bluuebunny/crossref_metadata_2025 huggingface dataset:
Spirituality and spiritual engagement as perceived by palliative care clients and caregivers
Authors: Penman Joy , Oliver Mary , Harrington Ann
Published: June 2024

Objective: The purpose of this study was to examine the lived experience of spirituality and spiritual engagement as perceived by palliative care clients and their caregivers.
Design: A qualitative hermeneutic phenomenological approach was used based on van Manen’s methodological structure of human science research to answer the research questions. Following ethics approval, fourteen home‑based in‑depth interviews were conducted with four palliative care clients and ten palliative care caregivers. Van Manen’s ‘holistic’ and ‘selective’ approaches were used to identify the main themes in this study.
Setting: The participants of this study were recruited from people across rural communities of South Australia who had received or were receiving palliative care and their caregivers.
Findings: Seven main themes emerged from the data. These were categorised under two headings: spirituality and spiritual engagement. Spirituality was associated with ‘God’, ‘coping’, ‘religion’ and ‘relationships with others’, while spiritual engagement was associated with ‘maintaining relationships’, ‘love’ and ‘participating in religious practices’.
Conclusion: This phenomenological inquiry set out to understand the lived experience of spirituality and engaging in spiritual matters for clients living with life‑limiting conditions and their caregivers. In the process, the study identified the many benefits that may be derived from engaging in spirituality. The findings have relevance to clients and caregivers because they may wish to seek opportunities to discuss spiritual matters with health professionals and for health professionals, who will be better prepared for such conversations.
Pursuing the golden mean ‑ moral decision making for precarious newborns
Authors: Zutlevics Tamara
Published: June 2024

Objective: To demonstrate a need, and develop a process, for moral decision making regarding precarious newborns.
Setting: The Neonatal Intensive Care Unit (NICU).
Primary argument: This paper argues that it is imperative for healthcare institutions to develop a formal process of ethical review for decision making regarding precarious newborns. Broadly, precarious newborns are those that fall into the following two categories:

babies with congenital anomalies which are either life threatening or which pose a risk of significant morbidities; and
extremely premature babies who are otherwise physically normal.

After identifying some of the reasons why decision making regarding these infants is particularly fraught, some examples are used to draw out the problems which arise in the absence of a formal decision making process.
Conclusion: Aristotle’s metaphor of the golden mean provides a framework for a moral decision making process which can be beneficially utilised in complex cases involving precarious newborns. The decision making process advocated in the paper is briefly characterised as a cooperative discursive one, based on inclusive representation and underpinned by core ethical principles such as non‑maleficence, beneficence, justice, and transparency.
Nurse Practitioner provision of patient education related to medicine
Authors: Cashin Andrew , Buckley Thomas , Newman Claire , Dunn Sandra
Published: June 2024

Objective: To describe the perceptions of Australian NPs and NP candidates (student NP and NPs in transitional roles but not yet authorised) in regards to their confidence and practice in providing medicine information to patients / clients.
Design: An electronic survey related to prescribing practices.
Setting: The survey was open to all Australian NPs (n=250 at time of survey) and NP candidates.
Subjects: The survey was completed by 68 NPs and 64 NP candidates (student NP and NPs in transitional roles but not yet authorised) across Australia.
Main outcome measures: Survey findings.
Results: Sixty seven percent of NPs and 54% of NP candidates identified feeling very confident in providing their clients with education about medicines. Of the NP respondents 78% identified they generally do inform patients of the active ingredient of medications and 60% of NP respondents indicated they provide or discuss CMI leaflets with their patients.
Conclusion: The results suggested that NPs and NP candidates are providing some of their clients with medicine information and using CMI leaflets in some prescribing consultations. Although confidence in the area of provision of education to patients related to medicines is high this may be incongruent with actual concordance supporting nursing behavior. Person centered patient education is central to the principles of building concordance. The incongruities between confidence in the provision of medication education to patients and self reported concordance building NP prescribing behavior needs to be a focus of critical reflection on NP prescribing practice.
Rethinking student night duty placements
Authors: McKenna Lisa , French Jill
Published: June 2024

