Objective: To explore the experiences of nursing students undertaking a vocational entry pathway of a Bachelor of Nursing course. Background: In Australia, there are three levels of nurses: Nurse Practitioners (NP), Registered Nurses (RN), and Enrolled Nurses (EN). ENs typically undertake vocational diplomas, while RNs complete bachelor’s degrees, and Nurse Practitioners undertake postgraduate master’s degrees. Many ENs seek career advancement to become RNs through degree pathways, a transition that offers expanded knowledge, skills, and scope of practice. This study examined the difficulties and experiences of ENs undertaking bachelor’s degrees to become RNs, particularly under challenges posed by the shift to online education during the COVID-19 pandemic. Study Design and Methods: A concurrent mixed-methods approach was employed. Qualitative focus group interviews, individual interviews, and cross-sectional surveys were conducted among transitioning ENs at an Australian university in 2022 and 2023. The qualitative component comprised of three focus groups with a total of 18 participants and five semi-structured individual interviews. The quantitative survey was disseminated to the same student population. Descriptive frequencies were used to analyse demographic and rating survey questions, summative content analysis for open-ended survey questions, and thematic analysis for individual interviews and focus groups. Results: Of the 77 students surveyed, 70 responded (90.91% response rate), with most participants being female and Australian-born. Survey data showed academic writing and referencing as the top academic challenge (mean score = 2.21), while managing work and study was the leading personal challenge (mean score = 1.81). Content analysis of open-ended responses revealed key concerns such as pace of learning, work-life balance, and short-notice placements. Thematic analysis of interviews and focus groups identified five overarching themes: academic challenges with course structure and online learning, balancing diverse commitments, adapting to university expectations, course management and support systems, and the transformative impacts of COVID-19. Conclusion: The transition from enrolled to registered nurse is marked by numerous obstacles, further exacerbated by the pandemic. Educational institutions and healthcare stakeholders need to recognise these challenges and provide individualised support. The study underscores the importance of holistic support mechanisms in assisting ENs in their professional development and ensuring the healthcare industry benefits from competent RNs. Implications for Research, Policy, and Practice: Research should focus on effective educational models for transition programs, considering online and traditional environments. Policies need to support flexible learning, resource allocation, and clinical placement management. In practice, institutions should implement support systems and individualised learning approaches, and healthcare settings should develop holistic development programs for transitioning nurses.
Objective: This study explored nurses’ perceptions of whether and how reflective practice groups (RPGs) had influenced professional practice and skills development. Background: A growing emphasis on technical competence has coincided with decreased focus on interpersonal aspects of nursing. Consequently, nurses can feel less prepared for the emotional requirements of their role, with potential adverse impacts on patient care. RPGs are a form of group supervision that prioritise interpersonal aspects of nursing care. Method: Purposive sampling recruited thirty-nine nurses who attended RPGs at an Australian regional teaching hospital. Transcripts from four semi-structured focus groups underwent inductive and deductive thematic analyses. Results: Inductive analysis revealed three prominent themes: (1) Trust: Participants who had attended fewer RPGs reported being more guarded, citing prior experiences of workplace incivility, while those who had attended more RPGs reported higher levels of trust. (2) Feedback: Differing opinions on RPGs as a space for giving and receiving feedback were also related to level of attendance, as well as sense of psychological safety and effectiveness of RPG facilitation. (3) Development of Relational Skills: RPGs were identified as a forum for exploring and enhancing interpersonal communication skills. Deductive analysis indicated that nurses used RPGs as a form of job crafting to develop interpersonal skills consistent with requisite professional standards. Discussion: Findings suggest that whilst RPGs are already valued by nurses for their restorative benefits, they also provide normative and formative functions in regard to definition and development of relational skills. Over time, effective facilitation can promote psychological safety and trust within RPGs, helping mitigate unhealthy workplace culture and dynamics that might inhibit authenticity, reflection, and self-evaluation. Conclusion: When effectively facilitated, RPGs can provide restorative, formative, and normative functions in relation to the interpersonal aspects of nursing, with potential positive impacts on workplace culture and patient care. Implications for research, policy and practice: RPGs should be considered as a mechanism for providing emotional and professional support, promoting critical reflection, and developing interpersonal skills for nurses.
