) interventions can support young people with chronic conditions in their move to adult health care., Objectives: To evaluate the feasibility and acceptability of a web-based HCT intervention codesigned with young people with SCI and parents/caregivers., Methods: Semi-structured individual interviews were conducted online with young people with SCI and parents/caregivers who transitioned or were preparing for the transition from pediatric to adult health care. Interviews were also conducted with health care professionals. The interviews were analyzed using a hybrid deductive and inductive qualitative content analysis process. Feasibility and acceptability were measured using Bowen and colleagues' framework, which includes eight focus areas: acceptability, demand, implementation, practicality, adaption, integration, expansion, and limited efficacy., Results: Overall, participants responded positively to the intervention and believed that it would be useful to young people with SCI and parents/caregivers. Two areas of Bowen et al.'s framework, implementation and integration, require further consideration in terms of how to embed the intervention into the current transition process., Conclusion: This study found the HCT intervention to be an innovative approach to support young people with SCI and their parent/caregivers that demonstrates promise in the areas of feasibility and acceptability., Competing Interests: Conflicts of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 American Spinal Injury Association.)

To build a nursing workforce that is equipped to undertake oral health promotion and screening, an educational program was needed. With codesign being used in multiple settings, it was selected as the approach to use, with Mezirow's Transformative Learning theory as the underpinning framework. This study aimed to develop an oral healthcare educational intervention for nursing students. Using a six-step codesign framework, nursing students and faculty staff were invited to participate in two Zoom™ Video Communication workshops to codesign the learning activities to be used in the classroom. The codesign process was evaluated through focus groups and analysed using a hybrid content analysis approach. A multifaceted oral healthcare educational intervention was developed. Learning material was delivered using a range of different learning and teaching resources such as dental models, podcasts, and an oral health assessment across two subjects. Multiple approaches to recruitment, the inclusion of participants, and good facilitation of workshop discussions were critical to the codesign of the educational intervention. Evaluation revealed that preparing participants prior to the workshops acted as a catalyst for conversations, which facilitated the codesign process. Codesign was a useful approach to employ in the development of an oral healthcare intervention to address an area of need.

Background: The global COVID-19 pandemic has affected data collection for many researchers, in particular research that involves face-to-face interviews., Aim: To share learning about the challenges encountered when face-to-face interviews could not continue as planned in a study and how to adapt data collection so that it can continue despite severe disruption., Discussion: This article examines the considerations and actions taken by the authors to ensure the continuity of data collection. The research aimed to use narrative inquiry to understand the experiences of significant others supporting people in intensive care units with severe burn injuries. But the pandemic meant the researchers could not meet face-to-face with participants as originally intended and so they had to consider new ways to approach data collection. The authors explore the process of adapting the interviews to video conferencing and telephone use while preserving the study's person-centred focus to remain coherent with narrative methodology., Conclusion: Adapting data collection is valuable in ensuring the continuity of research. Careful consideration and planning are required to ensure the research remains robust and ethically sound., Implications for Practice: Adapting data collection methods can allow for greater flexibility when participants cannot attend face-to-face interviews., Competing Interests: None declared, (©2023 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Purpose: To determine the scope of published literature on healthcare transition (HCT) interventions that have been co-designed with adolescents and young adults with chronic conditions, and to undertake feasibility assessments., Methods: Using Scopus, CINAHL, Medline-Ovid, Cochrane and PsycINFO databases, publications that included a HCT intervention to support paediatric to adult healthcare transition were included. Study location, design, population, description of the intervention, co-design methods, feasibility evidenced using Bowen and colleagues' framework, and outcome measures were extracted for review., Results: A total of 21 studies were included, relating to 17 co-designed HCT interventions that ranged across multiple medical specialties. There was no standard HCT intervention; characteristics, format and delivery mode varied. Only three studies reported a detailed description of the co-design method(s) used and none reported on the facilitators or barriers. Among the studies, five of Bowen and colleagues' eight dimensions of feasibility were measured., Conclusions: Despite the co-design process being neither described or evaluated extensively, all co-designed HCT interventions included in this review were considered to be feasible. Nevertheless, HCT interventions varied in their format and delivery method making it difficult to compare between them. Furthermore, interventions were often condition-specific and not representative of the extensive range of chronic conditions.Implications for RehabilitationHealthcare transition interventions can improve adherence to care, health outcomes, ongoing rehabilitation, and quality of life of adolescents and young adults with chronic conditions.Healthcare transition interventions should maximise long-term functioning and prioritise rehabilitation aimed at enhancing independence and self-management skills, while reducing hospitalisations.The engagement of individuals with lived experience in the co-design of interventions has been strongly advocated as it brings unique knowledge and experience to the research process.Minimal attention has been given to the involvement of adolescents and young adults with chronic conditions in the development of healthcare transition interventions, however, healthcare transition interventions co-designed with adolescents and young adults with chronic conditions are both feasible and acceptable.