Objective: Student clinical placements principally occur over morning and afternoon shifts. This paper reports findings from a qualitative study that investigated experiences and value of night duty placements for undergraduate nursing students.
Design: Final year students from one university were invited to participate in a two week night shift placement. A qualitative approach involving focus groups with students and ward nurses, prior to, and following the clinical placements was used. In addition, individual interviews were conducted with other key stakeholders from the university and health care service.
Setting: The study was conducted in one metropolitan public hospital in Victoria, Australia. A clinical teacher was employed by the university to provide student support during the placement.
Subjects: Fourteen final year nursing students, five permanent night staff from the hospital and four key personnel representing university and hospital perspectives consented to participate.
Main outcome measures: All transcripts were thematically analysed together within the context of placement value and experience.
Results: Three themes emerged from pre‑placement interviews: nature of night shift, preparing to be a graduate, and change and adjustment. Post‑placement interviews revealed the themes: time to learn and time to teach, adjusting, continuity and preparing to be a graduate.
Conclusions: Night duty placements offered a range of possibilities and challenges. They provided opportunities for skills consolidation, enhanced understanding of nursing work and were perceived to contribute to readiness for graduate practice. Further research is needed to explore such placements on a larger scale.
Enhancing the roles of practice nurses: outcomes of cervical screening education and training in NSW
Authors: Jasiak Shane , Passmore Erin
Published: June 2024

Background: There is a dearth of information about the roles practice nurses (PN) undertake in Australian general practice and what impact these roles have on patient health outcomes following specific education and training programs. Accurate data is vital to evaluate the usefulness and cost effectiveness of item numbers for PN and funding for PN education, in addition to providing some direction for the future education and support of PN.
Methods: An anonymous postal survey was sent to all PN who had completed the Family Planning NSW Well Women’s Screening Course (WWSC) between 2003 and 2007.
Results: Over three quarters of respondents reported their clinical role had expanded, that there was need for ongoing education on all aspects of women’s health, and for some PN there are barriers to role expansion.
Discussion: Role expansion has occurred for PN following education and training that contributes to patient outcomes. Existing methods for collecting specific activity of PN are incomplete. Barriers exist in the utilisation of PN which could be overcome with education of both general practitioners and the community regarding the role of PN and the valuable contributions they can make to general practice.
Development of a clinician‑led research agenda for general practice nurses
Authors: Halcomb Elizabeth , Hickman Louise
Published: June 2024

Objective: This study sought to identify and prioritise research issues as perceived by Australian general practice nurses. In this context, a research priority refers to the most pressing research problems that necessitate exploration to improve clinical practice.
Design: This paper reports the findings of a two‑round Delphi study. Initially, focus groups identified research issues. Subsequently, an online survey facilitated ranking of these issues on a 5‑point Likert scale.
Setting: Australian general practices.
Subjects: Twenty‑five practice nurses participated in the focus groups and 145 practice nurses responded to an online survey.
Main outcome measure(s): The main outcome measure was the prioritisation of research issues by practice nurses.
Results: The focus groups identified 53 research issues. These could be broadly classified as issues related to: (1) the practice nurse role and professional development; (2) general practice service delivery; and (3) disease prevention and health promotion. Survey data identified 34 priority areas from the 53 issues, that were considered important as indicated by a mean score greater than 4.0. These included 17 items related to disease prevention and health promotion, 12 items related to the practice nurse role and professional development and five items related to general practice service delivery.
Conclusions: Issues identified in this study reflect current patterns of practice nurse workload. Emphasis needs to be placed on the translation and use of evidence by practice nurses, as well as the ways in which evidence can support and promote development of their role. The study findings highlight the need for research that is responsive to clinical demands.
The relevance of psychosocial indicators in community palliative care: A pilot study
Authors: Oliver Mary
Published: June 2024

Objective: The objective is to discuss a framework in psychosocial care in community palliative care and the outcomes of a pilot study. This study adds to the existing body of knowledge in palliative care especially in psychosocial aspects of community care.
Design and Setting: Prior to pilot testing the psychosocial indicators for use in community palliative care, a twelve item framework in psychosocial care was developed and validated using the Delphi technique and group consensus from ten experts in community palliative care. The study setting was the community palliative care services consisting of multidisciplinary health professionals.
Subjects: A purposive sample of six participants comprising of palliative care nurses and allied health professionals participated in the pilot study. Using the psychosocial framework in community palliative care participant views on what constitutes psychosocial care in community palliative care was determined. Interview transcripts were the data sources that informed the pilot study.
Main outcome measure: The main outcome was the pilot study results validating the psychosocial framework consisting of 12 indicators in community palliative care. The study findings demonstrate the appropriateness of psychosocial indicators discerning patient and caregiver needs in community palliative care. All participants in the pilot study independently confirmed evidence of the 12 psychosocial indicators in their practice.
Conclusion: The pilot study shows that by incorporating psychosocial care in community palliative care improves decision making in the terminally ill. The implication for practice is that psychosocial aspects of palliative care can indicate patient’s care needs leading to better satisfaction.
Expert to novice: Experiences of professional adaptation reported by non‑English speaking nurses in Australia
Authors: Deegan Joan , Simkin Keith
Published: June 2024