Image-based sexual abuse (IBSA) is an escalating national and international problem that has evolved rapidly. In addition to recorded images, the emergence of artificial intelligence (AI) has enabled sophisticated image manipulation. As technology enables new forms of exploitation, IBSA must be recognised as a critical nursing issue that impacts professional conduct, public safety, and therapeutic trust. This editorial aims to raise awareness among all nurses about creating intimate digital images, the expanding forms of IBSA, its impacts on survivors, and the practical actions nurses and nursing leaders can take, grounded in trauma-informed care, moral courage, and professional accountability.
Objective: To reflect upon the potential of digital processing of Business Intelligence (BI) to facilitate nurse management practices across operational, financial and workforce areas. That is, beyond the usual safety and quality monitoring and improvement. Background: Nurse managers are responsible for nursing service delivery within their unit/division/directorate(s), taking a crucial role in the accountability of the functioning of the health system. While use of nursing dashboards as BI supports safety and quality nursing management practices, there is a need to understand BI’s potential to enable nursing practices to broader nursing management, such as financial and workforce areas. Study design and methods: This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. In this qualitative research, in August 2022, four nurse (unit) managers and two nurse leaders, with years of work experience ranging between 2 and 18 years, participated in one-on-one semi-structured interviews. Interview participants shared their experience of BI implementation in operational, financial, and workforce areas of nursing management. The participants were purposively selected from the medical and surgery units in two hospitals: a major metropolitan hospital and another, a principal tertiary referral hospital. Results: Thematic analysis, following an inductive analysis of the interview data, generated two overarching themes. One, BI contributing to enabling of nursing management and two, BI requiring continuous improvement. Discussion: Nursing dashboard implementation as BI in operations, finance and workforce areas provided efficient and timely access to consolidated, visually meaningful, and relevant data. The dashboard showed potential for supporting nursing management practices, such as proactive data analysis, data-informed work conversations with staff, and better decision-making in areas such as budgeting, staffing and patient flow management. However, the implementation of BI needs to be a continuous improvement process, with greater focus on educating and collaborating with end-users. The study implies nursing dashboards should be implemented with metrics of broader nursing management practices in alignment with the needs of the end-users and the relevant health system. Conclusion: There is a case for using BI in work areas beyond safety and quality to support nurses in broader nursing management practices. Future studies exploring nurses’ long-term experiences with BI and co-designing with end-users of BI would be beneficial to facilitating nursing management practices.
Objective: The study aims to examine the effect of a simulation escape room developed to practice clean intermittent catheterisation on senior nursing students’ knowledge, satisfaction, and self-confidence in learning. Methods: The study employed a single-group pre- and post-test design. The researchers developed a clean intermittent catheterisation simulation escape room based on Flow Theory. Students participated in the game immediately after receiving clean intermittent catheterisation training. A total of 102 students volunteered to take part in the study. Data were collected using a “Sociodemographic Questionnaire”, “Knowledge Test”, “Self-Evaluation Scale for Simulation Laboratory Practices”, and “Student Satisfaction and Self-Confidence in Learning Scale”. Numbers, percentages, means, and standard deviations were used to describe the data. The Kolmogorov–Smirnov test was used to assess normality. The Wilcoxon test was used to compare the students’ pre- and post-test knowledge scores. Results: The difference between students’ pre- and post-test knowledge scores was statistically significant (p = 0.001). Students’ levels of satisfaction and self-confidence were found to be notably high. They also expressed positive views regarding their self-evaluation of simulation laboratory practice scores. Conclusion: The clean intermittent catheterisation simulation escape room positively influenced senior nursing students’ “knowledge”, “satisfaction and self-confidence in learning”, as well as their “self-evaluation of simulation laboratory practices”. Implications for research, policy, and practice: The demonstrated positive impact of a clean intermittent catheterisation simulation escape room may encourage nurse educators to integrate this approach into undergraduate nursing curricula.