Objective: Nurses working in adolescent health often lack educational opportunities to develop their knowledge and practical skills to address the challenges faced by adolescents and young adults. This integrative review synthesised the evidence from peer-reviewed research that focused on educational programs to improve nurses' knowledge, attitude, and practice in adolescent and young adult health., Design: The five-stage framework by Whittemore and Knafl guided the integrative literature review and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement., Data Sources: A single search strategy was replicated across five electronic databases (CINAHL Plus, APA PsycInfo, PubMed, Scopus, and ERIC). Studies of educational interventions or training programs for nurses on adolescent and young adult health, published in English in the last 10 years were included., Review Methods: All studies found were reviewed for relevance independently by two authors, who likewise critically appraised the quality using the "Critical appraisal checklist for an article on an educational intervention" adapted from Morrison et al. (1999), with a third author providing consensus. Data were extracted using study specific standardised proforma and thematically analysed., Results: Seven studies met the inclusion criteria. Topics covered included cancer care, mental health and self-harm, with only one program including general adolescent health. A mix of face-to-face and digital asynchronous mode of delivery was employed in these programs with multi-strategic approaches used to enhance accessibility and engagement. While all studies reported improvement in knowledge and practice, including enhanced communication skills, some studies reported limited change in attitude. Success of the interventions was attributed to the flexibility of programs to accommodate nurses' workloads., Conclusion: Education interventions for nurses delivering care to adolescent and young adults enhance knowledge and skills, however, programs with institutional support for flexibility and accessibility are needed to influence a positive change in attitude., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

During a pandemic, dentists face enormous challenges due to restrictions placed on their practice and the need to comply with biosafety measures. This study aimed to explore the impact of the COVID-19 pandemic and infection control measures on dentists and their practice in Jordan and the global implications for other primary healthcare workers. A qualitative exploratory study employing face-to-face or telephone interviews, was conducted with ten dentists from the 9 th May to 20 th September 2020. An inductive thematic approach to analysis was used identifying three themes, each with two accompanying subthemes: (1) Response to COVID-19 pandemic: (1a) Government response and (1b) People's response; (2) The effects of the pandemic and response measures: (2a) Impact on work and practice and (2b) Impact on personal and social life; (3) The unanticipated gains: (3a) Altruism and (3b) Leadership and change. Stringent infection control measures were implemented to slow the spread of the virus, however limited government support made implementation unsustainable and caused financial hardship. Lack of clear guidelines, changes in practice, social distancing measures, and altered social interactions, adversely impacted daily life, triggering mental distress. Misinformation influenced response to COVID safety measures. Despite the negatives, working during the pandemic reaffirmed dental professionals' roles and purpose, with strong leadership boosting morale. Education, adequate biosafety resources and clear guidelines or policies to support and sustain stringent infection control procedures are crucial in ensuring that measures are implemented to meet the safety requirements of the pandemic response. Promoting the well-being of the healthcare workforce is equally important. Finally, altruism and strong leadership among healthcare workers can contribute to a meaningful and humane pandemic response., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Al-Amer, Ramjan, Maneze, Al-Rashdan, Villarosa, Salamonson and George.)

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 ' Ge nder Mi sconceptions of me N in nurs I ng (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. The 17-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 of 0.892). 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.

Background: Successful transition from pediatric to adult health care settings supports long-term health management and better overall outcomes in all domains. However, young people with spinal cord injuries (SCIs) continue to report challenges and unmet needs during the transition process. Including end users in health care research and intervention design is paramount as interventions designed in this way better meet their specific needs and are often more innovative. Although studies have reported involving young people with chronic conditions in the development of health care transition (HCT) interventions, few details have been provided as to how this was achieved., Objective: This study outlined the co-design and development of an HCT intervention to support young people with SCIs. It contextualized the co-design process, methods, materials used, and steps implemented from defining the problem to conceiving and designing the solution. This was accomplished by understanding and listening to end users' needs and recommendations for HCT., Methods: Using participatory methods, this qualitative study reports the co-design of an HCT intervention to support young people with SCIs and parents or caregivers. Two co-design workshops were conducted: one with young people with SCIs and one with parents and caregivers. Categories were defined through a hybrid deductive and inductive qualitative content analysis process that was informed by the Care Transitions Framework and guided the development of the HCT intervention. Following the creation of a prototype intervention, young people with SCIs, parents and caregivers, and key pediatric SCI stakeholders provided feedback on the intervention content and design in focus groups. Similar to the workshops, the focus groups were analyzed using a hybrid deductive and inductive qualitative content analysis process informed by the Care Transitions Framework. The Enhancing the Quality and Transparency of Health Research guidelines for qualitative research (Consolidated Criteria for Reporting Qualitative Research) were applied., Results: Overall, 4 young people and 4 parents or caregivers participated in the co-design workshops. Key recommendations for the HCT intervention were that participants wanted a "one-stop shop" for all their transition information needs and an editable portable medical summary to take with them to appointments. On the basis of the analysis of participants' recommendations from the workshops, it was determined that a website would be an appropriate hosting platform for the interventions. The focus group feedback on the design and content of the prototype website was extremely positive, with minor recommendations for improvement., Conclusions: This is the first study to co-design and develop an HCT intervention in partnership with young people with SCIs and parents and caregivers. Although the study sample was small, it has shown that it is possible to meaningfully engage and empower young people with SCIs and parents and caregivers in the co-design of an HCT intervention., International Registered Report Identifier (irrid): RR2-10.1136/bmjopen-2021-053212., (©Emily Alice Bray, Bronwyn Everett, Ajesh George, Yenna Salamonson, Lucie M Ramjan. Originally published in JMIR Formative Research (https://formative.jmir.org), 28.07.2022.)

