bluuebunny/crossref_metadata_2025 huggingface dataset:
Supporting the evolution of a research culture among nurses in Malaysia
Authors: Birks Melanie , Francis Karen , Chapman Ysanne , Mills Jane , Porter Jo
Published: June 2024

Objective: This paper describes a project to promote a research culture amongst nurses in Malaysia. The project, funded by the Australian Government’s Australia Malaysia Institute, and implemented by a group of Australian nurse academics, provided a rare professional development opportunity to nurses in urban and remote areas of Malaysia.
Setting: The Malaysian capital of Kuala Lumpur and the remote town of Sibu, on the Island of Borneo, were the setting for this project. The diversity of Malaysia was epitomized in the locations chosen for the implementation of tailored professional development seminars.
Conclusions: Evidence based practice in nursing is a global phenomenon. The importance of basing nursing care on scientifically derived, current evidence is a critical element of contemporary nursing practice. This notion is appreciated and accepted by nurses in Malaysia who, despite being impacted upon by barriers to the conduct and implementation of research in the clinical area, seek opportunities to enhance patient outcomes through evidence based practice. Projects such as the one described in this paper provide a means for nurses to undertake professional development through collaborative activities that are not limited by geographic, socioeconomic or cultural boundaries.
Fear of falling
Authors: Harding Stephen , Gardner Andrew
Published: June 2024

Objective: The purpose of the paper is to describe the ‘fear of falling’ phenomenon; to raise clinicians awareness; to consider the associated risk factors. 
Setting: Fear of falling can be experienced in any clinical setting or within people own homes.
Primary argument: Individual clinicians and the treatment and care teams should consider fear of falling in people with a disordered gait or balance, or in the months following a fall, particularly where there is a recognised decline in ‘recent’ activity or obvious activity avoidance and changes in patterns of activity
Conclusions: Fear of falling is an under recognised phenomenon. This paper suggests a range of assessment tools; and outlines some management options that are available to clinicians in order to address the problem of fear of falling.
Factors affecting sexual satisfaction in Korean women who have undergone a hysterectomy
Authors: Sung Mi Hae , Lim Young Mi
Published: June 2024

Objective: This study was undertaken to examine the factors affecting sexual satisfaction in women who had undergone a hysterectomy.
Design: The descriptive correlational study was conducted. The model contained three stages including antecedents (stage 1), interpersonal influence (stage 2), and outcome perception (stage 3). The antecedents included perception variables (eg negative body image and depression) and individual characteristics (eg age, education, employment and physical state before and after the hysterectomy). Stage 2 focused on social support. In stage 3, the outcome perception variable was sexual satisfaction.
Setting: The setting was a gynaecology outpatient clinic in a suburban general hospital in Korea.
Subjects: A total of 118 women who have had a hysterectomy participated.
Main outcome measures: The instruments used for this study were the Body Image Scale, the Self‑Rating Depression Scale, the Spousal Support Scale, and the Korean version of the Sexual Satisfaction Subscale.
Results: Results show spousal support (β=‑.419, p=.00) and negative body image (β=‑.301, p=.02) explained 30% of the variance in sexual satisfaction. Spousal support, as a mediating variable, was the highest factor predicting sexual satisfaction of women who have had a hysterectomy.
Conclusions: Findings suggest the causal relationships of sexual satisfaction can guide researchers and gynaecology nurses to understand the relative strength of predictors for sexual satisfaction. Nurse practitioners should play a leading role in assisting women who undergo hysterectomy to ensure they have emotional support from their spouse, as this can dramatically impact their sexual satisfaction.
Living with type 2 diabetes: ‘Putting the person in the pilots’ seat’
Authors: Handley Janice , Pullon Sue , Gifford Heather
Published: June 2024

Objective: To better understand the day‑to‑day lived experiences of those adults with type 2 diabetes, in particular, their historical and current ability to self manage this condition.
Design: This qualitative study utilised aspects of both phenomenology and grounded theory to inform the study design, namely an iterative thematic content data collection and analysis process. This enabled the identification of emerging themes.
Setting: Sample subjects all resided in Whanganui, New Zealand and were interviewed either in their own home, workplace or in a private room at the Whanganui Regional Primary Health Organisation.
Subjects: Nine in depth interviews were conducted with a purposively selected sample of adults living with type 2 diabetes; five females and four males; four New Zealand Europeans, four Māori and one Samoan. Years since diagnosis ranged from one to twenty three.
Results: The results demonstrate similarities between this research and that conducted internationally in terms of the impact of the diagnosis of type 2 diabetes and the difficulties adopting and adapting to the complex self care tasks required to manage this chronic condition on a daily basis. Support to self manage in this study was harnessed more readily from spiritual beliefs, family and friends rather than from health professionals.
Conclusion: Development of a sense of ownership or control of the condition is paramount to enable people to self manage effectively on a day to day basis and is determined primarily by the individual’s personal support systems. The primary focus of care should therefore be on the ‘person’, their story, needs and support systems, including the provision of health services and educational programs, well versed with and reflective of the broad principles of self management in a multi cultural environment.
Getting connected: How nurses can support mother/infant attachment in the neonatal intensive care unit
Authors: Kearvell Hayley , Grant Julian
Published: June 2024