Objective: The objective of this study is to provide a possible strategy to enhance professional integration through education relating to a new concept: Intra-Professional Cultural Competence (IPCC). This concept primarily focuses on the interactions between nurses within the workplace. Background: Australia's nursing workforce is starting to reflect the nation's diverse population. In 2022, 43% of the nursing workforce were born overseas, with 22% being internationally qualified nurses and 21% locally qualified, but overseas-born. As a result, up to 43% of the workforce may be culturally and linguistically diverse. Locally qualified, overseas-born nurses may be first-generation migrants or international students who have remained working in Australia after graduation. The latter group has been steadily rising. These three groups of nurses (overseas-born first-generation immigrants, international nursing graduates and internationally qualified nurses) may face similar challenges integrating into the workforce. Among the most frequently mentioned challenges for international students and internationally qualified nurses are language barriers, differences in communication patterns, and situations related to racism, discrimination, bullying, and harassment. Study design and methods: This article is structured as a discussion paper, grounded in research, and backed by relevant literature. Results: This paper defines IPCC as: “A set of congruent behaviours and attitudes that enable professionals to work respectfully and effectively in cross-cultural situations”. IPCC involves four main domains: a) mutual collaboration, b) the prevention of racism, discrimination, bullying, and harassment among nurses, c) respect of values, attitudes, and beliefs of colleagues that may differ across cultures, and d) appropriate responses to cross-cultural interactions with colleagues. Discussion: The descriptor "cultural competence" was deliberately chosen over alternatives like “cultural safety” or “cultural humility”, recognising that these concepts mainly focus on the power dynamics between healthcare providers and patients, which may not always apply to interactions between healthcare professionals. "Competence" suggests having the skills, knowledge, and abilities necessary for effective role fulfilment that could be developed through training and skill acquisition. Consequently, IPCC refers to the essential skills, knowledge, and abilities required to engage respectfully and effectively in cross-cultural interactions with other nurses. Conclusion: The relevance of this paper lies in identifying the growing proportions of both overseas-born, locally qualified nurses and internationally qualified nurses. Mutual collaboration and communication are essential to prevent incidents related to racism, discrimination, bullying, and harassment, while also fostering team cohesion, well-being, job satisfaction, and retention. Clear communication is crucial for maintaining quality care, ensuring patient safety, and preventing fatalities. This is particularly important in multicultural teams, such as those commonly found in Australia, where a growing number of nurses may not speak English as their first language. Implications for research, policy, and practice: With 43% of nurses being born overseas, the persistence of racism, discrimination, bullying, and harassment within clinical settings highlights the gap between existing regulations and their enforcement. Intra-professional cultural competence could positively influence communication, teamwork, and mutual respect within nursing, potentially reducing racism, discrimination, bullying, and harassment, improving nurse retention, and overall quality of care. Strengthening IPCC frameworks at institutional, national, and clinical levels and incorporating them into orientation programs and continuous professional education could serve as an effective strategy to address these issues.
ABSTRACT Cervical screening is not offered within all maternity services in Australia, with a clear gap between clinical guidelines and best practice. Women remain unscreened despite multiple pregnancies. Collective action is urgently needed across all professional groups to make cervical screening a routine part of maternity care. Nurses and midwives are well placed to champion this and the availability of self-collection for cervical screening makes this a realistic goal. However, implementation of screening in maternity care requires system changes to reduce structural hierarchies. We all have a part to play in the equitable elimination of cervical cancer. CORRECTION NOTICE - ERRATUMCorrection to: “Cervical screening in pregnancy: an opportunity for nurses and midwives to drive equitable cervical cancer elimination” by Jordan Dixon and Kate Flynn. A correction (ERRATUM) to this article has been issued at the request of the authors. In the original publication of this article, edits were introduced during the production process. This resulted in the publication of a version of the manuscript that did not represent the authors’ writing or position. The article has now been corrected to include the correct wording as written and intended by the authors. A Correction Notice (ERRATUM) has been published and is available at: https://doi.org/10.37464/2025.424.2494 The editors and publisher apologise for this error and any confusion it might have caused.