Statement of Problem: In the evaluation of interdisciplinary interventions for childhood overweight and obesity, behavioural determinants can provide valuable insight into the reasons behind lack of adherence, or ineffectiveness of the intervention. Therefore, it is vital to assess the behavioural determinants of staff when evaluating the implementation of such interdisciplinary interventions. This study aimed to develop and psychometrically evaluate the intention to engage in Children's Healthy Weight guideline (iCHeW) scale, which assesses the behavioural determinants influencing dental staff's intention to conduct children's growth assessments., Methods: Initial items were generated based on review of the literature and the dimensions of the integrative model of behavioural prediction (IM). To test this scale, a cross-sectional survey design was undertaken consisting of three phases: (i) face validity; (ii) content validity; and (iii) psychometric evaluation of the iCHeW scale with a national sample of 125 dental staff., Results: The 35 items generated for the iCHeW scale were revised following feedback from a reference group. These 35 items were then appraised by an expert panel, yielding 27 items for psychometric testing. Using exploratory factor analysis, a five-factor solution was extracted, which corresponded to the IM domains, with the deletion of two items. Overall, Cronbach's alpha of the iCHeW scale was 0.95, with the following values for each subscale: (i) attitudes, 0.93; (ii) behavioural constraints, 0.83; (iii) perceived norms, 0.93; (iv) self-efficacy, 0.94; and (v) behavioural intention, 0.95., Conclusions: The iCHeW scale is valid and reliable for assessing dental staff's intention to provide routine growth assessments to children and demonstrates potential for use with non-dental staff., (Copyright © 2022 Asia Oceania Association for the Study of Obesity. All rights reserved.)

Background: Considering the interdisciplinary role dental staff can play in addressing overweight and obesity in childhood, this study aimed to codesign guideline implementation strategies for children's growth assessment and dietary advice guidelines in the dental setting., Methods: This qualitative study utilised principles of codesign and appreciative inquiry through a series of four, two-hour focus groups with dental staff and parents. Focus groups were analysed using content analysis., Results: Discussion fell into two main themes, engaging patients throughout their care journey and supporting staff to engage with the guidelines. Six strategies were developed within these themes: (1) providing growth assessment information to patients and families before appointments, (2) providing refresher training to staff, (3) involving dental assistants in the growth assessment, (4) keeping dental staff updated regarding referral outcomes, (5) culturally appropriate information resources for patients and families, and (6) enabling longitudinal growth tracking in patient information systems., Conclusions: This study successfully designed six implementation strategies for children's growth assessment guidelines in the dental setting. Further research is required to determine their impact on guideline adherence., (© 2022. The Author(s).)