Objective: To explore how nurses can support the mother‑infant dyad within the neonatal intensive care unit.
Setting: Neonatal unit, Neonatal Intensive Care Unit.
Data Sources: A literature search was conducted using CINAHL, PubMed, Web of Knowledge electronic databases and other key references.
Primary Argument: Hospitalisation and infant ill health interrupts the natural attachment process between a mother and her baby. This can cause great stress and affect the mother‑infant relationship and their ability to bond reciprocally. While nurses provide specialised care to sick infants, two major themes and five sub‑themes emerged on how nurses can also support mother‑infant attachment. In the area of mother‑infant interaction kangaroo care, breastfeeding and participation in routine care were found to enhance the mother’s maternal role, feelings of closeness, inclusion and confidence. In the area of nurse‑mother interaction, nurses who provided psychosocial support, communicated and engaged with mothers were found to assist in developing positive and trustful relationships. This alleviated mother’s anxiety and enhanced their confidence when interacting with their baby.
Conclusion: Nurses working in neonatal intensive care units need to construct nursing care around the mother‑infant dyad, with roles and responsibilities that incorporate mother‑infant and mother‑nurse relationships in support of the mother‑infant attachment process.
Views and attitudes of nursing students towards ageing and older patients
Authors: Senol Celik Sevilay , Kapucu Sevgisun , Tuna Zahide , Akkus Yeliz
Published: June 2024

Objective: The objective of this study was to determine the views and attitudes of nursing students towards ageing and older patients.
Design: A qualitative approach with semi‑structured interviews was used in this study.
Setting: Participants were selected from the students of a nursing school in Ankara, Turkey.
Subjects: Five focus group discussions were held with 42 students of a nursing school. The sample for this study was selected from second‑year bachelour of scince, nursing (BSN) students. All of the participants were female with a mean age of 21.09±0.97.
Results: According to the results of this study, 42.8% of the participants had cared for an average of 7.46±4.57 older patients in hospital settings or homes for the aged. Results of this study showed more than half of the participants had negative views about ageing, but the majority of participants reported they behaved positively towards older patients and were sensitive whilst caring for them. Most of the participants indicated they had communication problems with their older patients.
Conclusions: This study demonstrates similarities with other international studies exploring nursing students’ attitudes towards older people (Lambrinou et al 2009; Wang et al 2009; Burbank et al 2006; Hweidi and Al‑Obeisat 2006; McKinlay and Cowan 2003). This study was the first reported research undertaken in Turkey, related to views and attitudes of nursing students about ageing. This study will offer an insight into new studies and educational programs about ageing.
A university clinic: an innovative model for improving clinical practice
Authors: Warner Paul , Jelinek Herbert , Davidson Patricia
Published: June 2024

Objective: This paper discusses interprofessional learning through interdisciplinary collaboration between undergraduate nursing and podiatry students at a university based cardiovascular screening clinic.
Setting: A cardiovascular risk assessment clinic at a university campus in rural New South Wales, Australia.
Subjects: Students from nursing and podiatry enrolled in a baccalaureate degree at Charles Sturt University (CSU) Albury Wodonga Campus.
Main Outcome Measures: Undergraduate health care students develop their clinical skills primarily through clinical rotation within accredited health care facilities. The value of these clinical placements to students is dependent upon availability, the quality of the facilitation and the perceived burden to the organisation of providing places for students. There is increasing competition for these clinical places with health care service managers and their staff frequently highly stressed due to increased demand for clinical services, workforce shortages and increasing fiscal constraints. As a consequence of these challenges, an innovative, interdisciplinary program, designed to both improve and extend the repertoire of clinical skills of undergraduate health care students was piloted at a regional university campus. The pilot program used an established community screening clinic conducted by CSU. Students were invited to attend the clinic and undertake assessment tasks relevant to their profession and curriculum requirements as well as learn and practice clinical skills outside their usual professional practice. Students were able to practise these skills in a supportive environment, without the inherent time constraints and pressures experienced in health care facilities. The effectiveness of this model was evaluated through interviews as well as a pre and post test evaluation of one clinical skill. Students reported enthusiasm towards the program and were particularly interested in the opportunity of working in an interprofessional community focussed context and having the opportunity to expand their scope of practice.
Historical imagination and issues in rural and remote area nursing
Authors: Wood Pamela
Published: June 2024

