Objective : To investigate the psychosocial effects of the COVID-19 pandemic on nurses and midwives working in acute care settings, specifically psychological distress, self-reported concerns, and perceived impact on their work and personal lives. Background : Little is known about the psychosocial impact of the pandemic on nurses and midwives in Australia, a country with a substantially lower number of COVID-19 cases and deaths than many others. Few studies investigating the prevalence of psychological distress among nurses during the pandemic have been conducted in more than one setting, especially in the Australian context. study design and methods : Cross-sectional survey design (STROBE checklist). Nurses and midwives (n=1,611) at four metropolitan tertiary health services in Melbourne, Australia completed an anonymous online survey between 15 May and 31 August 2020, which assessed symptoms of depression, anxiety and stress (DASS-21); concerns related to COVID-19; and other effects of COVID-19. Space was provided for free-text comments. results : Approximately one fifth of respondents reported moderate to extremely severe symptoms of depression, anxiety and stress. Fewer years of clinical experience were significantly associated with higher levels of psychological distress. More than half of the respondents were extremely/very concerned about passing COVID-19 on to family members and about their family’s health, and almost half were concerned about caring for a patient who had confirmed or suspected COVID-19. Respondents reported that certain precautionary measures such as personal protective equipment (PPE) interfered with their ability to provide optimal patient care. Positive

AIMS:To explore (1) the context in which nursing executives were working, (2) nursing's contribution to the healthcare response and (3) the impact from delivering healthcare in response to the pandemic.DESIGN:Retrospective, constructivist qualitative study.METHODS:Individual interviews using a semi-structured interview guide were conducted between 12 February and 29 March 2021. Participants were purposively sampled from the Victorian Metropolitan Executive Directors of Nursing and Midwifery Group, based in Melbourne, Victoria the epi-centre of COVID-19 in Australia during 2020. All members were invited; 14/16 executive-level nurse leaders were participated. Individual interviews were recorded with participant consent, transcribed and analysed using thematic analysis.RESULTS:Four inter-related themes (with sub-themes) were identified: (1) rapid, relentless action required (preparation insufficient, extensive information and communication flow, expanded working relationships, constant change, organizational barriers removed); (2) multi-faceted contribution (leadership activities, flexible work approach, knowledge development and dissemination, new models of care, workforce numbers); (3) unintended consequences (negative experiences, mix of emotions, difficult conditions, negative outcomes for executives and workforce) and (4) silver linings (expanded ways of working, new opportunities, strengthened clinical practice, deepened working relationships).CONCLUSION:Responding to the COIVD-19 health crisis required substantial effort, but historical and industrial limits on nursing practice were removed. With minimal information and constantly changing circumstances, nursing executives spearheaded change with leadership skills including a flexible approach, courageous decision-making and taking calculated risks. Opportunities for innovative work practices were taken, with nursing leading policy development and delivery of care models in new and established healthcare settings, supporting patient and staff safety.IMPACT:Nursing comprises the majority of the healthcare workforce, placing executive nurse leaders in a key role for healthcare responses to the COVID-19 pandemic. Nursing's contribution was multi-faceted, and advantages gained for nursing practice must be maintained and leveraged. Recommendations for how nursing can contribute to current and future widespread health emergencies are provided.

Introducing new technology, such as an electronic medical record (EMR) into an Intensive Care Unit (ICU), can contribute to nurses' stress and negative consequences for patient safety. The aim of this study was to explore ICU nurses' perceptions of factors expected to influence their adoption of an EMR in their workplace. The objectives were to: 1) measure psychological factors expected to influence ICU nurses' adoption of EMR, and 2) explore perceptions of facilitators and barriers to the implementation of an EMR in their workplace. Using an explanatory sequential mixed method approach, data were collected using surveys and focus groups. ICU nurses reported high scores for motivation, work engagement and wellbeing. Focus group analyses revealed two themes: Hope the EMR will bring a new world and Fear of unintended consequences. Recommendations relate to strategies for education and training, environmental restructuring and enablement. Overall, ICU nurses were optimistic about EMR implementation.

The use of electronic medical record (EMR) systems is transforming health care delivery in hospitals. Perioperative nurses work in a unique high-risk health setting, hence require specific considerations for EMR implementation. This research explored perioperative nurses' perceptions of facilitators and barriers to the implementation of an EMR in their workplace to make context-specific recommendations about strategies to optimise EMR adoption. Using a qualitative exploratory descriptive design, focus group data were collected from 27 perioperative nurses across three hospital sites. Thematic analyses revealed three themes: 1) The world is going to change; 2) What does it mean for me? and 3) We can do it, but we have some reservations. Mapping coded data to the Theoretical Domains Framework identified prominent facilitators and barriers, and informed recommended implementation strategies for EMR adoption by perioperative nurses.

In Australia, almost 40% of nurses are aged 50 years and older. These nurses may be vulnerable to leaving the workforce due to challenges experienced during electronic medical record (EMR) implementations. This research explored older nurses' perceptions of factors expected to influence their adoption of an EMR, to inform recommendations to support implementation. The objectives were to: 1) measure psychological factors expected to influence older nurses' adoption of the EMR; and 2) explore older nurses' perceptions of facilitators and barriers to EMR adoption. An explanatory sequential mixed methods design was used to collect survey and focus group data from older nurses, prior to introducing an EMR system. These nurses were highly engaged with their work; 79.3% reported high wellbeing scores. However, their motivation appeared to be predominantly governed by external rather than internal influences. Themes reflecting barriers to EMR and resistance to adoption emerged in the qualitative data.

Background: There are international concerns in relation to the management of patient deterioration which has led to a body of evidence known as the 'failure to rescue' literature. Nursing staff are known to miss cues of deterioration and often fail to call for assistance. Medical Emergency Teams (Rapid Response Teams) do improve the management of acutely deteriorating patients, but first responders need the requisite skills to impact on patient safety.Methods/design: In this study we aim to address these issues in a mixed methods interventional trial with the objective of measuring and comparing the cost and clinical impact of face-to-face and web-based simulation programs on the management of patient deterioration and related patient outcomes. The education programs, known as 'FIRST2ACT', have been found to have an impact on education and will be tested in four hospitals in the State of Victoria, Australia. Nursing staff will be trained in primary (the first 8 min) responses to emergencies in two medical wards using a face-to-face approach and in two medical wards using a web-based version FIRST2ACTWeb. The impact of these interventions will be determined through quantitative and qualitative approaches, cost analyses and patient notes review (time series analyses) to measure quality of care and patient outcomes.Discussion: In this 18 month study it is hypothesised that both simulation programs will improve the detection and management of deteriorating patients but that the web-based program will have lower total costs. The study will also add to our overall understanding of the utility of simulation approaches in the preparation of nurses working in hospital wards. (ACTRN12616000468426, retrospectively registered 8.4.2016).