Objectives: To identify subject matter, pedagogical approaches and assess outcomes of interventions implemented to educate nurses in urinary catheterisation care and management., Design: A systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement., Data Sources: Databases (CINAHL; MEDLINE; ProQuest; ERIC; Scopus; Cochrane; and APA PsycINFO) were searched using key concepts: education interventions, indwelling urinary catheter and nurses, from inception to July 2021., Review Methods: Two researchers searched the databases, whereupon data were extracted using a standardised proforma and were analysed applying an abductive approach. The Joanna Briggs Institute Critical Appraisal tool was used to assess the quality of the included studies. Findings were analysed and reported using narrative synthesis., Results: Out of 1159 studies screened, nine educational intervention studies related to upskilling nurses in catheter management were identified. Subject matter addressed included pathophysiology of the urinary system, clinical indications and management of indwelling catheter and associated complications. Although the subject matter and pedagogical approaches varied, all identified studies reported positive effects in improving participants' knowledge., Conclusions: Upskilling nurses and increasing their confidence to deliver patient-centred catheter care practices is an important intervention to improve outcomes for patients with long-term indwelling urinary catheters. However, actively engaging nurses who provide direct patient care is essential, in planning and implementing targeted educational interventions specific to learning needs. This review has identified a gap in the educational interventions for nurses, in better supporting the psychosocial needs of patients living with indwelling catheter. Codesigning educational interventions with nurses that are tailored to their contextual learning needs is likely to enhance behaviour change and improve current practice., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Severe burn injury is a traumatic experience for both patients and their significant others. Although research has focused on the experience of people with burn injury, there is a paucity of research focusing on the experiences of the significant other. Significant others are frequently expected to advocate and make decisions on behalf of the patient, which may have an impact on their psychological wellbeing. An understanding of the experiences of significant others will inform strategies to better support their needs., Objectives: The aim of this integrative literature review was to critically examine research related to the experiences of significant others supporting a patient with a severe burn injury in the hospital., Methods: CINAHL Plus with Full Text (EBSCO), MEDLINE ALL (Ovid), Scopus, and APA PsycINFO were searched up to December 2019 for English language studies using search terms burns, significant other, ICU, and psychological impact. Records were independently screened and assessed for methodological quality, and the data were synthesised., Results: Nine articles were included in the review. Three used a quantitative approach, and six were qualitative studies. Three major themes were identified, namely, (i) psychological consequences and emotional trauma, (ii) redefining relationships, and (iii) coping strategies., Conclusion: The review identified that significant others experience adverse psychological consequences including post-traumatic stress, anxiety, and depression. The burn injury resulted in a redefining of relationships with others and particularly with the patient through this shared experience. Significant others found ways to adapt to stressors, including taking control of the situation and seeking greater involvement in the patient's care., (Copyright © 2021 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Smartphones are ubiquitous, and for some, an indispensable companion. In nursing education curricula and clinical healthcare settings, smartphones have the potential to augment student learning. Nursing students report significant benefits to smartphone use, which extend beyond learning, to include enhanced communication, clinical decision making and evidence-based practice. Despite these benefits, little is known about the negative impact of smartphones on student learning., Objectives: This integrative review aimed to synthesise findings from published research that referred to the detrimental direct or indirect effect of smartphone usage on nursing students., Design: The integrative review was guided by the five-stage approach as conceptualised by Whittemore and Knafl (2005)., Methods: Seven electronic databases were systematically searched in consultation with a university librarian (CINAHL Plus, Ovid Medline ALL, Nursing and Allied Health Database, PsycINFO, PubMed, Scopus and ERIC) using a combination of key search terms and medical subject headings. A total of 646 articles were retrieved, and following removal of duplicates, screening of titles and abstracts, a final 27 articles met the inclusion criteria for this review., Results: Studies in the review originated from Korea (n = 7), Turkey (n = 6), India (n = 4), Spain (n = 3), USA (n = 2), Spain/Portugal (n = 1), Iran (n = 1), France (n = 1), Canada (n = 1) and Egypt (n = 1). Personal smartphone use was reported to be a distraction within clinical and classroom learning, and considered as uncivil, and compromised professionalism. Frequently, smartphones were used for entertainment (e.g. social networking) rather than professional purposes. The studies identified a concerning level of nomophobia and smartphone addiction among nursing students that caused stress and anxiety, and adversely affected sleep, learning and academic performance. Recommendations were proposed for smartphone policies., Conclusions: Excessive smartphones use among nursing students may adversely affect physical and mental health and potentially impact on student learning within the classroom and clinical environment. Educators should consider the implementation of policies or guidance for the responsible use of smartphones by nursing students whilst in the classroom setting and during clinical placement, to mitigate the potential negative impact on health and academic performance., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: With the increasing use of technology in nursing, the importance of interpersonal skills can often be forgotten. Patient safety can also be compromised if these skills are not emphasised in nursing education., Objectives: This review explores how drama in undergraduate and postgraduate nursing education can enhance the development of interpersonal skills such as empathy, emotional intelligence and communication., Design: A critical review of qualitative literature., Data Sources: Seven databases (CINAHL, MEDLINE, Scopus, Eric, Psycinfo, and databases dedicated to the Arts, Modern Language Association (MLA) and JSTOR were searched., Review Methods: Studies were screened against inclusion and exclusion criteria. Data from studies selected for the review were extracted using a summary table and a thematic analysis was conducted to identify major themes to answer the research question., Results: 1275 studies were identified. Following a rigorous screening process, 29 studies met the inclusion criteria and were critically appraised using the CASP tool. Of the 29 studies, 17 were excluded due to their methodological quality. A final 12 studies were included in this review. Four themes demonstrated the value of drama in nursing education. These were an understanding of the patient experience, the development of professional identity, the enhancement of communication skills and increased self-reflection and critical thinking., Conclusions: Interpersonal skills are at the core of nursing and educational interventions that use drama can enhance the development of these skills., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Little is known regarding the transfer of bioscience knowledge gained during undergraduate nursing studies into clinical practice., Objective: To explore the experiences of new registered nurses in applying bioscience concepts in their day-to-day nursing practice., Design: Descriptive qualitative design., Participants: Fifteen recently graduated registered nurses (RNs) who were working in acute care settings participated in the study., Methods: Semi-structured, face-to-face individual interviews were conducted. Interview data were audio-recorded and thematically analysed., Results: Four themes were identified from the qualitative interviews. The first and second themes demonstrated nurses' realisation of the relevance of theoretical bioscience knowledge learnt within the classroom to their practice and how this evidence-based knowledge translated into confidence in decisions made. The third and fourth themes revealed the impact bioscience knowledge had on RNs' relationships with patients and family members, which was viewed as providing compassionate care., Conclusions: The application of knowledge in biosciences gained during their undergraduate years, provided the basis for RNs to trust in their own clinical judgment and to speak with conviction. 'Connecting the dots' between bioscience knowledge and clinical practice provided the platform for RNs to gain and build trust with their patients. The practical utility of bioscience knowledge in everyday practice allowed RNs to contextualise their nursing care regimen and tailor holistic nursing care delivery to individual patient needs., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Globalisation has increased the number of students from culturally and linguistically diverse backgrounds enrolling in nursing programs where English is the primary medium of instruction. These students may experience challenges with English language usage and need to be identified early to ensure academic success., Objective: To develop and test the psychometric properties of a self-report English language usage scale (ELUS-11)., Methods: Prospective, correlational study of commencing nursing students enrolled in a communication unit at a university in the western Sydney region of Australia. English-language usage was measured using the ELUS-11, an 11-item self-report tool with a 5-point Likert scale response format. Factorial validity was examined using exploratory and confirmatory factor analysis and logistic regression was used to compute the predictive validity of the ELUS., Results: Of the 1723 students enrolled, 1100 (64%) returned surveys with all items of the ELUS-11 completed. The mean age of respondents was 25.4 years (SD: 8.0 years), 85% were female and 67% spoke a language other than English at home. Exploratory factor analysis yielded a one-factor structure that explained 65% of the variance, with factor loadings ranging from 0.72 to 0.86; and high internal consistency (α = 0.96). The ELUS-11 was able to discriminate among different groups of students based on age, domestic/international enrolment status and language spoken at home (all p < 0.001). Logistic regression revealed the ELUS-11 had good predictive validity, with those in the high ELUS-11 group over three times more likely to obtain a pass grade in their first written assessment (Adjusted odds ratio: 3.01, 95% CI: 2.05-4.43)., Conclusion: The ELUS-11 is a valid and reliable measure of English-language usage, and appropriate for use in an undergraduate nursing population to identify students at risk of poor academic performance., (Copyright © 2020. Published by Elsevier Ltd.)