Objective: Using issues in rural and remote area nursing as the example, this paper explores how nurses can use their historical imagination in considering professional issues today.
Setting: Rural and remote area nursing.
Primary argument: Historical imagination is the creative capacity to imagine possibilities of engaging with the past. Historical imagination in nursing has the potential to help nurses address current professional issues. Points of familiarity with the past can show nurses which issues are enduring and which are transient. A sense of familiarity can bring strength, encouragement and comfort. Points of difference can show nurses that problems are not necessarily permanent or can be dealt with differently. This paper uses aspects of the history of bush nursing in Australia to illustrate how nurses in rural and remote area nursing today could use their historical imagination in addressing current issues. It explores points of familiarity and difference between issues faced by bush nurses in the past and current issues in the international literature. Ways of using historical imagination in rural and remote area nursing recruitment are considered to illustrate the process.
Conclusions: As the example of engaging with the history of bush nursing in Australia attempts to demonstrate, nurses can use their historical imagination to identify points of familiarity and difference with the past to prompt a shift in thinking and strengthen creativity in addressing current issues.
Nursing and midwifery research grants: profiling the outcomes
Authors: Gledhill Susan , Mannix Janine , MacDonald Ross , Poulton Gordon
Published: June 2024

Objective: To profile the outcomes of nursing and midwifery research that was conducted as a result of a research grant program administered by a nursing and midwifery regulatory authority in Australia between 1996 and 2010.
Design: A cross‑sectional electronic survey relating to research grant outcomes.
Setting: The survey was open to all past and present research grant recipients in Australia.
Subjects: The survey was completed by 71 past and present research grant recipients from across Australia.
Main outcome measures: Survey findings.
Results: Thirty three percent of nursing and midwifery researchers who were funded through a grant program are engaging in research that has implications for the advancement of clinical practice, nursing and midwifery education, indigenous health, mental health, child health, rural and remote nursing and midwifery practice and technological advancement in health care.
Conclusion: The findings indicate that nursing and midwifery researchers are conducting a broad range of research studies that contribute to professional development and to health care in general. Respondents demonstrated the benefits of their research projects through clinical practice improvements, policy changes and through professional networking that contributed to the critical mass of nurse and midwifery research based knowledge. Most respondents disseminated their findings through various media on a national or international basis. The survey findings demonstrate the importance of a continuing commitment to nursing and midwifery research by relevant organisations.
What is psychosocial care and how can nurses better provide it to adult oncology patients
Authors: Legg Melanie
Published: June 2024

Objective: This paper explores psychosocial care; the potential barriers, how nurses provide it, utilise assessment tools and the impact, issues and benefits of providing effective psychosocial care.
Primary argument: Nurses are in a unique position to monitor patients and their psychosocial care. However there remains a barrier to exploring some of these facets of care. Nurses need to be more inclusive of patient’s sexuality, spirituality, optimism and hope when assessing psychosocial care and quality of life as these subjects can be the least explored by staff with their patients.
Conclusion: As hospital nurses we see the patient and their family throughout their cancer journey and are in a unique position to monitor a patient’s psychosocial coping and any distress. Providing psychosocial care to patients is essential but can be an over looked part of nursing care. In university we are taught how to be nurses but how to communicate with patients and other health care professionals is part of on the job training. Psychosocial care is part of a holistic patient perspective and allows patients to seek both informational and emotional support from care givers to help them manage their cancer journey.
“I don’t want to become a scientist”: undergraduate nursing students’ perceived value of course content
Authors: Birks Melanie , Cant Robyn , Al‑Motlaq Mohammad , Jones Janet
Published: June 2024

Background: In the development and delivery of pre‑registration baccalaureate nursing programs, universities must address both the needs of industry and the registering authorities that regulate health professional practice. Balanced with this, providers of education at this level also wish to deliver an experience to students that they both value and enjoy.
Objective: This paper describes the findings of a study examining these factors in the first year of four pre‑registration programs at a rural campus and outreach centre of one Australian university.
Design: A descriptive, exploratory survey was employed in this research, which is drawn from a larger study into entry pathway, success and academic experience.
Results: Results indicate that students found units such as fundamental nursing subjects and law most enjoyable and valuable. Units with a sociological foundation were considered less enjoyable and valuable. Overall, students recognised the value of the bioscience units while contrarily not expressing enjoyment of this aspect of their studies.
Conclusions: These findings have implications for nurse educators in respect of the content and delivery of pre‑registration nursing programs. As first year students, the participants may have been focused on learning fundamental nursing tasks, lacking an understanding of the breadth of knowledge required for their professional role. Future research into aspects of nursing studies found to be most valuable may provide a different perspective if conducted in the period post graduation.
Postoperative hypothermia and mortality in critically ill adults: review and meta‑analysis
Authors: Kiekkas Panagiotis , Theodorakopoulou Georgia , Stefanopoulos Nikolaos , Tsotas Dimitrios , Baltopoulos George
Published: June 2024