Objective: Adaptation to a new area of clinical practice creates a significant challenge for any nurse, but this is particularly so for migrant nurses of non‑English speaking background (NESB). The aim of the study was to understand the perceptions of overseas qualified nurses, from non‑English speaking backgrounds of their educational experiences in a competency based assessment program (CBAP) in Melbourne with a particular focus on the clinical component.Expert to novice: Experiences of professional adaptation reported by non‑English speaking nurses in Australia
Design: The study was conducted using a modified grounded theory approach. Data were collected using in depth audio taped interviews, observation in clinical practice and personal journal entries. Initially a purposive sample was chosen followed by theoretical sampling. Thirteen NESB nurses, one Australian born nurse and three of their teachers took part in the study. The constant comparative method was used to analyse data.
Setting: The CBAP was conducted in two Melbourne based universities. The study was carried out in four hospitals in Melbourne representing public and private facilities.
Participants: Thirteen NESB nurses, one Australian born nurse and three of their clinical teachers participated.
Main outcomes: Nurses reported feelings of disempowerment caused by discriminatory practices, professional isolation and unrealistic expectations by local nurses. The experience challenged feelings of competence as much as it expanded feelings of competence.
Results: Three themes emerged. Themes revolved around language use, quality of communication and non‑recognition of professional skills by local nurses, which resulted in disempowerment, damaged perceptions of competence and stunted progress towards regaining a full professional identity. There were some suggestions of workforce discrimination.
Conclusions: Strengths of the program revolved around the opportunity for NESB nurses to undertake a formal assessment process in order to achieve registration in Victoria. Limitations related to lack of support in the clinical environment. It was revealed that although the adaptation process was complicated for individuals by cultural, linguistic and professional issues, the main challenge seemed to relate more to the clinical workforce culture that operated at some hospitals. Nurses reported feelings of disempowerment caused by discriminatory practices, professional isolation and unrealistic expectations by local nurses.
Development and validation of a novel approach to work sampling: a study of nurse practitioner work patterns
Authors: Gardner Glenn , Gardner Anne , Middleton Sandy , Gibb Michelle , Della Phillip , Duffield Christine
Published: June 2024

Objectives: This methodological paper reports on the development and validation of a work sampling instrument and data collection processes to conduct a national study of nurse practitioners’ work patterns.
Design: Published work sampling instruments provided the basis for development and validation of a tool for use in a national study of nurse practitioner work activities across diverse contextual and clinical service models. Steps taken in the approach included design of a nurse practitioner‑specific data collection tool and development of an innovative web‑based program to train and establish inter rater reliability of a team of data collectors who were geographically dispersed across metropolitan, rural and remote health care settings.
Setting: The study is part of a large funded study into nurse practitioner service. The Australian Nurse Practitioner Study is a national study phased over three years and was designed to provide essential information for Australian health service planners, regulators and consumer groups on the profile, process and outcome of nurse practitioner service.
Results: The outcome if this phase of the study is empirically tested instruments, process and training materials for use in an international context by investigators interested in conducting a national study of nurse practitioner work practices.
Conclusion: Development and preparation of a new approach to describing nurse practitioner practices using work sampling methods provides the groundwork for international collaboration in evaluation of nurse practitioner service.
Attendance at outpatient cardiac rehabilitation: is it enhanced by specialist nurse referral?
Authors: Johnson Natalie , Inder Kerry , Nagle Amanda , Wiggers John
Published: June 2024

Objective: Strength of physician recommendation is the principal predictor of outpatient cardiac rehabilitation (CR) participation. Since nurses spend more time with inpatients than physicians, recommendations by nurses may be significant. This study sought to determine which health care provider recommendations were independently associated with CR attendance.
Design and setting: Secondary analysis of cross‑sectional survey data provided by patients discharged between March 1998 and February 1999 with coronary heart disease from public hospitals in the Hunter region of New South Wales.
Subjects: Surveys seeking information about advice to attend CR and CR attendance were mailed to 1933 patients aged 20 to 84 years, discharged with a principal diagnosis of acute myocardial infarction, unstable angina pectoris, congestive heart failure, and ischaemic heart disease including those undergoing coronary artery bypass graft surgery and percutaneous coronary intervention. Multiple logistic regression was used to determine which health care provider recommendations were associated with CR attendance.
Main outcome measures: Self‑report of one or more health care provider recommendations to attend CR and self‑reported attendance.
Results: Among the 404 patients advised to attend CR (70% male, 53% ≥65 years), 66% (266/404) attended at least one session. The odds of attendance were significantly higher among patients referred to CR by a CR nurse after adjustment for strength of physician recommendation and other potential confounding variables (odds ratio 3.40, 95% confidence interval 1.74‑6.64).
Conclusions: Since recommendations by CR nurses increased the odds of CR attendance, CR nurse recommendations should be included
Building research capacity in the nursing workforce: the design and evaluation of the nurse researcher role
Authors: Chan Raymond , Gardner Glen , Webster Joan , Geary Alanna
Published: June 2024

