Aim: To examine the professional role development of new graduate nurses (NGNs) across three transition stages within a major Australian health service. Background: The shift from student to registered nurse is a critical period marked by emotional strain, role ambiguity, and transition shock. Structured support programs have emerged to ease this transition, yet few are evaluated through longitudinal, theory-informed approaches using validated tools. Design: A longitudinal quantitative study guided by Duchscher’s Stages of Transition Theory and the Transition Shock Model. Methods: A customised 75-item questionnaire, adapted from the Professional Role Transition Risk Assessment Instrument and Professional and Graduate Capability Framework, was distributed across three transition points (March 2020 to March 2021). The survey assessed four domains: Responsibilities, Role Orientation, Relationships, and Knowledge and Confidence. Descriptive statistics, Principal Component Analysis, Chi-square tests, and multinomial logistic regression were used to analyse patterns, trends, and predictors of successful transition. Results: A clear developmental trajectory emerged. Early-stage participants experienced stress, low self-efficacy, and role confusion. By Stage 3, most demonstrated increased clinical confidence, autonomy, and integration into professional healthcare teams. A coordinator-to-graduate ratio of 1:12 facilitated personalised mentorship and supportive practice environments. Statistically significant improvements were observed in critical thinking, leadership perception, emotional resilience, and team communication. Conclusions: This study provides robust empirical support for theoretically grounded and policy-aligned Graduate Nurse Transition Programs. Targeted interventions tailored to each transition phase—such as early mentorship, mid-stage stress support, and end-stage leadership development—can enhance confidence, improve role clarity, and promote long-term workforce capability and sustainability.

Background: The transition from student to registered nurse is a vulnerable period characterised by emotional strain, role ambiguity, and transition shock. Although Graduate Nurse Transition Programs (GNTPs) aim to strengthen early practice readiness, few evaluations use longitudinal, theory-informed approaches or validated tools. Aim: To examine the professional role development of new graduate nurses (NGNs) across three transition stages within a major Australian health service. Design and Methods: A longitudinal quantitative study guided by Duchscher’s Stages of Transition Theory and the Transition Shock Model. A customised 75-item questionnaire—adapted from the Professional Role Transition Risk Assessment Instrument and the Professional and Graduate Capability Framework—was administered at three transition points (March 2020–March 2021). Four domains were assessed: Responsibilities, Role Orientation, Relationships, and Knowledge and Confidence. Descriptive statistics, Principal Component Analysis (PCA), chi-square tests, and multinomial logistic regression identified developmental patterns and predictors of transition stage. Results: PCA supported a four-factor structure consistent with the theoretical domains, explaining 62% of variance. Significant stage-based improvements were found in clinical decision-making (RS6, p = 0.005), managing pressure (RS11, p = 0.003), leadership perception (RO5, p = 0.001), and emotional regulation (RL20, p < 0.001). Regression analysis identified role confusion (RS7, χ2 = 18.112, p = 0.001), leadership potential (RL1, χ2 = 25.590, p < 0.001), workplace support (RL16, χ2 = 12.760, p = 0.013), and critical thinking confidence (KN13, χ2 = 10.858, p = 0.028) as strong predictors of transition stage. By Stage 3, most NGNs demonstrated increased autonomy, confidence, and professional integration. A coordinator-to-graduate ratio of 1:12 facilitated personalised mentorship. Conclusions: Findings provide robust evidence for theoretically grounded GNTPs. Tailored interventions—such as early mentorship, mid-stage stress support, and late-stage leadership development—can enhance role clarity, confidence, and workforce sustainability.

Background: Midwives and maternity nurses use evidence-based active management of the third stage of labor (AMTSL), a practice recommended by the World Health Organization, which is crucial for preventing postpartum hemorrhage (PPH). This study investigates the knowledge, attitudes, and practices of Omani midwives and maternity nurses regarding third-stage labor management and the factors affecting the implementation of evidence-based AMTSL guidelines. Methods: A cross-sectional study was conducted with 300 midwives and maternity nurses from six Omani hospitals with varying care levels. Convenience sampling was used to collect the data using a validated questionnaire and the Prevention of PPH Initiative Checklist. The analyses included frequencies, binary logistic regression, and Fisher’s exact test (P < 0.05). Results: With an 80% response rate (n = 240; 9 maternity nurses, 231 midwives), 39.2% correctly identified all AMTSL components and 62% reported full adherence, although oxytocin was often delayed. Knowledge and adherence were associated with age (<34 years: adjusted odds ratio [AOR] =2.6; >45 years: AOR = 3.1) and experience (≥5 years: AOR = 3.1). Full adherence (62%, n = 149) was higher in tertiary hospitals (AOR = 1.8) and maternity nurses (AOR = 1.9). Staffing shortages and high workloads have hindered implementation, emphasizing the need for better staffing and training. Conclusion: Omani midwives and maternity nurses need improved education, training, staffing, and updated policies to bridge the gap in knowledge and practice regarding evidence-based third stage of labor management. This study offers valuable insights for future research and evaluation.