Aims and Objectives: The objectives of this study were to examine a) if those with reported clinical performance issues were more likely to experience course progression issues or withdrew from the program; b) the relationship between clinical and academic performance; c) the relationship between students social-demographic characteristics and clinical performance issues; and d) the utility of Hofstede's cultural dimensions theory in explaining the clinical performance issues students may experience during clinical placement., Method: Retrospective textual reports of clinical issues from 2014 to 2018 were collected. A mixed methods design, particularly Embedded Design, was used. The qualitative data was analysed using Directed Content Analysis using Hofstede's six dimensions as the coding categories, which were further broken down into high and low poles, making a total of 12 subcategories. Univariate and multivariate logistic regression was utilised to analyse the quantitative data., Results: Using Hofstede's framework, it was determined that nursing students 21 years and younger were more likely to have issues related to low long-term orientation. Male students were more likely to have issues related to low uncertainty avoidance and also displayed masculinity related issues. Overseas-born students were less likely to experience issues related to low power distance and students that had not failed a unit of study were less likely to have issues related to low long-term orientation. The study also found that students experienced issues related to poor psychomotor skills and language barriers. Furthermore, the study identified that students who experienced clinical placement issues were three times more likely to leave the course., Conclusion: Hofstede's cultural dimensions framework can be used to explain clinical performance issues among undergraduate nursing students. Early identification of the students likely to experience these issues can lead to targeted and preventative interventions., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the authors., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: The P -value is frequently used in research to determine the probability that the results of a study are chance findings. A value less than 0.05 was once typically considered only to mean that results are 'statistically significant', as it indicates the chance they are false positives is less than one in 20 (5%). However, P<0.05 has transcended into meaning a study has had positive findings and its results are true and meaningful, increasing the likelihood it will be published. This has led to researchers over-emphasising the importance of the P-value, which may lead to a wrong conclusion and unethical research practices., Aim: To explain what the P -value means and explore its role in determining results and conclusions in quantitative research., Discussion: Some researchers are calling for a move away from using statistical significance towards meaningful interpretation of findings. This would require all researchers to consider the magnitude of the effect of their findings, contemplate findings with less certainty, and place a greater emphasis on logic to support or refute findings - as well as to have the courage to consider findings from multiple perspectives., Conclusion: The authors argue that researchers should not abandon P -values but should move away from compartmentalising research findings into two mutually exclusive categories: 'statistically significant' and 'statistically insignificant'. They also recommend that researchers consider the magnitudes of their results and report whether findings are meaningful, rather than simply focusing on P -values., Implications for Practice: Lessening the importance of statistical significance will improve the accuracy of the reporting of results and see research disseminated based on its clinical importance rather than statistical significance. This will reduce the reporting of false positives and the overstatement of effects., Competing Interests: None declared, (© 2020 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Nursing students are increasingly undertaking paid work while studying and most choose paid work in health care or hospitality. This paper is drawn from a larger sequential exploratory mixed-method study which examined the relationship between students working while studying nursing and the impact on academic performance. In this paper, we explored first year nursing students' perceptions of communication skills gained through paid work. Using a qualitative exploratory design, 50 first year commencing nursing students from four nursing schools (3 Australia; 1 New Zealand) were interviewed. Inductive thematic analysis was used which identified two themes: (i) recognising the value of learning interpersonal communication skills and; (ii)opportunities to develop effective interpersonal communication skills. Paid work provides interpersonal communication skills; active listening, being present and interacting while multi-tasking and emotion management. Undergraduate education providers need to recognise the benefits of paid work for students, including enhancing interpersonal skills., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Clinical placement experience is an integral component of nursing education as students acquire the essential knowledge and skills through learning in a supervised clinical environment. The role of the facilitator is pivotal to ensure students are practising safely and competently. The aim of this review was to explore the clinical performance issues identified by clinical facilitators, examine the relationship between students' academic and clinical performance, and factors influencing performance and attrition. A scoping review was undertaken to identify relevant literature, emerging themes and gaps in the literature, searching five electronic databases for primary and secondary papers, and the grey literature. No date limit was set for the review. Fifteen papers met the inclusion criteria. The top three themes relating to clinical performance issues included: i) Poor communication skills, ii) Inadequate knowledge or clinical incompetence and, iii) Unprofessional behaviour. The review also identified the relationship between academic and clinical performance, and negative experiences influencing students' decisions to leave the course. This scoping review highlighted the paucity of literature relating to clinical performance from the perspective of the facilitator, as well as the relationship between student characteristics and clinical performance and attrition., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Aim : To explore the impact of educational interventions for patients living with indwelling urinary catheters. Methods : Systematic scoping review in accordance with PRISMA guidelines, guided by Cochrane methodology, quality appraisal using Centre for Evidence-Based Medicine (CEBM) Joanna Briggs Institute (JBI), GRADE criteria and Quality Improvement Minimum Quality Criteria Set Version 1.0 (QI-MQCS V 1.0) tools. Studies ( n  = 446) were retrieved from CINAHL, Cochrane Library, Scopus and Medline from 2000 to 2020. Results : A total of 15 primary research studies were included in the narrative thematic synthesis, nine were from the USA, two from Australia, two from the UK, one from Italy and one from Turkey. These 15 studies were published between 2003 and 2019 and accounted for 19918 patients with an age range 15-99 years. Study design varied; there were 11 quantitative and 4 qualitative studies. Studies were of low-moderate quality. A total of four themes were identified; (i) information needs of patients living with long-term catheters; (ii) core learning content and educational approaches; (iii) feasibility and effectiveness of educational interventions to reduce complications and improve quality of life; and (iv) common outcome measures. Conclusion : The dissemination of information and the delivery of urinary catheter education to patients is inadequate. Core components of educational interventions should address fluid intake, bowel management, hygiene and self-monitoring/management, including adverse events. There is a need for future robust trials of educational and self-management interventions to improve the quality of life of patients living with indwelling urinary catheters in the community. Impact : This review addressed the educational needs of patients living with indwelling urinary catheters and the impact of educational interventions. Despite the heterogeneity in educational interventions, all studies included in this review reported the specific approach undertaken was effective in minimising catheter-associated complications and improving the quality of life of patients.