Objectives: The Nurse Researcher Project (NRP) was initiated to support development of a nursing research and evidence based practice culture in Cancer Care Services (CCS) in a large tertiary hospital in Australia. The position was established and evaluated to inform future directions in the organisation.
Background: The demand for quality cancer care has been expanding over the past decades. Nurses are well placed to make an impact on improving health outcomes of people affected by cancer. At the same time, there is a robust body of literature documenting the barriers to undertaking and utilising research by and for nurses and nursing. A number of strategies have been implemented to address these barriers including a range of staff researcher positions but there is scant attention to evaluating the outcomes of these strategies. The role of nurse researcher has been documented in the literature with the aim to provide support to nurses in the clinical setting. There is, to date, little information in relation to the design, implementation and evaluation of this role.
Design: The Donabedian’s model of program evaluation was used to implement and evaluate this initiative.
Methods: The ‘NRP’ outlined the steps needed to implement the nurse researcher role in a clinical setting. The steps involved the design of the role, planning for the support system for the role, and evaluation of outcomes of the role over two years.
Discussion: This paper proposes an innovative and feasible model to support clinical nursing research which would be relevant to a range of service areas.
Conclusion: Nurse researchers are able to play a crucial role in advancing nursing knowledge and facilitating evidence based practice, especially when placed to support a specialised team of nurses at a service level. This role can be implemented through appropriate planning of the position, building a support system and incorporating an evaluation plan.
Nurse practitioners are well placed to lead in the effective management of delirium
Authors: Burge Deanne , Kent Wendy , Verdon Jacqui , Voogt Stephen , Haines Helen
Published: June 2024

Objective: To acknowledge the detrimental impact that delirium continues to have on an individual and at the system level in an Australian acute inpatient setting and highlight the potential role that nurse practitioners can play in evidenced based prevention and management.
Setting: Australian acute inpatient public hospital.
Primary argument: Despite extensive literature and national policy driven initiatives delirium continues to be a neglected iatrogenic condition for elderly people. A local investigation by nurse practitioner candidates in an acute care hospital setting highlights the poor recognition of the problem. Delirium management must be a key part of the scope of practice for the gerontological nurse practitioner.
Conclusions: Recognition and management of delirium is problematic. Leadership and continuity of care using evidence based prevention strategies; accurate diagnosis and treatment are important aspects of the gerontology nurse practitioners’ (GNP) scope of practice.
Nursing care of older patients in hospital: implications for clinical leadership
Authors: Milton-Widley Kathleen , O'Brien Louise
Published: June 2024

Objective: This study investigated how nurses managed the care of acutely ill older patients in acute hospital settings.
Design: Constructivist inquiry has been used that included multiple methods of data collection: interviews, observations and documentation of care.
Setting: Participants were recruited from five acute medical and surgical units across two public hospitals.
Participants: Twenty seven registered nurses caring for patients who were aged 65 years and older.
Results: Three themes were identified from the data analysis: being informed about care; limiting care; and rationalising actions. Nurses articulated they understood that quality care was important, but care was limited and interventions were prioritised. The participants blamed health services, lack of clinical leadership, patients, other nurses, and themselves.
Conclusion: These findings have implications for issues of professional agency and clinical leadership. While there is a need for good clinical leadership which is aligned with empowerment to exercise professional agency, speculation about how the dynamics within the units in this study developed and were maintained needs further consideration.
A quality improvement project to prevent, detect, and reduce delirium in an acute setting
Authors: Foster Noellene , Waldron Nicholas , Donaldson Mark , Margaria Helen , McFaull Andrea , Hill Anne-Marie , Beer Christopher
Published: June 2024

