Pregnancy introduces a multitude of changes in the body, including hormonal fluctuations and metabolic changes, which can lead to atypical ocular signs and symptoms. Ocular manifestations range from fluctuations in vision, to microstructural changes in the retina and choroid, to dry eye disease. This narrative review highlights the range of pregnancy-related effects on the eye and vision that are likely to present in the context of routine eyecare. Specifically, physiological ocular changes and pathological ocular changes that manifest for the first time, or are exacerbated, in uncomplicated pregnancy are discussed. The literature has evolved from simply noting differences in the eye between pregnant and non-pregnant groups, to refining knowledge of the proposed underlying pathophysiology with the advent of newer technologies in eyecare. A particular focus of this review is navigating when pregnancy changes in the eye occur or peak during the gestational period, and whether the changes are short-lived or might extend past pregnancy. While many pregnancy-associated changes are temporary and resolve post-partum, it is also recognised that some changes persist after pregnancy, with a notable absence of literature on ocular changes with loss or termination of pregnancy. Currently or previously pregnant women (or those planning to become pregnant), and other health professionals, should be educated about the importance of seeking eyecare before, during and after pregnancy.

BACKGROUND:Frameworks in higher education can support strategic curriculum change in complex systems. The impact of these frameworks in achieving their stated purpose is less known. An interprofessional education (IPE) framework and related multi-activity curriculum designed to develop health profession graduates with the requisite skills for collaborative care, was introduced in a large university, across eleven health professions. OBJECTIVE:To determine the utility of an interprofessional framework and impact upon perceived work readiness for collaborative practice. METHOD:A multimethod design using the context, input, process, product (CIPP) evaluation model was selected taking a social constructivist theoretical stance. Data collection included staffing allocation to IPE, curriculum audit, and reflections from representatives of all health professions courses offered at the institution. Data was analyzed using framework analysis. PARTICIPANTS:Interviews or focus groups were undertaken with academic Faculty (n = 13), recent graduates (n = 24) and clinical supervisors/employers of recent graduates (n = 17). RESULTS:The framework assisted the systematic implementation of interprofessional curriculum across the different health courses at the university. Collaborative work-ready learning outcomes were identified in graduates where targeted curriculum had been implemented across all four domains of the framework. Gaps identified in framework implementation were consistent with gaps identified in graduate knowledge and skills related to collaborative practice. The combination of formal university-based IPE and informal workplace learning as part of clinical placements contributed to achieving the desired learning outcomes. CONCLUSIONS:These findings offer insights into the use of shared frameworks to drive specific learning activities related to collaborative practice.

Background There is conflicting and limited information regarding factors that influence undergraduate nursing students' academic and clinical performance prior to entry to practice. Objective To identify factors influencing the academic and clinical performance of undergraduate nursing students throughout the course. Design Mixed methods study utilizing a retrospective cohort and a qualitative study. Setting Monash University, Melbourne, Australia. Participants Longitudinal existing data of nursing undergraduate students who commenced in 2017 (n = 176) and 2018 (n = 76), and two focus groups with final year nursing students were analyzed. Methods Retrospective students' records were used to determine the students' academic and clinical performance using the weighted average mark (WAM) of the theoretical and clinical components of the curriculum, separately. The WAM considered the year level of each unit and was scored out of 100. Multivariate linear regression was used to determine predictor factors of academic and clinical performance. Variables include entry cohort (with no previous nursing qualification vs. diploma of nursing), admission category (domestic vs. international), campus (metropolitan vs. outer metropolitan), and secondary school (year 12) results. Two focus group discussions were conducted and thematically analyzed. Results More than two-thirds of the students were aged 18–20 years and mainly female. Almost 20% of the participants were international students. Students with higher secondary school (year 12) results and studying at the outer metropolitan campus achieved a higher academic performance while international students had significantly lower academic performance compared to domestic students. Students with a previous diploma of enrolled nursing and international students had lower clinical performance. Students identified that a comprehensive orientation, interactive curriculum, formal and informal support structure, and educator qualities influenced their academic and/or clinical performance. Conclusions A supportive educational environment with an interactive curriculum may enhance students' academic and clinical performance and readiness for practice. Furthermore, targeted interventions for international students, those with lower secondary school (year 12) results, and those with a former diploma of nursing may be required to increase academic and clinical performance.