CORRECTION NOTICE - ERRATUM Correction to: “Cervical screening in pregnancy: an opportunity for nurses and midwives to drive equitable cervical cancer elimination” by Jordan Dixon and Kate Flynn A correction (ERRATUM) to this article has been issued at the request of the authors. In the original publication of this article, edits were introduced during the production process. This resulted in the publication of a version of the manuscript that did not represent the authors’ writing or position. This is not standard practice for the journal and resulted in the incorrect and unapproved manuscript moving forward to publication. The article has now been corrected to include the correct wording as written and intended by the authors and is available from: doi:10.37464/2025.424.2478 A comprehensive list of edits can be viewed in the PDF on this page. The original article, marked with a Correction Notice, has been archived and be available upon request from the journal. The editors and publisher apologise for this error and any confusion it might have caused
Objective: To aid nurses’ understanding of effect size utilisation in clinical and research contexts. Design and data sources: Methodological discussion paper that is based on the author’s experiences as a clinician and researcher and is supported by literature. Primary arguments: Patient change is a key consideration for clinical nurses and nurse researchers. Nurses routinely use measurement instruments to identify and quantify such change informing intervention outcomes, clinical decision-making, and health research conclusions. Whether improvement or deterioration, patient change should be operationalised through the magnitude of change (i.e., effect size). Effect sizes relative to the context of change (clinical vs empirical) and the reliability of the instruments used are important considerations here. However, despite discourse on the utilisation of effect sizes in health, aspects of effect sizes can be poorly understood, misapplied or overlooked. Furthermore, nurse researchers may default to Cohen’s d for use in power analysis and results reporting where they should be considering an effect size derived from other methods in the first instance. In part, this is due to the literature surrounding aspects of effect size being inherently complex, impacting on nurse and nurse researchers’ capacity to acquire a thorough understanding of the topic. Conclusions: Effect size in health can be particularly complex. Nevertheless, nurses and nurse researchers should have some understanding about effect sizes and their role in measuring patient change in clinical and empirical contexts. They need to be aware of how measurement instruments detect, track and quantify patient change and the resultant magnitude of effect relative to the clinical significance of the change for the patient. This paper aids nurses to effect robust change based on informed decision making thus strengthening their evidence-based practice. What is already known about the topic? Patient change informs nurses clinical decision-making strategies; however, nurses may not consider the magnitude of change relative to the context of change and the reliability of the instruments used to identify and quantify the change Effect size is one of the four criteria needed for power analysis and is perhaps the most difficult to identify Underpowered studies result in imprecise estimation of the true effect, which could be an over- or an under-estimation What this paper adds: This paper dispenses with the inherently complicated and technical terminology on effect size often found in the literature that can impact understanding. Consequently, this paper equips nurses to critique research literature and apply this knowledge to their clinical practice Provides other methods for identifying a suitable effect size for use in power analysis and results reporting as opposed to defaulting to Cohen’s d Draws attention to the importance of reporting effect size and associated confidence interval with research results data
Objective: To synthesise the origin, evolution, and definition of comprehensive care. Background: Understanding comprehensive care is of great importance for rapidly evolving modern healthcare systems to adapt to a more holistic approach to care delivery. However, its concept remains poorly defined and inconsistently applied. Study design and methods: We searched literature via PubMed, Scopus, and CINAHL as well as Google Scholar, supplemented by our prior review and empirical research. Findings were synthesised narratively to support a critical discussion of the origin, evolution, and definition of comprehensive care. Results: Comprehensive care emerged in the 1950s-1960s. Its concept has evolved significantly since its inception. Different interpretations and applications emerged as this term became more widely referenced. We identified three defining characteristics of comprehensive care (person-centredness, multidisciplinary collaboration, and care coordination), and proposed an operational definition grounded in these principles. Conclusion: This paper proposes an operational definition of comprehensive care to support consistent understanding and practice. Aligning policy with comprehensive care principles is essential for translating the concept into practice. Implications for research, policy, and practice: This paper contributes to the theoretical development of comprehensive care by clarifying its fundamental characteristics, which can support a more consistent understanding that can inform future standards, research, and implementation efforts.
Background: Seventy percent of hospital admissions require a peripheral intravenous catheter (PIVC) and there is a shortage of skilled inserters. In some countries, undergraduate nursing and midwifery programs teach PIVC insertion, however, in Australia, this is typically limited to simulated PIVC insertion, without hospital-based PIVC insertion experience. We aimed to achieve nursing and midwifery undergraduate clinical competence in PIVC insertion by including hospital-based training. Objectives: To understand 1) the experience of undergraduate nurse/midwife students who received hospital-based training to achieve PIVC insertion competency; and 2) the impact of the training on nurses/midwives' future PIVC insertion practice.Study design and methods: Final year students completed a 5-day clinical placement with a hospital vascular access surveillance and education service. Semi-structured interviews occurred at the completion of the placement. A brief cross-sectional survey 12 months later questioned the impact of this training on their subsequent practice as registered nurses/midwives. Interviews were analysed using Braun and Clarke's six phases of inductive thematic analysis to detail participants' experiences and beliefs. Survey data was described descriptively and barriers and enablers to clinical competency were explored. Results: A total of 19 students participated in the clinical placement between March and September 2022 with 16 achieving clinical competency. Eleven students were interviewed. Key themes developed include: 1) clinical PIVC training for undergraduate nurse-midwives builds knowledge, skills, and confidence; 2) mixed mode clinical placement learning builds on undergraduate university training; and 3) barriers and enablers to clinical competency. At 12 months, 60% of participants were employer-certified as PIVC competent and had performed the procedure as a graduate nurse or midwife. Conclusions: Clinical placement with hospital-based vascular access services can enable undergraduate student nurses and midwives to develop PIVC competency. The study highlights the critical role of clinical placements in better preparing nursing and midwifery students for the demands of contemporary healthcare practice. What is already known about the topic? center dot In Australia, nursing and midwifery undergraduate education commonly includes PIVC insertion, however, students do not have the opportunity to obtain competency in PIVC insertion via a hospital-based training program. center dot Nurses and midwives have the opportunity to obtain their PIVC competency once registered, usually within specialty departments such as emergency, operating theatres, and birth suite. center dot Internationally, nursing students commonly learn to insert PIVCs and continue to utilise this skill for the duration of their clinical placements. What this paper adds center dot This paper demonstrates that nursing and midwifery students are able to obtain PIVC competency as part of a hospital-based training program and maintain this skill after one year.