Background: End-of-life (EOL) decision-making in the intensive care unit (ICU) can be emotionally challenging for both doctors and nurses, who are sometimes placed in difficult positions where they are required to make decisions on behalf of patients. With an ageing population and advances in medical technology, there is an increase in such decisions being made in ICUs., Objectives: The objective of this study was to explore the perspectives of doctors and nurses involved in the EOL decision-making process in an ICU., Methods: This study used a qualitative methodology based on naturalistic inquiry. Intensive care nurses and doctors from a large Sydney metropolitan public hospital were purposively selected, and data saturation was reached after a total of eight nurses and four doctors were interviewed. Data were collected through semistructured interviews, either face-to-face or over the telephone. Interviews were then transcribed verbatim, and themes were identified and coded through a line-by-line analysis of each transcript (manual thematic analysis)., Findings: The findings revealed two main themes: 'Doctors' and nurses' roles in decision-making' and 'Managing family expectations'. These themes highlighted key differences in decision-making processes, in that doctors tended to aim to meet the family's needs, while the nurses tended to advocate on behalf of the patient and what they interpreted as the patient's best interests. Furthermore, nurses tended to feel undervalued in decision-making during family conferences, when in reality, the doctors were making decisions based on all information obtained, primarily from nursing staff., Conclusions: EOL decision-making is complex and affects doctors and nurses involved in different ways. More emphasis on interprofessional education and collaboration between the two disciplines may enhance future decision-making processes., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

The ability to safely calculate and administer medications are indispensable, core nursing skills in nursing education and practice. Therefore, it is imperative that nursing students are adequately prepared with the necessary numeracy skills during their undergraduate nursing studies. The focus of this study, conducted at a single multi-campus university in the western Sydney region of Australia, was to determine the effectiveness of a suite of blended learning approaches on numeracy self-efficacy from the students' perspective. Surveys were administered as part of the study and included open-ended questions. 525 students provided open-ended responses that were analysed by the research team. Four main themes were identified from the open-ended responses: (i) Self-realisation; (ii) Practice, practice, practice; (iii) Boosting confidence; and (iv) Wanting more. The themes captured students' perceptions of the benefits of having a rigorous learning design in blended learning approaches. The study showed that a structured pedagogical approach to nursing numeracy in undergraduate programs improved students' self-reported self-efficacy with mathematics and assisted students in realising the importance of learning and applying these skills as nursing clinicians., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the authors., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

The Objective Structured Clinical Examination (OSCE) or Assessment (OSCA) has traditionally been used in disciplines such as medicine and nursing, to assess students' competence to perform clinical skills safely in a simulated hospital environment. Despite its accepted use, a validated and reliable tool has yet to be developed and tested to assess students' perception of and satisfaction with this mode of assessment. This study developed and tested the psychometric properties of a brief Objective Structured Clinical Examination tool for assessing student perception that could have transferability across health education settings. The study used a cross-sectional survey design. Final year students (n = 727) enrolled in an undergraduate nursing program in Western Sydney completed the 10-item Satisfaction with Nursing Skill Examination: Objective Structured Clinical Assessment (SINE-OSCA) Scale in 2017. Exploratory factor analysis uncovered a one-component structure with component loading that ranged from 0.45 to 0.86. Cronbach's alpha of the SINE-OSCA was 0.91. Socio-demographic group comparisons revealed that respondents who were: i) male (p = 0.003); ii) non-native-born (p < 0.001); iii) non-English-speaking (p < 0.001); and iv) International (p = 0.001), reported higher satisfaction with clinical assessments, as measured by the SINE-OSCA scale. The SINE-OSCA scale demonstrates validity and reliability in identifying students who may have difficulty with this mode of clinical skill assessment., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the authors., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Aims and Objective: To capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer., Background: Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus and cancer. There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting. Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting., Method: An exploratory, descriptive study was employed using focus groups to gather narrative data, which was then subject to qualitative analysis. Eleven mental health inpatient wards within a local health district in Sydney, Australia, were studied, comprising ward-based nurses (n = 64) and nurse unit managers (n = 8). This paper follows the COREQ guidelines for reporting qualitative health research., Results: Qualitative data analysis revealed three themes central to the nurses' experience: (a) lack of clarity (subthemes: procedures and leadership accountability); (b) confidence in the workforce (subthemes: knowledge and skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes); and (c) complexity (subthemes: complexity as the new norm and suitability of the mental health environment)., Conclusion: The themes found in this study can be used to guide and inform healthcare policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer., Relevance to Clinical Practice: Findings provide a rich data set for the generation of measurement tools and protocols to guide physical health care and evaluate performance., (© 2019 Commonwealth of Australia Journal of Clinical Nursing © 2019 John Wiley & Sons Ltd.)

Aims and Objectives: This study sought to explore undergraduate nursing students' perceptions of the role and value of their bioscience tutors in a blended learning curriculum., Background: Blended learning approaches typically have reduced face-to-face contact with tutors-particularly in bioscience subjects which nursing students have traditionally found difficult, and the move to more web-based learning resources may compound this difficulty., Design: Qualitative descriptive study., Methods: This qualitative study was conducted with 19 undergraduate nursing students enrolled in bioscience subjects, at a large university in outer metropolitan Sydney, Australia in 2016. Semi-structured interviews were conducted over the telephone or face-to-face. Duration of interviews ranged from 13 to 71 min. Results were thematically analysed. EQUATOR guidelines for qualitative research (COREQ) applied., Results: Two main themes with accompanying sub-themes were identified. The first theme identified the importance of the tutor in bioscience, including their qualities, expertise and contextualisation of learning. The second theme provided insights into students' perceptions of what they considered good and poor approaches to learning., Conclusions: This study has clearly shown that while nursing students appreciated the flexibility offered by the online component of a blended learning curriculum, they still wanted an experienced bioscience tutor with clinical experience for their face-to-face classes. While the tutor was seen as crucial to providing clarification and context for content that was often challenging, they also played a key role in engaging and motivating students and creating a learning environment where students felt empowered to ask questions and debate issues with their peers. Given the increased use of online learning, further research could determine if the current study findings are also applicable in nonscience areas of study., Relevance to Clinical Practice: The importance of students having a sound understanding of the biosciences for safe, effective clinical practice cannot be underestimated., (© 2019 John Wiley & Sons Ltd.)