Patients are central to healthcare clinicians and organizations but often subsidiary to clinical expertise, knowledge, workplace processes, and culture. Shifting societal values, technology, and regulations have remoulded the patient-clinician relationship, augmenting the patient's voice within the healthcare construct. Scaffolding this restructure is the global imperative to deliver person-centered care (PCC). The aim of the scoping review was to explore and map the intersection between patient feedback and strategies to improve the provision of PCC within acute hospitals in Australia. Database searches yielded 493 articles, with 16 studies meeting inclusion criteria. Integration of patient feedback varied from strategy design, through to multi-staged input throughout the initiative and beyond. Initiatives actioning patient feedback fell broadly into four categories: clinical practice, educational strategies, governance, and measurement. How clinicians can invite feedback and support patients to engage equally remains unclear, requiring further exploration of strategies to propel clinician-patient partnerships, scaffolded by hospital governance structures.

Australian Journal of Rural HealthVolume 29, Issue 2 p. 248-252 SHORT REPORT Interprofessional education in rural clinical learning environments: The role of clinicians Lorraine Elizabeth Walker MN(Res), Corresponding Author Lorraine Elizabeth Walker MN(Res) lorraine.walker@monash.edu orcid.org/0000-0001-9726-1853 School of Nursing and Midwifery Faculty of Medicine, Nursing and Health Sciences Monash University, Clayton, Australia Centre for Rural Health, School of Health Sciences College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia Correspondence Lorraine Elizabeth Walker, School of Nursing and Midwifery Monash University, PO Box 527 Moorooduc Road, Frankston, Vic. 3199, Australia. Email: lorraine.walker@monash.edu Contribution: Conceptualization, Data curation, Formal analysis, Methodology, Writing - original draft, Writing - review & editingSearch for more papers by this authorTony Barnett PhD, Tony Barnett PhD orcid.org/0000-0002-1376-6414 Centre for Rural Health, School of Health Sciences College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia Contribution: Conceptualization, Supervision, Writing - review & editingSearch for more papers by this authorMerylin Cross PhD, Merylin Cross PhD orcid.org/0000-0001-5526-4650 Centre for Rural Health, School of Health Sciences College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia Contribution: Conceptualization, Supervision, Writing - review & editingSearch for more papers by this author Lorraine Elizabeth Walker MN(Res), Corresponding Author Lorraine Elizabeth Walker MN(Res) lorraine.walker@monash.edu orcid.org/0000-0001-9726-1853 School of Nursing and Midwifery Faculty of Medicine, Nursing and Health Sciences Monash University, Clayton, Australia Centre for Rural Health, School of Health Sciences College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia Correspondence Lorraine Elizabeth Walker, School of Nursing and Midwifery Monash University, PO Box 527 Moorooduc Road, Frankston, Vic. 3199, Australia. Email: lorraine.walker@monash.edu Contribution: Conceptualization, Data curation, Formal analysis, Methodology, Writing - original draft, Writing - review & editingSearch for more papers by this authorTony Barnett PhD, Tony Barnett PhD orcid.org/0000-0002-1376-6414 Centre for Rural Health, School of Health Sciences College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia Contribution: Conceptualization, Supervision, Writing - review & editingSearch for more papers by this authorMerylin Cross PhD, Merylin Cross PhD orcid.org/0000-0001-5526-4650 Centre for Rural Health, School of Health Sciences College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia Contribution: Conceptualization, Supervision, Writing - review & editingSearch for more papers by this author First published: 13 May 2021 https://doi.org/10.1111/ajr.12723Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume29, Issue2Special Issue: Educating Health Professionals for Rural and Remote Practice.April 2021Pages 248-252 RelatedInformation

AIMS To offer a rough guide to a quality rural/remote interprofessional educational activity. CONTEXT Australian remote and rural interprofessional undergraduate placements offered in Modified Monash Model 3-6 locations. APPROACH Biggs' triple P framework from the interprofessional educational literature and Allport's contact hypothesis are used to describe map, and explore the educational dimensions and positive elements, of a quality rural/remote interprofessional educational activity. CONCLUSION Delivery of a quality interprofessional educational activity requires attention to all dimensions of the activity with acknowledgement of the value of the remote or rural contexts. Interprofessional learning requires constructive alignment and positive contact conditions to ensure a quality and sustained experience.

Global Environmental Changes are dynamic and complex, crossing disciplines, sectors, regions, and populations and shaping the health of current and future generations. GECs present an unprecedented challenge demanding a response of equal scale and complexity involving unfettered collaboration beyond disciplines with implications for global health. At this critical point, health professions’ education should have moved on from building consensus about the relevance of education for sustainable healthcare (ESH) to active implementation. In this commentary, we discuss why transdisciplinary problem-solving and interprofessional education should be considered in education for sustainable healthcare. We review types of collaborative educational practices, outline opportunities, challenges, and resources to enable implementation.