Background: Globally, healthcare systems struggle to retain critical care nurses (CCNs) due to high turnover intentions. The mediating roles of emotional intelligence and sense of belonging in mitigating moral distress, stress, and fatigue are insufficiently explored. Objective: This study investigates how moral distress, work stress, and fatigue influence CCNs' turnover intentions through the mediating pathways of emotional intelligence and a sense of belonging. Study design and methods: A multicentre, crosssectional survey was conducted across eight public and private hospitals. The study enrolled 432 CCNs between May 20 and July 31, 2024. Each participant completed a validated, structured questionnaire that was self-administered and paper based. Descriptive statistics, ANOVA, independent samples t-tests, and path analysis were utilised for data analysis. Results: CCNs reported high mean scores for fatigue (21.50), moral distress (65.10), and turnover intention (14.75). Path analysis indicated a direct significant positive effect of moral distress on fatigue ((3= .69), work stress ((3 = .38), and indirectly on turnover intention ((3 = .12). Fatigue further intensified work stress ((3 = .40). Notably, significant moral distress was inversely associated with emotional intelligence ((3 =-.24) and positively with sense of belonging ((3 = .24). In turn, both emotional intelligence ((3=-.31) and a sense of belonging ((3=-.27) were negatively associated with turnover intentions. Conclusions: This study elucidates the significant influence of adverse workplace factors, specifically moral distress, fatigue, and work stress, on the CCNs' turnover intentions. Such stressors erode core nursing competencies and present a tangible risk to patient care standards. Importantly, the results underscore the protective functions of emotional intelligence and a strong sense of belonging, which appear to attenuate the negative impact of these occupational stressors. Implications for research, policy, and practice: By mitigating the impact of moral distress and cultivating a more supportive work environment, healthcare organisations can foster environments that reduce occupational stress, alleviate fatigue, and consequently decrease nurses' turnover intentions. Addressing these detrimental workplace dynamics is essential for enhancing the work environment for nurses and ensuring the provision of optimal patient care within healthcare settings.
Objective: To justify and discuss a model of nurse leadership development that recognises the inherent leadership potential of novice nurses. Background: Effective nurse leadership is associated with quality and safety of patient care, enhanced staff engagement, organisational efficiency and adaptation to current challenges. Extensive research into nurse leadership has produced a range of evidence-based theoretical frameworks that integrate significant leader characteristics with practice implications. However, few studies encompass inherent leadership characteristics and practice capabilities of novice nurses within a leadership development framework. Methodology: A review of current academic literature on novice nurse practice and development was undertaken to inform selected themes and discussion. Discussion: This paper discusses novice nurse leadership development as represented by a novel theoretical framework that places novice nurses within the context of their emerging practice. An exploration of four core dimensions, 1) leading self, engaging others, 3) shaping teams, and 4) embracing innovation, presents opportunities for development within university and workplace learning contexts. Conclusion: This paper offers a focused and novel framework for developing novice nurse leadership skills. This approach represents a change from traditional paradigms that equate leadership with Implications for research, policy, and practice: This discussion contributes to a wider discussion on the preparation of the nursing workforce for future practice in an environment that is characterised by complex healthcare systems and workforce challenges. Our framework can be used to reflect on current novice nurse leader development in universities and workplaces, and signals avenues for research of current practice areas. What is already known about this topic? center dot There is widespread advocacy for nursing leadership development. center dot The positive influence of effective leadership on patient care and nursing workplaces has been established. center dot Conceptual frameworks for novice nurse leadership development have emerged from the academic literature. What does this paper add? center dot This paper extends existing frameworks by encompassing inherent leadership characteristics and practice capabilities of novice nurses within a leadership development framework. center dot Contemporary novice nurse leader roles, practice challenges and opportunities for development are explored. center dot A model of novel nurse leadership that includes leading self, engaging others, shaping teams, and embracing innovation is proposed.