Objective: To identify, appraise and synthesise published literature about hospital mortality associated with inadvertent postoperative hypothermia of adult patients directly transferred to the Intensive Care Unit (ICU) after surgery.
Design: Systematic literature review and meta‑analysis.
Methods: Using key terms, a search was conducted in English‑language, peer‑reviewed journals indexed by CINAHL, PubMed and Cochrane Database focusing on articles published between 1980 and 2010. Data extraction and quality appraisal was performed. After evaluating heterogeneity among studies, quantitative synthesis was applied where possible.
Results: Seven observational studies met the inclusion criteria. In five of them, hospital mortality was significantly higher in hypothermic patients. Unadjusted odds ratio of core temperature<350C on hospital mortality was combined in a meta‑analysis and the pooled estimate was 3.29 (95% confidence interval 1.58‑6.85). In the multivariate level, independent associations between hypothermia and mortality were detected in four studies.
Conclusions: Existing evidence supports the positive association between postoperative hypothermia and hospital mortality in surgical ICU patients. Effective hypothermia prevention can be crucial for improving outcomes of this population, but further research is needed for confirming the independent contribution of hypothermia on mortality.
Occupancy data: unravelling the mystery
Authors: Stevenson Johanna , Anderson Susan , Veach Kate , Hine Bette-Anne , Webster Joan , Fleming Lesley , Osborne Sonya
Published: June 2024

Objective: The main purpose of this study was to clarify the method used to calculate bed occupancy rates.
Design: Qualitative, using semi‑structured face‑to‑face interviews, telephone interviews and email correspondence with internal and external stakeholders, as well as analysis of key documents.
Setting: A tertiary hospital in Queensland, Australia.
Participants: Nursing and administrative staff from 34 clinical areas, nurse managers and finance officers.
Main outcome measure: Identification of the method used to calculate bed occupancy.
Results: A number of issues potentially impact on the accuracy of occupancy data including timeliness of data entry, knowledge about what should be entered and skill deficits. There was also considerable confusion and misinformation about how occupancy data is calculated, used and reported.
Conclusion: Occupancy data integrity may be compromised by timeliness and accuracy of data entry and by methods used for calculation. Until these problems are resolved, occupancy remains a woolly measure on which to estimate nursing resources.
Identifying medication documentation errors using handwritten versus pre‑printed ICU flowcharts
Authors: Franklin Natasha
Published: June 2024

Objective: To compare and review medication documentation errors using handwritten versus pre‑printed ICU flowcharts.
Design: Randomised retrospective audit comparing handwritten ICU flowcharts from 2004 and pre‑printed ICU flowcharts from 2009.
Setting: Ten bedded, Level 2 Intensive Care Unit in Australia.
Subjects: Total of 60 ICU flowcharts: 30 handwritten flowcharts from 2004 and 30 pre‑printed flowcharts from 2009.
Main outcome measures: To determine whether using pre‑printed ICU flowcharts eliminated or significantly reduced the number of medication documentation errors compared to handwritten medication orders using ICU flowcharts.
Results: Although the sample size of this audit was small, this audit showed that there was no overall difference when using handwritten and pre‑printed ICU medication flowcharts. Four error categories were initially measured against, but a fifth category was identified during the audit. The third category ‘prescribing documentation errors’ was identified as the largest category for errors, with a 44% error rate using handwritten ICU flowcharts and a 78% error rate using pre‑printed ICU flowcharts.
Conclusion: This audit demonstrated although there was no overall difference using handwritten or pre‑printed ICU medication flowcharts, using pre‑printed ICU medication flowcharts reduces the risk of an adverse drug event that may result in patient harm by classifying error categories. This audit has also highlighted the need for further research into medication documentation errors using paper‑based or electronic medication charting in the ICU, the role of pharmaceutical review during the prescribing process and to explore the role of nurse practitioners in the ICU.
The influence of personal characteristics on perioperative nurses' perceived competence: implications for workforce planning
Authors: Gillespie Brigid , Hamlin Lois , Polit Denise , Chaboyer Wendy
Published: June 2024