Objective: To implement a best practice approach to assessment, management and prevention of delirium in two acute medical wards.
Design: Twelve month quality improvement project using local data to develop and implement local guidelines and tools.
Setting: Two acute medical wards in a tertiary hospital.
Subjects: Ward staff and stakeholders.
Interventions: Delirium screening tool, local clinical pathway, educational program, standardised nursing care plan, practical resource ‘rummage’ boxes, and a carer information pamphlet.
Main outcome measures: Ward audit, focus groups and staff perception survey.
Results: Delirium was found in ten patients among a total of thirty participants (prevalence of 37%) but only half of these cases were diagnosed by the ward medical team. Confusion was noted by nursing staff in all cases of delirium. Almost all of the participants (29/30) had three or more risk factors for delirium and thus were at high risk.Focus group participants were knowledgeable about delirium, but felt that resources and support were limited. Project tools used were acceptable to ward staff (participants of focus groups); however, substantial numbers of staff remained unaware of the project materials.
Conclusion: A global approach to prevention in high risk hospital populations may be needed. Nursing staff are well placed to screen for delirium, however, sustaining change is challenging.
Living with chronic obstructive pulmonary disease: a qualitative study
Authors: Avşar Gülçin , Kaşikç Mağfiret
Published: June 2024

Objective: The purpose of this study is to explore the experience of living with chronic obstructive pulmonary disease, with the aim of gaining an understanding of how the disease affects the patients’ lives.
Design: This study is a phenomenological study.
Setting: The study was conducted in Atatürk University chest service.
Subjects: The study consisted of 14 participants who had, had chronic obstructive pulmonary disease (COPD) for at least one year. The participants ranged from 55‑81 years of age.
Results: Breathlessness was identified as the most troublesome symptom leading to panic and fear. Participants also described a feeling of frustration and loss of social activity. This also resulted in loss of roles and led to emotional trauma.
Conclusion: This study provided valuable insights into how patients view the overall impact and their subsequent degree of coping with COPD from day to day.
The adaptation of probation period of employment on the Aboriginal nursing graduates in Taiwan
Authors: Shih Whei‑Mei Jean , Tsao Lee‑Ing , Liu Ying-Mei , Chuang Su-Hui , Lee Hsiang-Chun
Published: June 2024

Objective: The purpose of this study was to explore the adaptation of probation period of employment on Taiwanese aboriginal nursing graduates in health care institutions.
Design: A cross‑sectional, descriptive design using a questionnaire was employed.
Setting: The setting for the study was an institute of technology in Taiwan offering five‑year, two‑year, four‑year and graduate vocational nursing program.
Subjects: Taiwanese aboriginal nursing student graduates (n=145) were recruited for the study.
Results: Results of this study showed out of 21 items in clinical familiarity, only one item ‘realised organisation culture’ score was fewer than three (out of four). Most graduates felt confident in their job after the three month probation period. All aboriginal nursing graduates felt certain levels of influence in health, leisure activities, social activities, appetite, and sleep. They also expressed a delay of thirty minutes to up to four hours, in completing their scheduled shift. When facing difficulties in their work, they were willing to actively search for solutions. Talking to someone or partaking in leisure activities were two major methods of coping with stress for these graduates.
Conclusion: The results of this study show that the impression of nurse educators and clinical managers that aboriginal nursing students are less adapted in clinical settings than their non‑aboriginal peers may be unfounded.
Team nursing: experiences of nurse managers in acute care settings
Authors: Ferguson Lorriane , Cioffi Jane
Published: June 2024

Objective: This study aimed to explore and describe nurse managers’ experiences with a team‑based approach to nursing care in hospital settings.
Design: A qualitative descriptive study using interviews to explore managers’ experiences of team nursing.
Setting: Medical and surgical wards in an acute care setting
Participants: Five nurse managers (four female and one male) who volunteered to participate following calls for ‘expressions of interest’ in three acute care hospitals.
Findings: The team nursing experiences of nurse managers are described using three main categories: adapting to team nursing, gains with team nursing and concerns with team nursing.
Conclusions: Nurse managers considered gains for staff and patients were made with the implementation of a team‑based approach to nursing care. This team‑based approach to care was regarded by managers to enable nursing staff of varying experience and skill to provide care more safely as direct supervision by more experienced staff was possible. However the role of team leader necessitated staff development and support to enhance clinical leadership skills involved in this new role.
Foot care within the Jordanian healthcare system: a qualitative inquiry of patient’s perspectives
Authors: Abu‑Qamar Ma’en , Wilson Anne
Published: June 2024

Objective: The objective of this study was to elaborate patient’s views of diabetic foot care within the Jordanian healthcare system.
Design: A qualitative approach with unstructured face‑to‑face interviews was used in this study.
Setting: Participants were recruited from six hospitals throughout Jordan plus a university affiliated healthcare centre.
Subjects: Seven patients with diabetes and suffering from a foot burn injury were recruited from a university affiliated hospital plus public hospitals located in Amman, the capital of Jordan. In addition to Amman, the facilities were located in two main Jordanian governorates; Irbid and Al‑Karak.
Results: Our findings are consistent with what is known about barriers to effective diabetic foot care. Participants were not practising preventive foot care behaviours due to personal beliefs about healthcare and the structure and culture of healthcare practice in  Jordan. Specifically, participants of this study believed that the presence of diabetes does not necessitate the need for regular foot examination when there are no active ulcers on their feet. Additionally, providers of healthcare were not performing foot examination as part of regular diabetes care.
Conclusions: Efforts should be made to promote preventive care practices within the context of the Jordanian healthcare system. By so doing, the incidence and severity of diabetic foot ulceration and other consequences may be reduced.
The benefits of debriefing as formative feedback in nurse education
Authors: Cant Robyn , Cooper Simon
Published: June 2024