Objective:This scoping review will describe the extent and range of the literature on virtual care technologies in the delivery of nursing care for the purpose of hospitalization avoidance.Introduction:There has been a recent and rapid uptake of virtual care technologies in nursing to help reduce the burden on hospitals and to provide care for people in place. The nursing workforce must be supported to use new technologies and adopt new working methods in the delivery of care. There is a need to synthesize the available literature to understand and explore how virtual care technologies can be used by nurses to provide high-quality care.Eligibility criteria:This review will include primary research that examines virtual care technologies in the delivery of nursing care for the purpose of hospitalization avoidance. All care settings (primary care, aged care, etc.) will be examined and all virtual technologies will be considered, including telehealth, remote monitoring, and other digital health technologies.Methods:This review will use the JBI methodology for scoping reviews and report against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRIMSA-ScR). Searches will be conducted in MEDLINE, Embase, Emcare, and PsycINFO (via Ovid); CINAHL (via EBSCOhost); and Scopus. Figures, tables, and accompanying narrative synthesis will be used to present the results in line with the review questions. Studies will be mapped in terms of virtual care technologies used, patient group/condition serviced, the role of nurses in the delivery of care using virtual technologies, and the competencies that nurses require to effectively provide care using virtual technologies.Review registration:OSF https://osf.io/5u6rj

Background The World Health Organisation (WHO) recommends implementing evidence-based active management of the third stage of labour (AMTSL) guidelines for all women during the third stage of labour (TSL). Midwives and maternity nurses play a major role in the management of third stage of labour and prevention of postpartum haemorrhage. Aim To investigate midwives' and maternity nurses' knowledge, attitude and self-reported practices in Oman towards management of third stage of labour and factors that influence implementation of AMTSL guidelines. Methods A cross-sectional survey of 300 midwives and maternity nurses working in childbirth wards in six hospitals in Oman between July and September 2019. Descriptive statistics and binary logistic regressions were used to identify the factors associated with knowledge, attitude and self-reported practice. Results The survey achieved a response rate of 80% (n = 240; 231 midwives and 9 maternity nurses). Just over half of the respondents (n = 132, 55%) correctly identified the core characteristics of the recommended management of TSL of WHO guidelines. Fewer respondents correctly identified specific components of AMTSL, such as the administration of recommended dose of oxytocin following birth (n = 108, 45%), cord clamping and cutting (n = 130, 54.2%) and no continuous uterine massage (n = 23, 9.6%). Regarding self-reported practice, 149 respondents (62%) reported always adhering to the AMTSL guidelines. Staff age and years of experience in the birthing ward were both independently associated with knowledge that was consistent with the WHO guidelines (p = 0.05). Hospital type, job title and staff age were associated with self-reported adherence to WHO guidelines (p = 0.05). Participants in all hospital types consistently identified lack of time and staff shortages as barriers to guidelines implementation. Conclusions There is a gap between knowledge and self-reported practice in the management of the third stage of labour, and between international WHO guidelines and current maternity care in Oman. This study provides insights for nursing and midwifery leaders and policymakers and informs future workforce training and strategies.