Objective: This case study describes the introduction and evaluation of a structured perioperative education program for novice nurses in the theatre setting to address ongoing retention and attrition rates of skilled perioperative nurses. Background: A proficient and dynamic workforce is essential for speciality areas, including surgical theatre environments. Whilst perioperative nurse education occurs at undergraduate and postgraduate universities, assimilation and further development of skills into the work environment takes time and requires a supportive workplace culture. Lack of support and exposure to clinical experience limits the competency and confidence of novice nurses, which negatively affects retention in specialty areas. Study Design: Twenty novice nurses underwent a three-month rotation across 14 perioperative speciality areas with an assigned nurse mentor between 2021 and 2024. An educational learning package was developed to track the knowledge, confidence, and capability of novice nurses. Focus group sessions were held every three months, and surveys were administered to assess the overall effectiveness of the program. Results: Nineteen novice nurses reported increased confidence in their knowledge and overall confidence in the clinical area. Findings demonstrated that the program's structure was a strength, while organisational impacts were the main barrier, including a lack of staff and time pressures identified as barriers. Overall, workplace culture was improved for all staff with improvements in staff retention. Conclusion: The retention of skilled perioperative staff is essential for best patient outcomes, organisational efficiencies, and a positive work culture and environment. This project has been successful in bridging the theory-practice gap, promoting skill acquisition and professional confidence for NN, whilst enhancing positive workplace culture and staff retention within the study setting. There is a need to review the self-paced learning booklets to enhance the documentation and to show completion by all participants. Implications for practice: Attrition rates in speciality areas that require a high level of ability, such as the perioperative environment, remain a constant concern for healthcare. This study proves the importance of investing in skill development for novice perioperative nurses through a structured educational program in the clinical setting. Supportive frameworks enhance nurses' knowledge and confidence, leading to retention in speciality areas. What is already known about the topic? center dot Perioperative areas are high-pressure environments that require a skilled, specialised workforce to ensure patient safety. center dot Maintaining a skilled workforce is problematic as a result of an ageing nursing workforce and the impact of the global pandemic (COVID-19 pandemic). center dot Perioperative nurse education occurs at undergraduate and postgraduate universities, although assimilation of skills into the work environment takes time and requires a supportive workplace culture. What paper adds. The findings add to current literature, which finds competency and confidence of novice nurses can be enhanced through supportive education and clinical exposure in the perioperative environment. It proves that providing a supportive educational framework that incorporates a mentoring structure can be beneficial for novice and senior nurses in fostering a positive work culture.
Objective: To explore the perceptions of registered nurses and personal care workers in residential aged care facilities (RACFs) regarding factors contributing to early clinical deterioration and potentially unnecessary hospital presentations. Background: Persistent workforce shortages, inadequate staffing levels, inconsistent care standards, and suboptimal communication in RACFs contribute to increased hospital transfers. However, many hospital presentations from RACFS are unwarranted and avoidable, and many residents could be better treated by alternative means in place. Study design and methods: This study used a qualitative methodology in which semi-structured focus groups with registered nurses and personal care workers from two private RACFs in Queensland were used to gather in-depth accounts of experience and perceptions. Data was analysed using Braun and Clarke's reflexive thematic analysis approach. Results: Four major themes emerged: 1) Clinical decision-making and confidence under pressure, with RNs reporting low confidence and anxiety regarding whether or not to transfer; 2) Organisational and interprofessional dynamics, with staff describing tensions with emergency and ambulance services; 3) Clinical reasoning and support structures, where staff described the value of Nurse Practitioners and clinical guidelines in decision making; 4) PCW role clarity and communication, where uncertainty about scope of practice and fragmented handover procedures were described. Conclusion: Hospital transfer decisions in aged care are complex and heavily influenced by the experience and confidence of Registered Nurses (RNs). Less experienced RNs tend to make more cautious decisions, sometimes leading to avoidable transfers. Nurse Practitioners (NPs) help support better decisions, but organisational pressures and unclear roles, especially for Personal Care Workers (PCWs), create challenges. These factors collectively promoted risk-averse decision-making and increased reliance on hospital transfers. Improving training, clarifying roles, and fostering teamwork can reduce unnecessary transfers and improve care quality.