Objective: To examine the influence of personal characteristics on perioperative nurses’ perceived competence.
Design: A cross-sectional survey design was used.
Setting: A census of 3,209 operating room nurses who were members of the Australian College of Operating Room Nurses across all Australian states and territories was invited to participate.
Primary Outcome Measure: The Perceived Perioperative Competence Scale-Revised, a 40-item survey consisting of six subscales  measuring the dimensions of perioperative competence was used.
Results: A total of 1,044 usable surveys were analysed representing 32.5% of the accessible population. Across the six subscales, demographic predictors accounted for 5% to 33% of the variance in nurses’ perceived perioperative competence.
Conclusions: These results may inform workforce planning initiatives designed to address the needs of this diverse specialty group. Efforts to retain older nurses need to be centred on redesigning workplaces, increased remuneration and professional recognition, and integrating technology to promote efficiency and safety. Workforce planning should include strategies such as creating academic partnerships with universities, to provide perioperative nurses access to specialty education and advanced skills programs.
The challenges for families managing an adolescent with an intellectual disability and type 1 diabetes
Authors: Hillege Sharon , Gallagher Susan , Evans Jennifer
Published: June 2024

Objective: This paper describes the experiences of two families caring for their adolescent sons who have type 1 diabetes (T1D) and an intellectual disability.
Design: This paper arises from a larger study and reports on the findings from four parents, (two couples), who have adolescent sons with both type 1 diabetes and intellectual disability. Case study analysis of these interviews gave a more in-depth understanding of management of these dual conditions from the perspective of the parents.
Setting: The interviews occurred in the parents homes.
Subjects: Family one consisted of a mother, father, and three children aged 16 to 20 years. Family two comprised both parents and four children attending secondary school. At the time of the study all siblings were living at home. The two adolescent men with intellectual disability and T1D were 19 year old, still living at home and attending sheltered employment.
Main Outcome Measures: This paper describes the experiences of two families caring for their adolescent sons who have T1D and an intellectual disability.
Results: Independence was the major issue. Obtaining independence was hindered on several fronts: having an intellectual disability and having to manage T1D concurrently, and the short and long-term effects this management has on the family now and in the future.
Conclusion: The complex management of T1D coupled with intellectual disability makes independence more difficult to attain for these adolescents. The parents in this study accepted that full independence may not be possible for their sons and voiced concern for their future wellbeing.
Understanding compliance with protective eyewear amongst peri-operative nurses: a phenomenological inquiry
Authors: Neo Felicia , Edward Karen-leigh , Mills Cally
Published: June 2024

Objective: The objective of this study is to obtain an in-depth understanding of the phenomenon of peri-operative nurses’ use of protective eyewear in the operating room (OR), and to understand nurses’ attitudes and beliefs towards protective eyewear.
Design: Data was collected via one-on-one interviews with eight peri-operative nurses working in a private hospital in Melbourne. The data collected underwent rigorous thematic analysis using an extended version of Colaizzi’s method of phenomenological inquiry.
Setting: The participating site is a large, private, metropolitan hospital that has 420 beds and employs 1,100 nurses and midwives, of which 31% are peri-operative nurses.
Subjects: Eight registered nurses were recruited. They were all female, aged between early 20s to early 60s, ranging in experience in the peri-operative setting from more than six months to approximately twenty years.
Main outcome measure: The investigation of the phenomenon of peri-operative nurses’ use of protective eyewear in the OR with information to help further understand peri-operative nurses’ attitudes and beliefs towards protective eyewear.
Results: For nurses, being compliant with protective eyewear is a combination of intrapersonal, environmental and professional factors, including protecting self, risk appraisal, beliefs, previous experiences, fear, comfort and functionality, professionalism, leadership, forgetting versus routine, time pressure and accessibility, alternatives and patient-centred care.
Conclusion: Individual nurse’s beliefs towards protective eyewear and its impact on work, life and patient care influence their decision to use protective eyewear. Peri-operative nurses are more compliant when they are well informed and are in a supportive work environment.
Health literacy screening instruments in adults with cardiovascular disease and their importance to the nursing profession
Authors: Chan Alex
Published: June 2024

Objective: To provide context information about the currently available health literacy screening instruments that may be applicable to adults with cardiovascular disease and their importance to the nursing profession.
Primary argument: Cardiovascular disease is a major health concern in Australia. Most cardiovascular diseases can be prevented and managed by reducing the cardiovascular risk factors. However healthcare professions, including nurses, may overestimate the health literacy skills of adults, and result in ineffective communication and misunderstanding. Adults with inadequate health literacy skills are often less compliant with their prescribed preventive treatments. As such an accurate health literacy assessment would not only promote therapeutic communication and the relationships between nurses and adults but it would also improve the compliance of secondary preventive treatment and the overall health outcomes. So this leads to the question, what health literacy screening instruments are available to measure the health literacy skills of adults with cardiovascular disease?
Conclusion: A review of primary research dated from 2005 to 2014 indicated the derivative versions of TOFHLA and REALM are the two main instruments used to measure the health literacy skills of adults with cardiovascular disease. Accurate health literacy measures can assist nurses to develop strategies to improve the overall health outcomes of adults with complex needs and inadequate health literacy skills. As nurses comprise a substantial proportion of the healthcare workforce, they have the potential to make changes in the healthcare system and improve the quality of health education provided to this population group.
Radiation awareness among nurses in nuclear medicine departments
Authors: Alotaibi Muhammad , Al-Abdulsalam Amal , Bakir Yousif , Mohammed Ahmed
Published: June 2024