Competing Interests: Declaration of competing interest No conflict of interest has been declared by the authors. There has not been any funding received to support this research.

Background: Clinical skill assessment via Objective Structured Clinical Assessment (OSCA) has many challenges for undergraduate nursing students. These include high levels of anxiety that can compromise performance during the assessment, inconsistency with assessor reliability and is inconsistent with clinical skills performance in the real world. The implementation of a Video Assessment of Clinical Skills (VACS) that integrates formative feedback may be a way to address the challenges posed by OSCA assessment., Objectives: The aim of this study was to examine the acceptability, utility, and nursing student satisfaction with a formative feedback strategy - the Video Assessment of a Clinical Skill (VACS)., Design: A cross sectional survey., Settings: Undergraduate Bachelor of Nursing degree students from a large Australian University., Participants: Third year undergraduate nursing students (final year) enrolled in a Bachelor of Nursing Program., Methods: Participants were recruited via purposive sampling. A pre-survey (prior to VACs assessment) and post-survey (after VACS assessment) were completed. This paper reports on the open-ended responses in the post-survey that explored students' insights and perceptions into formative feedback and its impact on their learning for the VACS assessment., Results: A total of 731 open-ended responses were analysed with findings being organised into 3 major themes; (i) Flexibility and reflexivity, (ii) Editing and repeated attempts, and (iii) Working together., Conclusions: Video Assessment of a Clinical Skill has demonstrated good utility, acceptability, and satisfaction among undergraduate nursing students., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Working while engaging in tertiary studies can have potential benefits for students in developing their repertoire of employability skills, including teamwork, time management, customer service and interpersonal communication. Not unexpectedly engaging in excessive hours of work can have a detrimental effect on students' grades. Yet little is known about the impact of engaging in different types of paid work (nursing or non-nursing), and the amounts, on first year nursing students' academic performance across different nursing programs., Objectives: The aim of this study was to examine the association between: a) amount; and b) type of term-time weekly paid work, particularly its effect on academic performance, among commencing undergraduate students in the first semester of nursing studies across different nursing programs., Design: Inception cohort study., Settings: Four tertiary institutes across Australia and New Zealand., Participants: All commencing Bachelor of Nursing students attending Orientation sessions at their respective institutes were invited to participate in the study. The median age of participants was 23 years, the majority (87.5%) were female and nearly two-thirds were non-school leavers. Among those in paid work, the median hours worked was 20 h., Methods: A baseline survey, completed by consenting students at the start of their Orientation session included items related to respondents' demographic data, self-reported paid work engagement (type and hours); we also requested their permission to link grade point average (academic performance data) at the end of first semester. Data were analysed using SPSS Version 25., Results: A total of 1314 students completed the survey and 89% of survey respondents agreed for their survey to be linked to academic grades at the end of the semester. There was an inverse relationship between time spent in weekly paid work and academic performance. Additionally, three predictors emerged as statistically significant for high grade point average: (i) engaging in non-nursing related work (AOR: 1.64, 95% CI: 1.19-2.26); (ii) not being first in family to attend university (AOR: 1.57, 95% CI: 1.20-2.07) and; (iii) being a school-leaver (AOR: 1.49, 95% CI: 1.12-1.98)., Conclusions: Despite the diversity among undergraduate nursing students studying across Australasia, it is evident that the amount and type of paid work engagement can impact on students' academic performance while studying. This underscores the importance for tertiary institutes to not only support students in their learning but also understand the need to achieve the right balance, in working while studying, to support students' academic success., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Guideline implementation has been an ongoing challenge in the dental practice setting. Despite this, there are no reviews summarising the existing evidence regarding effective guideline implementation strategies in this setting. In order to address this, this systematic review examines the effectiveness of guideline implementation strategies in the dental practice setting., Methods: A systematic search was undertaken according to the PRISMA statement across nine electronic databases, targeting randomised controlled trials and quasi-experimental studies which evaluated the effectiveness of guideline implementation strategies in improving guideline adherence in the dental setting. All records were independently examined for relevance and appraised for study quality by two authors, with consensus achieved by a third author. Data were extracted from included studies using a standardised data extraction pro forma., Results: A total of 15 records were eligible for inclusion in this review, which focused on the effects of audit and feedback, reminders, education, patient-mediated interventions, pay for performance and multifaceted interventions. Although there were some conflicting evidence, studies within each category of implementation strategy indicated a positive effect on guideline adherence., Conclusions: This study has identified education, reminders and multifaceted interventions as effective implementation strategies for the dental practice setting. Although this is similar to research findings from other health sectors, there is some evidence to suggest patient-mediated interventions may be less effective and pay for performance may be more effective in the dental setting. These findings can inform policy makers, professional associations, colleges and organisations in the future adoption of clinical guidelines in the dental practice setting., Trial Registration: This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration ID CRD42018093023.