Objective: To explore patients' perspective about promoting tracheostoma self-care. Background: Promoting self-care is one of the main areas of intervention for nurses who care for patients undergoing tracheotomy/total laryngectomy. Self-care can improve autonomy, quality of life and reduce tracheostoma complications. To achieve this, interventions need to be evidence-based and sensitive to the patients' needs and preferences. However, little is known about patients' experiences of learning to care for their tracheostoma and their preferences. Study design and methods: A qualitative descriptive study was carried out through semi-structured, individual, and face-to-face interviews with patients who had undergone tracheotomy/ total laryngectomy (n = 17). Purposive sampling was performed with maximum variation. All interviews were audio-recorded and transcribed verbatim, and data were analysed using qualitative content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: This study identified two main themes. The first was the experience of living with a tracheostoma. Participants recognised the implications of the tracheostoma in everyday life, the importance of tracheostoma awareness, critical moments, possible response patterns, and the personal, social, and health-related factors that can affect this experience. The second theme identified was the promotion of tracheostoma self-care. The participants mentioned the rebuilding of autonomy as the main objective, the thematic content that should be addressed by nurses before and after the surgery, the different strategies and resources that can be used, and what determines the appropriate time to intervene. Conclusion: Despite the challenges of living with a tracheostoma, participants acknowledged the promotion of self-care as crucial for regaining autonomy. Nursing interventions that incorporate contents, methodologies, and implementation moments sensitive to the preferences, needs, and characteristics of each patient, which are maintained over time, appear to be the desired approach according to the participants. Implications for research, policy, and practice: This study's findings can help to design and implement nursing interventions to promote tracheostoma self-care that leads to better health outcomes. What is already known about the topic? center dot Undergoing a tracheotomy/total laryngectomy requires adapting to a new condition of life. Promoting self-care in these patients enhance autonomy, and adaptation to the tracheostoma. center dot Nursing care for tracheostoma patients is poorly systematised. So, interventions to promote tracheostoma self-care should be created and tested, to improve clinical practice. center dot Nursing interventions tailored to the specificities, needs, and preferences of the target population are more likely to be accepted and effective. Therefore, it is important to understand patients' perception and involve them in identifying appropriate interventions. What this paper adds center dot This study can help nurses to understand the complexities faced by people living with a tracheostoma. Recognising the implications, critical events, response patterns, and factors that influence this experience can assist nurses in anticipating care needs over time. center dot The study participants emphasised the relevance of self-care for maintaining autonomy. They identified the issues, strategies and resources, and significant moments for promoting self-care for people with a tracheostoma. center dot The results of this study can contribute to defining more coordinated, timely, and tailored nursing care models that meet the needs of individuals and improve health outcomes.
Objective: To explore the motivation and ability of midwives in Victoria to contribute to maternity service reform recommendations, specifically expansion and promotion of midwifery continuity of care models. Background: Since the inception of the National Maternity Services Plan in Australia in 2010, midwifery continuity of care has been a key priority area for maternity service reform. It is known that midwifery continuity of care models improves outcomes for mothers and babies, and that midwives' value and support working in these models. What is not known, is the motivating factors and ability of midwives in Victoria to contribute to Maternity Services Reform, through promotion of the initiation and expansion of midwifery continuity models. Study design and methods: A cross-sectional, qualitative descriptive design was used. Ten midwives participated, resulting in six semi-structured individual interviews and one focus group of four midwives. Interview and focus group data was analysed using thematic analysis. Results: Midwives in this study were generally supportive of maternity service reform, especially midwifery continuity of care models, but many felt powerless to contribute to reform agenda. Midwives described limited knowledge of maternity service reform and lack of exposure to midwifery continuity of care models. Systemic issues like medical dominance and lack of institutional support further hindered midwives' ability to enact change. Despite these challenges, many midwives expressed a desire to work to their full scope, suggesting that with adequate education, mentorship, and leadership, they could become more active agents of reform. Conclusion: Midwives within this study are motivated to contribute to Maternity Services Reform and support greater access to midwifery continuity of care models, however, the majority felt unable to make an appreciable contribution to the expansion and promotion of these models. Strategies identified to improve midwives' contribution to reform included: education on transforming maternity care, having access to supportive midwifery leaders, successful interdisciplinary collaboration, and fostering a strong midwifery professional identity. Implications for research, policy, and practice: Participants in this study were motivated to contribute to maternity service reform and practice in midwifery continuity of care models. However, there were many aspects of their role as a midwife and the current maternity care system that did not enable them to contribute. Recommendations to improve midwives' ability to contribute include education programs that focus on continuity of care experiences, successful and respectful interdisciplinary collaboration, identifying midwifery leaders with a strong vision for reform agenda, and strengthening midwifery as a profession. What is already known about the topic? center dot Widespread implementation of midwifery continuity of care models remains slow in Australia. center dot Midwives' ability and motivation to contribute to these models is unknown. center dot Australia's maternity service reviews have recommended expansion of midwifery continuity of care models. What this paper adds To contribute to reform recommendations around midwifery continuity of care models, midwives require: center dot education on transforming maternity care. center dot supportive midwifery leaders & interdisciplinary collaboration. center dot a strong midwifery professional identity.