Objective: This paper explores the nursing literature to identify the educative process and essential features of debriefing.
Setting: Nursing education settings: undergraduate, postgraduate and professional development in nursing and midwifery.
Data sources: Studies of debriefing in nurse education were located in peer reviewed journals between 1990 and May 2010. Searches were made using keywords in six healthcare and one education database. Eleven nursing studies reporting education of individuals and six studies of teams were selected for inclusion; only one study provided learning outcome data. Hence, the literature was synthesised in a narrative form to include related studies.
Primary argument: Formative feedback is important in experiential learning and is often applied in nursing in the form of facilitated structured debriefing. Debriefing is most commonly reported in relation to clinical skills development and as part of individual and team‑based simulation training. Educational outcomes are dependant upon the skills of the facilitator in offering feedback in accordance with best practice. Although a key component of higher level education, there is a lack of published evidence with regard to the effectiveness of debriefing techniques in nurse education. A framework for debriefing practice is presented.
Conclusion: Structured facilitated debriefing is an important strategy to engage students in learning and is essential in simulation training. Further research is warranted to fully understand the impact of the method in nurse education.
A culture change in aged care: The Eden Alternative
Authors: Brownie Sonya
Published: June 2024

Objective: The purpose of this article is to provide an overview of the values that The Eden AlternativeTM represents. The benefits, challenges and potential risks, associated with implementing this model for culture change will also be discussed.
Setting: Currently, 36 residential aged care facilities in Australia and New Zealand have implemented The Eden AlternativeTM. Alzheimer’s Australia has recently adopted The Eden AlternativeTM in two Western Australia respite centres to advance care practices.
Primary argument: The Eden AlternativeTM is a model for culture change in aged care that aims to enrich the lives of all who live and work in residential aged care facilities. Children, animals and plants enliven the environment and create an atmosphere reminiscent of home. The Eden AlternativeTM promotes human growth in aged care environments and strives to empower and enable older people to fulfil their right to construct and pursue meaningful lives.
Conclusions: In the United States of America (USA), The Eden AlternativeTM is associated with numerous benefits, including reductions in the total number and type of medications used by residents, (i.e. a decline in mind and mood‑altering drugs); reduced infection rates among residents; improved levels of sociability among residents; reduced levels of boredom and feelings of helplessness among residents, and improved staff retention rates. However, these findings need to be interpreted cautiously due to lack of information about, and limitations in, study designs. Further research is needed in Australia to establish the impact of this model for culture change on residents and nurses who live and work in these facilities.
Measuring ‘magnetism’ in Australian nursing environments
Authors: Joyce-MCoach Joanne , Crookes Patrick
Published: June 2024

Objective: The aim of this research project was to use the NWI‑R:A tool to measure the organisational features that impact on ‘magnetism’ in Australian health facilities.
Design: The cross sectional survey questionnaire incorporated the Nursing Work Index‑Revised: Australian (NWI‑R:A) developed by Joyce and Crookes (2007).
Subjects: Participants were registered nursing staff (n=262) including ward nurses and managers within a group of four Australian hospitals.
Main outcome measures: To measure the organisational features that impact on ‘magnetism’ in Australian health facilities using the NWI‑R:A tool specifically developed for the Australian context.
Results: The results have identified a number of consistent patterns in nursing staff views in relation to the magnet features present in their current practice environment. The findings have affirmed results reported by Joyce and Crookes (2007) that respondents in the Australian surveys consider positively, the quality of care and the level of support from management in their workplace. The calibre of leadership and support was also considered favourably as were the relationships between health professionals. Conversely the respondents indicated their workplace provided insufficient nurse participation in decision making and inadequate staffing and resources for practice.
Conclusions: The establishment of a tool for the reliable measurement of magnetism in Australian facilities allows for the transferability of the magnet concept to Australia. A better understanding of nursing staff perceptions on the presence of magnet features in their workplace can be used to inform the development of magnetism in Australian health facilities. This research develops the concept of `magnetism’ to health organisations in Australia extending on existing research. By using the magnet framework to underpin the planning and development of organisational governance administrators and managers will be well positioned to improve staff retention.
Enhancing facilitation skills through a practice development Masterclass: the other side of the rainbow
Authors: Hardy Sally , Bolster Danielle , Kelly Teresa , Yalden Joan
Published: June 2024