Objective: The aim of this study is to explore the awareness level of radiation risks among nurses working in nuclear medicine departments (NMDs).
Design: A cross-sectional survey was used. Data were collected between February and March 2011.The data were collected using a self-administered, structured questionnaires. One open-ended question was added at the end of the questionnaire.
Setting: The study was conducted in NMDs representing five Kuwaiti governmental general and specialised hospitals and centres.
Subjects: This study comprised twenty one non-Kuwaiti female nurses who worked in NMDs.
Results: Nearly all of the nurses did not attend any radiation protection courses, they were not aware of the ALARA principle and they were not familiar with Geiger-Mueller counter. Most of these nurses were not able to read the dosimetry reports and they were not familiar with the terms RSO, RSC, and the 10 day rule concept.
Conclusion: Nearly all nurses working in NMDs in Kuwait are not aware of radiation protection and risks. This lack of awareness has serious implications on both patients and nurses. Courses on radiation risks and protection should be provided to nurses during and after their formal nursing education.
Enhancing the online learning experience using virtual interactive classrooms
Authors: Andrew Lesley , Ewens Beverley , Maslin-Prothero Sian
Published: June 2024

Objective: Enhancing online learning through the design, implementation and evaluation of a project piloting virtual interactive classrooms.
Design: The virtual interactive classroom (classroom) design was underpinned with current best practice in higher education pedagogy. Evaluation of the project used a cross-sectional, electronic survey.
Setting: This study was undertaken at a School of Nursing and Midwifery in a Western Australia University.
Subjects: 144 nurse students: 130 undergraduate, 14 postgraduate.
Interventions: Classroom options were introduced into two online units, incorporating blended learning approaches and promoting active participation in learning.
Main outcome measures: Quantitative measures included student demographics, ease of classroom navigation, percentage participating in the classroom option in real-time and those who did so actively (questioning, discussing, etc.). Qualitative data ofstudent learning experiences informed the findings further.
Results: Fifty-six percent of enrolled students participated in classrooms in real-time and 9% viewed recorded sessions. The survey response rate was 56%. Non-traditional students were highly represented; with 65% of undergraduate and 100% of postgraduate students being mature-age. Seventy-one percent of undergraduate and 89% of postgraduate survey responders who participated in classrooms in real-time did so actively. The most common reason for participation in real-time was family and work commitments (76%). Participating students gave overwhelming positive feedback of the classroom experience, in particular around its interactive nature, blended learning approaches and user-friendliness.
Conclusion: The classrooms supported active student participation in online learning. Students valued the interactive and blended learning features, known to be congruent with effective learning, student satisfaction and retention.
Prevention of postnatal mental health problems: a survey of Victorian Maternal and Child Health Nurses
Authors: Wynter Karen , Rowe Heather , Burns Joanna , Fisher Jane
Published: June 2024

Objectives: To investigate Maternal and Child Health (MCH) nurses’ views on what contributes to mental health problems among new mothers, and their current practices regarding risk factors for maternal mental health problems that are potentially modifiable in primary care.
Design: Cross-sectional, online survey.
Setting: Universal MCH service offered free to all new parents in Victoria, Australia.
Subjects: All MCH nurses employed in full or part-time clinical practice were invited to participate.
Main outcome measures: MCH nurses’ views on risk factors for maternal mental health problems and for unsettled infant behaviour; and their current practice regarding addressing unsettled infant behaviour and inclusion of fathers in services.
Results: Surveys were completed by 343/1051 eligible MCH nurses (32.6%). Respondents identified social factors as major determinants of postnatal mental health problems among women, including: parents having limited knowledge about infant sleep needs and skills to manage unsettled infant behaviour; and lack of support, including from intimate partners. Respondents offered widely divergent advice to mothers about management of unsettled infant behaviour. They regarded the inclusion of fathers in routine services as valuable, but acknowledged practical barriers, including difficulties in offering services and programs outside conventional office hours.
Conclusions: MCH nurses identified risks to maternal mental health that are potentially modifiable in primary care, but face barriers in addressing these. To facilitate more consistent advice to new parents about management of unsettled infant behaviours, evidence-based guidelines and training programs should be developed. Inclusion of men in routine services would require practical barriers to be overcome.
The role of specialist nurses in cardiac genetics - the Victorian experience: supporting partnerships in care
Authors: Thompson Tina , Morgan Natalie , Connell Vanessa , Zentner Dominica , Davis Andrew , Pflaumer Andreas , Woodford Noel , Winship Ingrid
Published: June 2024