Aim: To explore the clinical support experiences of new graduate nurses' (NGNs) and how these experiences influenced their learning, job satisfaction and skill development during their new graduate transition., Background: As supervising NGNs is different to other groups, nurse managers must be aware of NGNs' unique needs to successfully transition to practice. Clinical support is crucial, but little is known about what is effective in supporting the learning and development of clinical capability in this critical period., Methods: Using a qualitative exploratory design, semi-structured interviews were conducted with NGNs working in a tertiary level teaching hospital in Sydney, Australia. Nurses were interviewed upon completing their 12-month transitional support programme (TSP) in late 2013-2014. Data were thematically analysed., Results: Twenty-six NGNs were interviewed. Three major themes identified were as follows: (a) clinical support facilitates learning; (b) conditions required for good clinical support; (c) transforming me., Conclusion: Themes identified specific supportive strategies, including informal and formal clinical support to nurture confidence, competence, professional growth and increase satisfaction of NGNs., Implications for Nursing Management: Findings describe essential clinical support practices for fostering successful NGN transition., (© 2019 John Wiley & Sons Ltd.)

Aims and Objectives: To explore the experiences of first-year nursing students, their motivations for working and how they juggled study and other commitments while engaging in paid work., Background: There has been a global rise in the number of students balancing full-time study, paid work and other commitments, with the main antecedent financial reasons., Design: Qualitative exploratory study., Methods: Drawn from a larger Australasian sequential exploratory mixed-method study, this qualitative study was conducted with fifty first-year undergraduate nursing and midwifery students who commenced their nursing studies in 2017. Telephone or face-to-face interviews were conducted with purposively selected students engaged in either nursing or non-nursing fields of work. Interviews were conducted from April-July 2017. Interviews lasted from 15-40 min. Results were thematically analysed. EQUATOR guidelines for qualitative research (COREQ) applied., Findings: Two main themes and accompanying subthemes were identified. The first theme explored students' motivation behind combining work and study and identified the need for financial security and "me time". The second theme "Juggling many balls" provided insights into the benefits students perceived, how they kept the "balls" in the air and at times dropped "balls" while balancing work, study and other commitments., Conclusions: The motivation behind paid work was mainly financial; however, students also reported work allowed an escape and time for self which had social and health benefits. Working provided a range of positive benefits, including a sense of achievement, improved self-esteem and financial independence., Relevance to Clinical Practice: Being able to juggle and multi-task improved skills such as organisation and the ability to prioritise, all skills that have applicability for the role as registered nurse., (© 2019 John Wiley & Sons Ltd.)

Aim and Objectives: To examine the factors that influence nursing students' mathematics self-efficacy, the effect of numeracy instruction on self-efficacy, and the association between self-efficacy and numeracy test performance., Background: Medication administration errors, including administering incorrect dosages or infusion rates, can result in serious harm to patients. Hence, it is essential that nursing students are adequately prepared with the necessary numeracy skills during their nursing program., Design: This quasi-experimental cohort study used a pre- and post-test survey design. The study complied with the STROBE checklist for cohort research., Methods: In total, n = 715 undergraduate first year nursing students participated in the study from June to October 2017 at a single multi-campus university in the Western Sydney region of Australia. Data were collected at three time-points: (a) baseline, including assessing pre-instruction mathematics self-efficacy (NSE-Math scale); (b) 6-week follow-up; including assessing post-instruction mathematics self-efficacy; and (c) numeracy test performance was collected at 7-week follow-up., Findings: At baseline, those with high NSE-Math scale scores were more likely to be male and have at least high school advanced mathematics level education. Following structured numeracy instruction, NSE-Math scale scores increased significantly, and those who obtained a satisfactory grade in their numeracy assessment were more likely to have high NSE-Math scale scores and high academic performance in the previous semester., Conclusion: The study shows that structured numeracy instruction improved mathematics self-efficacy, which in turn influenced numeracy test performance., Relevance to Clinical Practice: Using a structured medication numeracy pedagogical approach, to teach skills in nursing undergraduate programs, provides students with the foundations to improve mathematics self-efficacy and to be successful and safe with medication numeracy calculations and administration in clinical practice., (© 2019 John Wiley & Sons Ltd.)

Aims: To examine the usefulness of the annotated exemplar as an academic support strategy, and explore the characteristics of students who were more likely to engage with this academic support tool. Additionally, to identify if there was any influence on the academic performance in the assessment activity among those who engaged with the annotated exemplar., Background: Annotated exemplars have the potential to target students en masse and provide meaningful, task specific comments that guide students prior to assessment submission. Effective strategies to support student learning are needed as nursing students are increasingly entering tertiary studies from non-traditional backgrounds., Design: A cohort study was used to collect administrative data, academic grades and annotated exemplar usage statistics., Setting: A large multi-campus university in NSW, Australia during Spring semester 2016., Participants: Second year undergraduate students enrolled in a single unit in the Bachelor of Nursing Program., Methods: Quantitative data related to marks, grades and usage information; and demographic data and contact details were extracted from the online learning management system and student electronic records., Results: Of the 1120 students enrolled in the unit, 49.5% of students engaged with the annotated exemplar. Students more likely to engage with the tool were older, female, born outside of Australia and had higher hit rates on the online learning management site. Of those who engaged with the annotated exemplar, there was no demonstrated increase in assessment mark., Conclusion: To improve student performance it is essential that feedback is engaging and effective. While, in this study, use of the annotated exemplar was not reflected in student marks, it is unclear how students may have performed without access to the exemplar. Further research is required to explore the reasons why students did not engage with the annotated exemplar and, for those who did, why the intervention did not impact on assessment mark., (Copyright © 2019. Published by Elsevier Ltd.)