Objective: Professional impact and practice based outcomes of an inaugural Practice Development Facilitation Masterclass, for facilitators of Practice Development activity in Victoria, Australia, is presented. The Masterclass educational program format is designed to incorporate experiential learning strategies with individual transformation as an explicit goal. The program structure is underpinned by critical social science and delivered through a co-operative inquiry approach. Evidence of personal and professional transformation, identified as a consequence of participation in the Masterclass is reviewed, as we aim to share the ‘other side of the rainbow’, as a symbol of participant’s transformation during the Practice Development Facilitation Masterclass experience.
Primary argument: Skilled facilitation is a key requirement in modern health care, as practitioners are expected to innovate within a changing and complex workplace environment.
Conclusion: Using a Practice Development facilitation Masterclass program format as outlined, provides a structured experiential educational program that could enhance and enable many professional teams to understand and facilitate effective health care practice. Engaging in a co-operative inquiry process provides a supportive yet challenging learning culture for sustaining individual and team’s professional development.
Skin inspection for evaluating the presence of risk indicators to developing pressure ulcers
Authors: Santos Francisca , Vitor Allyne , Teixeira Iane , De Melo Renata , Lopes Marcos
Published: June 2024

Objective: The skin of patients with multisystem trauma or spinal cord injury was inspected in order to evaluate the presence of indicators of risk for pressure ulcer development associated with the Nursing Outcomes Classification (NOC) descriptor ‘Tissue Integrity: Skin and Mucosa’.
Design and setting: A cross‑sectional descriptive study performed in a tertiary referral hospital integrated into the public health network of Fortaleza, Ceará state, Brazil.
Subjects: Forty‑nine patients with multisystem trauma or spinal cord injury.
Results: Most participants were young men with multisystem trauma. The majority used pressure redistribution devices; the most common was a pyramidal mattress. Among NOC indicators for tissue integrity, texture showed the most change, followed by tissue temperature. The sacral region showed the greatest change in colour and temperature, and the scapulas showed the greatest change in temperature. Seventy‑five percent of subjects had a final score of 5:5, indicating non‑compromised skin.
Conclusion: Classification parameters were developed based on NOC indicators and their applicability in our patients was verified. Use of the NOC skin integrity outcomes may be an effective method for identifying risk indicators for pressure ulcer development.
Handover: Faster and safer
Authors: Bradley Stacey , Mott Sarah
Published: June 2024

Objective: This study aimed to introduce bedside handover to three rural South Australian hospitals.
Design: A mixed‑method, pre‑test post‑test evaluative approach involving quantitative (quasi‑experimental) and qualitative (ethnographic) elements was used.
Setting: This study was set in three acute hospital wards.
Subjects: The sample comprised forty‑eight self‑selected enrolled/registered nursing staff; forty‑seven females and one male. Main outcome measure(s) A 7‑point Likert scale (19 items) and ethnographic interview questions covered themes relating to nurses satisfaction of pre and post‑handover processes, frequency of incidents and estimations of time taken to conduct handover processes. Pre and post‑handover processes were digitally timed. Documentation review of pre and post incident frequencies and journaling were also undertaken.
Results: With regard to handover duration, the average total time taken to conduct handover had decreased between 13% and 70% depending on the site. From a practical aspect, this can be regarded as significant. With regard to incident comparison, there is a clear trend from pre to post; the total number of incidents dropping from eighteen to seven.
Conclusions: The results of this study indicate that bedside handover approach is significantly less time consuming than the closed door approach previously adopted. The findings indicate a trend in the reduction of frequency of incidents under the bedside handover process. Literature suggests that incident reduction is directly correlated with increased information accuracy, however, this was not found to be the case in this study. Further research is warranted into factors, other than information accuracy, that may increase safety in clinical settings.
How competency standards became the preferred national technology for classifying nursing performance in Australia
Authors: Grealish Laura
Published: June 2024