AIMS:To understand the perspectives and experiences of healthcare providers who have experience working with an enhanced recovery care after elective caesarean birth pathway with next-day discharge and home midwifery. DESIGN:This study applies a qualitative study design with a pragmatic realist approach. The realist framework was used while also taking a post-positivist philosophy. METHODS:The work was conducted in South Australia, Australia between May and October 2019. Twenty-three semi-structured interviews were completed with 5 doctors and 18 midwives who had occupational experience working with the pathway. Interviews were analysed using following the six-phase qualitative thematic analysis process outlined by Braun and Clarke. COREQ guidelines were followed. RESULTS:Four main themes and 11 sub-themes were identified. Main themes identified were as follows: The pathway is more than just early discharge; experiences with the process; staff engagement with the pathway; and the impact of the pathway within the health system. CONCLUSION:Healthcare providers generally accepted the pathway and found enhanced recovery care to be a positive and beneficial model of care. Staff identified five main challenges with implementing the pathway: early discharge; eligible women's automatic inclusion on the pathway; engaging women; change for staff and organisational constraints and procedures. Elements that support integration include the following: education for women; reassurance and communication with women and families; prepared care and supports including home midwifery; staff education and communication of the evidence; clear guidelines and protocols; defined staff roles; enough clinical time and clinical flexibility. IMPACT:Knowledge from staff in this study would be useful for other health services to consider when looking to deliver similar models of care. PATIENT OR PUBLIC CONTRIBUTION:The health service and health providers were involved with the initiation and development of the research aims and design.

INTRODUCTION:Screening for substance use during pregnancy is critical for enhancing maternal health and perinatal outcomes. However, disparities persist in screening and intervention rates within maternity services. This retrospective case note review explored contemporaneous practices around screening and interventions for substance use among pregnant women during routine antenatal care. METHODS:A random sample of 100 sets of maternity records were reviewed. Eligible cases included any woman attending initial pregnancy assessments at one of two South Australian metropolitan Hospital-based antenatal clinics, from July 2019-September 2020. Screening rates for past and current alcohol, tobacco and other substance use were identified and compared with data from a subset of a nationally representative survey. Intervention details and referral pathways were also assessed. RESULTS:The final sample of eligible cases (n = 93) demonstrated prioritisation of screening for current use, over past use, across all substances (p < 0.001). Screening was most likely for tobacco and least likely for e-cigarettes (p < 0.001). Significant underreporting of past use compared with the benchmark was identified for all substances (except tobacco, p = 0.224). Interventions typically involved written resources, which were usually declined by clients. DISCUSSION AND CONCLUSIONS:Despite longstanding recommendations, screening and intervention practices for substance use appear inconsistent. With the recent emergence of vaping, no evidence of updated approaches to identifying e-cigarette consumption in pregnant women was found. Several opportunities for enhancing routine screening and intervention practices within antenatal clinics were identified, and will inform the development of policy directives, targeted training modules, and other resources for health professionals working in these services.

Objective: Explore the impact of transition program policy directives grounded in foundational elements of transition theory. Background: Within fast-track health service environments nurse leaders remain committed to improving transition programs that support wellbeing and retain new graduate nurses. Duchscher’s Stages of Transition Theory and Transition Shock model was the framework chosen by the health service nurse leaders to implement in the clinical environment, however, implementing elements can be problematic without sufficient support and clear policy directives. Study Design and methods: Descriptive study using multiple methods in one major national health service that incorporates a number of private (eight) and public (four) hospitals across Australia. Online surveys were distributed to new graduate nurses at one, five and eleven months into the initial transition year. The survey tool was a synthesised adaptation of the Professional Role Transition Risk Assessment Instrument and Professional and Graduate Capability Framework. At the end of the transition year telephone interviews were conducted with the Nurse Managers who were responsible for implementing transition programs policies and processes. Resulting data were summarised using descriptive statistics for quantitative data and a thematic analysis for qualitative data. Results: 158 new graduate nurses returned the online survey and eight Nurse Managers participated in the telephone interviews. As a whole the new graduate registered nurses described feeling accepted during their transition and expressed feeling comfortable when approaching senior staff. They managed challenges of shift work and took time for self-care. The clear majority (88%) of participants reported no plans to leave the profession. Nurse Managers were able, in most clinical areas, to apply transition program policy and directives and enable the implementation of Duchscher’s Stages of Transition as the framework for the transition support initiatives. Retention of new graduates on their wards at the end of the program was determined to be a positive outcome for Nurse Managers. Discussion: A carefully structured Graduate Nurse Transition Program founded on sound theoretically grounded ideology alongside integrated policy directives guided the Nurse Managers implementation of Duchscher’s Stages of Transition Theory and Transition Shock model into practice. Additionally, a dedicated Graduate Nurse Coordinator role with a manageable ratio of graduate nurses was an important component included in the transition program at each participating hospital as it facilitated support of both graduates and Nurse Managers. These positions should be costed into any Graduate Nurse Transition Program. An interesting finding was the consistency in smaller units that were unable to provide or mobilise preceptors for the required allocated mirrored shifts and it was felt this workload management issue impacted the success of graduate transition nurse programs on those units. Conclusions: Implementing policy directives grounded in foundational elements of Duchscher’s Stages of Transition theory and Transition Shock model delivered consistent experiences for new graduate nurses across one major health service that incorporates a number of hospitals across Australia. Data suggested some practical challenges to program implementation for Nurse Managers, including unit/ward size, staffing, and varying levels of understanding of preceptor roles. Implications for research, policy, practice: Introducing formal policy directives that are grounded in strong theoretical frameworks of professional role transition, agreed to and funded by health service nurse leaders are important in guiding a consistent approach across health services in the implementation of evidence-based Graduate Nurse Transition Programs. What is already known about the topic? Duchscher’s foundational research on the Stages of Transition theory and Transition Shock model is applied to inform Graduate Nurse Transition Programs on an international level. There is a current workforce shortage within Australia and internationally. The importance of retention of newly graduated nurses has become a focus for health care services implementing supportive transition programs to prevent new graduates from leaving the profession in the first year. What this paper adds The inclusion of specific policy directives based on Duchscher’s Stages of Transition theory and Transition Shock model provides clear direction to Nurse Managers related to the required implementation steps and time frames to be met during the transition year. Additional Graduate Nurse Coordinator positions, with a manageable ratio of New Graduate Registered Nurses (NGRNs), are important supports for both graduates and Nursing Managers to meet policy directives. Additional positions should be costed within transition programs. Provides additional evidence that well supported newly graduated nurses are likely to remain within the health service.