AIMS AND OBJECTIVES:To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus.BACKGROUND:Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care.DESIGN:Delphi Method.METHOD:A three-round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist.RESULTS:High patient acuity or complexity, as well as inadequate bed space on wards, are "very high" risks that occur "often" and "very often," respectively. The pressure to admit patients, delayed medical review and patient boarding are all "high" risks that occur "often." Though only occurring "sometimes," inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a "very high" risk to patient care.CONCLUSION:The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system-wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise.RELEVANCE TO CLINICAL PRACTICE:This study provides a description of the challenges that face acute care nursing in the provision of safe and high-quality care.

BACKGROUND:Interprofessional collaboration is key to addressing the complexity of contemporary health care, therefore it is imperative that students from different disciplines have access to interprofessional education to equip them with the requisite skills and attributes. While interprofessional education promotes a person-centred approach and mutual recognition of one another's contributions to health outcomes, interprofessional education in Australian universities is fragmented and presents challenges that can be addressed through clinical placements.OBJECTIVES:This article reports student perceptions and readiness for interprofessional education in the rural clinical learning environment in one region of Australia.DESIGN:A mixed methods approach.SETTINGS:Rural clinical learning environments in one geographic area in Victoria, Australia.PARTICIPANTS:60 undergraduate healthcare students from allied health, medicine, nursing and midwifery.METHODS:A survey incorporating Readiness for Interprofessional Learning Scale, Interdisciplinary Education Perception Scale and focused interprofessional questions. Qualitative data were collected via survey comments, interviews and focus groups.RESULTS:Students had numerous opportunities for interprofessional education, to observe role modelling in the workplace and considered that learning with other professions would help them become more effective members of the health care team. Students valued learning about collaborative practice, the roles of other professions and identified activities that enhanced interprofessional engagement.CONCLUSIONS:This study provides important insights regarding students' perceptions and readiness for interprofessional education. These results demonstrate that there are numerous opportunities to embed interprofessional education within the rural clinical learning environment and offer new insights into students' experiences and preferences for potential activities. These findings may resonate with others implementing interprofessional education in the workplace and guide facilitators in planning activities for students. Factors influencing differences in attitudes towards interprofessional education and how students acquire an understanding of their professional or disciplinary role warrant further study.

INTRODUCTION Interprofessional collaboration and effective teamwork are core to optimising rural health outcomes; however, little is known about the opportunities available for interprofessional education (IPE) in rural clinical learning environments. This integrative literature review addresses this deficit by identifying, analysing and synthesising the research available about the nature of and potential for IPE provided to undergraduate students undertaking rural placements, the settings and disciplines involved and the outcomes achieved. METHODS An integrative review method was adopted to capture the breadth of evidence available about IPE in the rural context. This integrative review is based on a search of nine electronic databases: CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, Web of Science and Google Scholar. Search terms were adapted to suit those used by different disciplines and each database and included key words related to IPE, rurality, undergraduate students and clinical placement. The inclusion criteria included primary research and reports of IPE in rural settings, peer reviewed, and published in English between 2000 and mid-2016. RESULTS This review integrates the results of 27 primary research studies undertaken in seven countries: Australia, Canada, USA, New Zealand, the Philippines, South Africa and Tanzania. Despite geographical, cultural and health system differences, all of the studies reviewed were concerned with developing collaborative, interprofessional practice-ready graduates and adopted a similar mix of research methods. Overall, the 27 studies involved more than 3800 students (range 3-1360) from 36 disciplinary areas, including some not commonly associated with interprofessional education, such as theology. Interprofessional education was provided in a combination of university and rural placement settings including hospitals, community health services and other rural venues. The education activities most frequently utilised were seminars, tutorial discussion groups (n=21, 84%), case presentations (n=11, 44%) and community projects (n=11, 44%) augmented by preliminary orientation and ongoing interaction with clinicians during placement. The studies reviewed demonstrate that rural clinical learning environments provide rich and varied IPE opportunities for students that increase their interprofessional understanding, professional respect for other roles, and awareness of the collaborative and interprofessional nature of rural practice. CONCLUSION This review addresses the lack of attention given to understanding IPE in the rural context, provides Australian and international evidence that initiatives are being offered to diverse student groups undertaking placements in rural settings and proposes a research agenda to develop a relevant framework to support rural IPE. Rural clinical learning environments afford a rich resource whereby health professionals can conceptualise IPE creatively and holistically to construct transformative learning experiences for students. This review develops a case for supporting the development, trialling, evaluation and translation of IPE initiatives that harness the opportunities afforded by rural placements. Further research is required to examine the ways to optimise IPE opportunities in the rural clinical context, including the potential for simulation-based activities, the challenges to achieving sustainable programs, and to evaluate the impact of interprofessional education on collaboration and health outcomes.