Objective: In Victoria, Australia, a unique referral process exists for families who require investigation for possible inherited cardiac disease. This is spearheaded by a team of specialist nurses located at the Royal Children’s Hospital Melbourne (RCH), the Royal Melbourne Hospital (RMH) and the Victorian Institute of Forensic Medicine (VIFM), who ensure that all potentially at-risk families are offered the opportunity for clinical assessment and consultation.
Setting: In Victoria, approximately 5,500 deaths are reported to the Coroner each year. Where there is a suspicion of a causative heritable cardiac condition, the surviving relatives are offered referral to a tertiary centre for assessment and screening.
Subjects: A specialist nurse employed by the VIFM is the focal point for forensic pathologists to flag families requiring referral. Concurrently, specialist nurses within the cardiac genetic services of RMH and RCH accept, review, triage and action these referrals. All three services work closely to create a seamless model of care, which is age appropriate and provides ease and equity of access to consistent care.
Primary argument: The nurse specialists are a critical part of the multidisciplinary team, providing the first entry point into the hospital system. Their background experience encompasses intensive care and cardiology nursing. This is essential to the provision of professional and empathetic care in which families can approach the difficult issues surrounding post mortem consideration of a diagnosis.
Conclusion: The Victorian nurse led system is an effective model, which could be trialled in other jurisdictions, and other disorders, where multidisciplinary care is required.
Risk stratification for obstructive sleep apnoea and optimal post-operative monitoring in an overnight stay ward
Authors: Kadam Vasanth Rao , Markman Phuong , Neumann Sally , Kingisepp Sandi
Published: June 2024

Objectives: Prospective data is required to clarify the role of a one night stay ward (23-hour ward, 23HW) for the post-operative monitoring of surgical patients with obstructive sleep apnoea (OSA). The aim was to use a modified American Society of Anesthesiologists (ASA) screening tool to stratify the perioperative risk of OSA related complications and evaluate the role of a 23HW in the post-operative management of this patient group.
Design: Prospective cohort study.
Setting: Tertiary referral centre.
Subjects: Patients identified in pre-anaesthetic clinic as having a mild to moderate risk of complications from OSA were scheduled for post-operative monitoring in a 23HW.
Outcome measures: Primary end points were incidence of desaturation events (Continuous pulse oximetry measuring SpO2 90-94% mild, <90% severe) in the recovery unit and in the 23HW. Secondary endpoints included type of anaesthetic, utilisation of continuous positive airway pressure (CPAP) and oxygen therapy, and major adverse events.
Results: One hundred seventy three patients (median age 56) were identified. Of these, 61 had previous formal diagnosis of OSA by sleep study while the remaining 112 patients were provisionally diagnosed in pre-anaesthetic clinic by clinical parameters. Ninety-four patients received a general anaesthetic, 79 patients received regional anaesthesia with sedation. The incidence of desaturation events was 4.0% in the Recovery Unit and 22.0% in the 23HW.
Conclusion: The ASA screening tool can identify perioperative patients at risk of developing respiratory complications from OSA, enabling their safe monitoring in a 23HW, thus avoiding the need for limited High Dependency Unit resources.
A nurses’ guide to the hierarchy of research designs and evidence
Authors: Ingham-Broomfield Rebecca (Becky)
Published: June 2024

Objective: This article provides a breakdown of the components of the hierarchy, or pyramid, of research designs. Its intention is to simplify the components of the hierarchy to enable novice readers of research to better understand the differing approaches and levels of evidence.
Primary Argument: Evidence-based Practice (EBP) is the integration of the best research evidence with clinical expertise and the patient’s unique circumstances. This includes respect of patient values, and their needs, whilst delivering high-quality, cost effective health care. Understanding the differing levels of evidence, and their reliability, is paramount to making correct and appropriate health care decisions. Nurses are required to use evidencebased practice as they are responsible for a significant amount of judgments and decisions every day, and therefore, they must use research literature as part of their clinical decision-making.
Conclusion: The content, or levels of evidence, of the hierarchy will be discussed in a systematic, logical order from the base to the apex of the pyramid. A comparative grid at the end may lead the nurse to better understand the differing components of the seven levels of evidence or, depending on the source, eight.
Access to healthcare services for people living with HIV experiencing homelessness – a literature review
Authors: Crock Elizabeth
Published: June 2024

Objective: People living with HIV (PLHIV) who are homeless or at risk of homelessness experience significantly worse health outcomes than those in stable housing. They are more likely to be diagnosed late, use substances, engage in high–risk sexual activities and have difficulty adhering to treatments. This review identifies strategies described and evaluated in the international social science literature which can improve access to HIV–treatment and care for PLHIV who are homeless or at risk of homelessness, to inform policy and service development in Australia.
Setting: The principle research question addressed in this review is:

 What strategies enhance the ability of PLHIV who are homeless to access health care services, in particular community nursing services?