Background: Recurrent ascites is a common complication of liver decompensation that often requires repeated abdominal paracentesis for symptom management. This study was to retrospectively analyse the safety and feasibility of a nurse-led abdominal paracentesis clinic at a regional health service ambulatory care unit. Methods: The Advanced Practice Nurse (APN) identified to lead this service had ten years of post-graduate nursing experience, six of which included specialised hepatology training in a role as a Hepatology Clinical Nurse Consultant. She was enrolled for further study as a Nurse Practitioner. The APN observed five paracentesis procedures by Interventional Radiologists and Medical Officers. She was then supervised for five paracentesis procedures, before attempting the procedure independently. A retrospective analysis was conducted to assess the safety and feasibility of this service. Results: From July 27, 2022, to March 22, 2023, 59 abdominal paracentesis procedures were performed by an APN. The overall success rate was 97%. The average amount of ascitic fluid removed was 7.57 Liters. The average time of the procedure within the ambulatory care unit from admission to discharge was 5.75 hours. There were no episodes of abdominal wall haematoma, hemoperitoneum, intraperitoneal haemorrhage, infection, spontaneous bacterial peritonitis or death post-paracentesis. There was 1 episode of excessive leakage at insertion site (1.69%), 1 episode of pain at insertion site (1.69%) and 1 episode (1.69%) of localised erythema to the insertion site. These complication rates are comparable to published studies of nurse-led paracentesis in other countries. Conclusion: Nurse-led paracentesis is a safe and feasible way to manage patients with abdominal ascites secondary to liver disease. Expanding the scope of practice of an APN would improve access to care and support for those living with cirrhosis in regional and remote areas. This would help address the current health workforce maldistribution and consequent disparate health outcomes within regional Australia.
Objective: To decrease the mean length of stay in the neonatal intensive care unit (NICU) for term infants requiring less than 24 hours of continuous positive airway pressure (CPAP). Background: Term infants with respiratory distress are frequently admitted to the NICU for noninvasive respiratory support with CPAP. The most common cause of respiratory distress in term babies is transient tachypnoea of the newborn (TTN). In term infants with mild to moderate cases of TTN, symptoms typically resolve within 24 hours. However, we observed that many term infants who were admitted with respiratory distress had prolonged admissions to NICU, even after their respiratory distress had resolved. Study design and methods: Quality improvement methodology was used to undertake this study. We used the Evidence-Based Practice for Improving Quality (EPIQ) framework to conduct a single plan-do-study-act (PDSA) cycle. The principal change idea was developing and implementing a new guideline incorporating a nurse-led decision-making model of care. We chose outcome, process, and balancing measures to determine the risks and benefits of implementing this guideline. Periods pre-and post-implementation of the guideline were selected for comparison. Results: A total of 69 term infants who required less than 24 hours of CPAP were included in the study (30 pre-and 39 post-). The mean length of stay in NICU significantly decreased from 21.4 to 14.0 hours (p<0.001). There were statistically significant decreases in the commencement of intravenous glucose infusions (83.3% to 23.1%, p<0.001), the time to enteral milk feed (8.0 to 2.4 hours, p<0.001), and the time to first suck feed (13.1 to 9.7 hours, p = 0.003). No differences in other project measures were found. Conclusions: This quality improvement project implemented a guideline that enabled nurse-led decision-making, significantly decreasing the length of stay in the NICU and the use of intravenous glucose infusions. There was no evidence of any adverse outcomes with this approach.