Monash University aims to produce dynamic graduate nurses and midwives recognized for their excellent, innovative practice and positive impact on people's lives.

AbstractBackground: Collaboration between education providers and clinical agencies to develop models that facilitate cross-disciplinary clinical education for students is essential to produce work-ready graduates.Methods and Findings: This exploratory study investigated the perceptions of and opportunities for interprofessional education (IPE) from the perspectives of 57 clinical staff from three regional/rural health services across Victoria, Australia. Data were collected through a semi-structured questionnaire, interviews, and focus group discussions with staff from 15 disciplinary groups who were responsible for clinical education. Although different views emerged on what IPE entailed, it was perceived by most clinicians to be valuable for students in enhancing teamwork, improving the understanding of roles and functions of team members, and facilitating common goals for patient care. While benefits of IPE could be articulated by clinicians, student engagement with IPE in clinical areas appeared to be limited, largely ad hoc, and opportunistic. Barriers to IPE included: timing of students’ placements, planning and coordination of activities, resource availability, and current regulatory and education provider requirements.Conclusions: Without the necessary resources and careful planning and coordination, the integration of IPE as a part of students’ clinical placement experience will remain a largely untapped resource.

In order to identify opportunities to build capacity for clinical placements, we mapped and described the organisation of student placements at three hospitals, each with multiple education providers, in rural Victoria, Australia. Using a cross-sectional, mixed method design, data were collected by survey, interviews and discussion with student placement coordinators representing 16 clinical health disciplines. Teaching and supporting students was regarded as an important part of the service each hospital provided and a useful staff recruitment strategy. There were peaks and troughs in student load over the year, though this was less marked for medicine and dentistry than for nursing and allied health disciplines. Whilst placements were managed largely on a discipline basis, each hospital had taken steps to communicate information about student placements across disciplines and to identify opportunities for interprofessional education (IPE). Placement capacity could be increased by sharing placement data within hospitals, smoothing the utilisation patterns across the year, capitalising on opportunities for IPE when there is concurrent placement of students from different disciplines, and through better employment of underutilised clinical areas.

The current shortage of health professionals necessitates new approaches to clinical education that can expand the number of undergraduate students undertaking clinical placements without increasing the burden on clinical staff or placing patients at risk. Interprofessional education has the potential to help increase clinical capacity whilst enriching students' clinical experience. This paper reports on a project which investigated the potential for interprofessional education to increase undergraduate clinical placement capacity in clinical settings. The project utilised an exploratory descriptive methodology to obtain the views of health care professionals about the use of interprofessional education in clinical education at three rural health facilities in Victoria, Australia. Participants (n = 57) had a key role with each health care facility in coordinating and facilitating undergraduate clinical placements. This paper examines the clinicians' views about the central role that leadership plays in actioning interprofessional education in the clinical setting. Whilst interprofessional education was regarded favourably by the majority of participants, data indicated that leadership from education providers, health services, and regulatory authorities was crucial to enable interprofessional education to be implemented and sustained within the clinical learning environment. Without leadership from each of these three spheres of influence, interprofessional education will continue to be difficult to implement for undergraduate students and compromise their exposure to an important aspect of the working life of health care professionals. Such a failure will limit graduates' readiness for collaborative and cross-disciplinary practice.

Aim: To determine how clinical agencies and universities can best prepare student nurses to develop the capability to contribute to healthcare reform. Method: A list of desirable reform capabilities (graduate attributes) was developed and validated. A case study approach was used and interviews conducted with personnel at six clinical agencies in Victoria and South Australia to assess the extent to which student nurses achieved or were likely to achieve these capabilities and to identify strategies that would assist their development. Background: As a significant component of the healthcare workforce, nurses are positioned to play a critical role in healthcare reform. A major challenge facing the profession is how best to prepare nurses and equip them with the skills and attributes necessary to contribute to the reform agenda. Results: Nine reform capabilities were identified. Some were more likely to be achieved than others during undergraduate preparation. Strategies were identified to assist the development of each capability though a number of challenges were also identified by participants. These related to: university-agency relationships, the clinical learning environment, student-graduate transition, curriculum and organisational culture.

Postpartum weight retention and depressive symptoms have a high prevalence among low income women. This qualitative study describes low-income women's experiences of weight changes and depressive symptoms during the late postpartum period. Women (n = 25) who were either overweight or had depressive symptoms, or both, at 12 months postpartum participated in an ethnically-congruent focus group. Women's experiences indicated altered personal control related to retained postpartum weight and depressive feelings. Retained weight negatively affected self-esteem and family functioning. Depression left women feeling isolated yet reluctant to seek help. These findings could provide the basis for health promotion interventions relevant to this population.