A literature review of social science research relating to the research question in the international and Australiancontexts was conducted.
Primary argument: No literature was identified that addressed access to community nursing services for PLHIV experiencing homelessness in Australia, and very little internationally. Community–based nursing organisations are well–placed and experienced in engaging marginalised groups in health care. Specific interventions need not always be developed: rather, better use could be made of existing services that utilise assertive outreach models of care and co–location with other services.
Conclusion: HIV–specialist community nursing services could be better integrated with homelessness services to enhance access to care, link PLHIV into the health system and keep them engaged in care. The absence of research on engagement with HIV specialist community nursing services demands exploration.
Doctoral education for nurses today: the PhD or professional doctorate?
Authors: Walker Kim , Campbell Steven , Duff Jed , Cummings Elizabeth
Published: June 2024

Objective: This paper seeks to stimulate discussion and debate about the future of doctoral education for nurses in Australia.
Setting: A large Magnet recognised acute care private hospital in New South Wales and a large regional university in Australia.
Primary argument: Healthcare today and into the future is increasingly more complex and requires ever more highly skilled healthcare professionals to meet the challenges of providing safe, quality care. Doctoral research and education based in the workplace and designed to improve healthcare while skilling up nurses and other professionals in research methods has never been more relevant and appropriate.
Conclusion: Nurses have generally not seen the PhD as the best fit for their higher professional development. The professional doctorate offers a compelling and dynamic alternative to the more academic focus of the PhD and prepares ‘inquiry driven leaders’ for tomorrow’s challenges.
Assessing the effectiveness of clinical education to reduce the frequency and recurrence of workplace violence
Authors: Adams Jillian , Knowles Alex , Irons Garry , Roddy Alison , Ashworth John
Published: June 2024

Objectives: This study assessed the effectiveness of clinical education to identify patients with a high risk for violence and to reduce the frequency of violent incidents.
Design: A before and after design with an education intervention.
Setting: Data were gathered from the direct care staff and from records of violent/aggressive incidents which occurred on two adult medical wards at a teaching hospital in Western Australia.
Subjects: Nurses, Assistants in Nursing and Patient Care Assistants working on the study wards participated in the education intervention (n=65) and completed a questionnaire before and after the education. Details of 48 violent/aggressive incidents perpetrated by 21 patients were examined.
Intervention: An education program addressed four key areas (assessment, planning, implementation [crisis], post incident). Case studies and in-patient scenarios provided context, immediacy and relevance, and 77% of the staff completed the program.
Main outcome measure: Knowledge, confidence and capability of direct care staff to prevent/manage violent/aggressive incidents were measured. Incident data measured the frequency and recurrence of violence/aggression, and if perpetrators met the high risk criteria.
Results: Post education, knowledge increased significantly (p=0.001, CI 0.256-0.542), the use of verbal de-escalation increased significantly (p=0.011, 1df) and the frequency and recurrence of incidents decreased. All perpetrators met criteria indicating a high risk for violence.
Conclusions: Education and coaching provided by clinical experts resulted in increased knowledge, greater use of verbal deescalation and less incidents. However, more time/coaching is required to improve the perceived capability of clinical staff to manage these incidents.
The impact of clinical placement model on learning in nursing: A descriptive exploratory study
Authors: Birks Melanie , Bagley Tracy , Park Tanya , Burkot Camilla , Mills Jane
Published: June 2024

Background: Learning in the clinical setting is an essential component of nursing education. Two common models of clinical learning place students in facilities using either block or distributed approaches.
Aim: The aim of this study was to examine nursing students’ perceptions of the impact of block versus distributed model of clinical placement on their learning experience.
Design: The study employed a descriptive, exploratory approach. Focus groups and an individual interview were conducted with third-year undergraduate nursing students.
Setting: Students from four Australian universities took part in the study.
Subjects: The average age of the 22 student participants was 37.5 years and 91% were female. More than half (55%) studied full time.
Results: Thematic analysis of the data identified five overarching themes: We’re there to learn; Taking all that knowledge out and practising it; You actually feel a part of the team; Just prepare them for us coming; and It’s really individual.
Conclusions: It is clear that both block and distributed modes of placement have inherent advantages and disadvantages that might be magnified depending on the individual student’s circumstances. Sequencing, consistency and preparation must be considered when planning either mode of clinical placement to ensure the best possible experience for students. Most significantly, students need to feel as though they are part of the team while on placement to get the most out of the experience. These findings have implications for education providers planning the integration of clinical placement into the nursing curriculum.