Objective: The aim of this study was to explore how competency standards came to be the preferred technology for classifying and nursing performance in Australia at the end of the 20th century.
Design: A genealogical approach to the history of the development of the Australian Nurse Regulatory Authorities Conference (ANRAC) Competencies (1990) is adopted.
Setting: The setting is Australia during the period of 1975 to 1990.
Subjects: Data was collected from minutes of ANRAC meetings, including ANRAC Competencies Committee meetings, government reports, a review of the literature on nurse assessment and competence, and interviews with five nurse leaders involved with the competencies development or regulation during this period.
Main outcome measure: Description of how competency standards came to be the preferred technology for classifying nursing performance in Australia.
Results: The emergence of a national competency standards technology is closely associated with the transfer of nursing education into the higher education sector, an expected shortage of skilled nurses, and microeconomic reform intended to position Australia as a world leader in a global economy. Through skilled rhetoric, nurse leaders established the need for national competency standards to address the issues confronting diverse social worlds while advancing the professional status of nursing through competency standards design.
Conclusion: The national nursing competency standards is a technology that addressed the confluent concerns of those interested in the social worlds of nursing education, nursing research, occupational regulation, professional guilds, and national economic productivity thereby privileging it among instruments to classify nurse performance.
Human factors in nursing: The time is now
Authors: Fryer Lynette
Published: June 2024

Objective: To raise awareness for nurses about the differences between human factors, patient safety, and communication for safer process and system redesign.
Setting: Nursing service environments.
Primary argument: Nursing contributes at the sharp end of healthcare service provision. Communication is the most consistent pre‑condition and consequence in any incident. Clarification of the role of Human Factors design in communication is critical to future research on process improvement in nursing. Human Factors is a key to the best practice management of system and process design as it builds‑in the capabilities and limitations of humans in the workforce. Human Factors design is especially important for nursing as the ‘caring’ profession is vulnerable to high, unmonitored workloads directly and indirectly associated with the nurse’s role and scope of practice. Patient Safety data and subsequent literature supports the aim of designing systems to fit better with humans, not humans working to suit systems. The question remains, how should nurses be doing this?
Conclusion: Health care service provision is complex, but understanding the underpinning human factors of the work environment and engaging in strategies to manage productivity fundamentally bound to human performance is paramount to higher‑quality, safer care. Nurses need to recognise the precursory and antecedent human factors known to cause errors, and study their effect in redesigned systems using anterograde studies. Adoption of Human Factors research and proactively using the lessons learned
To investigate the concerns and benefits of job sharing a community based Clinical Nurse Consultant role
Authors: Woodhouse Gay , Finn Tracey , Johnson-De Wit Karen
Published: June 2024

Objective: The purpose of this study was to identify concerns and benefits of job sharing the Clinical Nurse Consultant (CNC) Youth Health team role and how these impact on job sharing a nursing leadership role.
Design: qualitative descriptive method was used in this study.
Setting: Primary care.
Subjects: The sample comprised of key stakeholders of the Youth Health care team including members of the multidisciplinary team and health care referrers to the Clinical Nurse Consultants as well as the Clinical Nurse Consultants whom share the role.
Main outcome measures: Identification of needs required to assist in developing recommendations for nursing leadership job share models for a changing workforce in healthcare.
Results: The study identified several themes needed to ensure successful job sharing of a leadership role: effective communication, compatibility, support, teamwork, mentoring and flexibility in care provision. Implementing systems that support and encourage these are necessary.
Conclusion: Results suggest that concerns do exist for organisations when staff job share a leadership role. However, several key points can aid in successful job sharing for organisations and nurses as well as improved patient outcomes. These results should help nurses to develop and facilitate increased success for job sharing of leadership roles and contribute to the current need to be flexible in workforce models of nursing.
Practice-based simulation model: a curriculum innovation to enhance the critical thinking skills of nursing students
Authors: Park Mee Young , McMillan Margaret , Conway Jane , Cleary Sonja , Murphy Leonie , Griffiths Sharee
Published: June 2024

Objective: The purpose of this paper is to describe the Practice-Based Simulation Model (PBSM) as a pedagogical framework that enables the integration of simulation in a way that ensures critical thinking skills are explicitly taught as part of the processes and outcomes of students’ learning.
Setting: The PBSM is an innovative pedagogical strategy that offers greater flexibility; one that can be applied to various types of educational contexts and delivery modes, while simultaneously ensuring desired learning outcomes.
Primary argument: The use of simulation has been gaining popularity because of its capacity to provide effective experiential learning as a method of enhancing learners’ critical thinking skills. Despite ample literature that highlights the need for the integration of simulation into nursing curricula, there are few papers demonstrating simulated learning experiences that are underpinned by sound pedagogy. This paper asserts that simulated learning experiences need to be integrated into a curriculum underpinned by sound pedagogy, such as the PBSM, in order to ensure that learning facilitates the development of the critical thinking abilities deemed essential for nursing.
Conclusion: The PBSM demonstrates an example of effective integration of simulation into a curriculum, and highlights the importance of the integral relationship of simulation as a key component of curriculum.