Background Alcohol, tobacco and illicit drug use during pregnancy can cause significant harm to women and their developing fetuses. Despite recommendations for abstinence during pregnancy, some women continue to use, making screening for substance use during antenatal clinic attendances an important strategy for reducing risk. This study aims to improve the rates of screening and intervention for substance use among pregnant women, including appropriate referral for those who may be substance-dependent. The protocol outlined here focuses on a multi-stage implementation study. Methods This study will occur in four phases. Phase 1 will identify a baseline rate of screening and subsequent care at the antenatal clinics of two, South Australian hospital-based maternity services, through a retrospective case note audit. Rates of self-reported substance use identified in the case notes will also be compared against representative data from Adelaide Primary Health Network to establish rates of over or underreporting. Phase 2 will involve an online Training Needs Analysis of midwifery staff working at those services, to assess their knowledge, attitudes, beliefs, and commitment to the care of women who use substances during pregnancy. Phase 3 will involve a training package for all midwifery staff at those services, focused on routine screening for substance use, and how to provide appropriate care. Outcome measures from phase 2 will be reassessed during phase 3 and any changes since training will be evaluated. Phase 4 will then repeat phase 1 to compare the changes in rates of both screening and any associated intervention before and after training. Discussion From a public health perspective, this project has the potential to make a significant impact on reducing risk of harm from substance use disorders among pregnant women, and contribute to better health outcomes for their children. Trial registration: This trial has been pre-registered under the Open Science Framework. Registration: https://doi.org/10.17605/OSF.IO/73FDZ .

BACKGROUND:An Australian health-service implemented an 'enhanced recovery after elective caesarean' pathway with next-day discharge.PROBLEM:Previous anecdotal reports indicated that a large percentage of eligible women were not discharged the next day and therefore were not regarded as having completed the pathway. Psychosocial factors were expected to be the leading reason for prolonged hospitalisation.AIM:The study objectives were to: enumerate the percentage of women assessed as eligible for EREC who subsequently did not complete the pathway and the reasons; and to describe women's antenatal satisfaction with preparation, preferences, and perceived support. Women who completed the pathway versus those who did not were compared on antenatal biopsychosocial characteristics.METHODS:This exploratory prospective cohort study enrolled consenting eligible women from antenatal clinics and used patient records and questionnaire data. Comparative statistical techniques were used.FINDINGS:62 % of women did not complete the pathway, with medical and obstetric factors being the most common reasons (80 %). There was statistically significant evidence of lower antenatal stress levels for those who completed EREC (median=5) relative to those who did not (median=8; P = 0.035); although these findings may not be of clinical importance. Antenatally, 51 % of women felt prepared for early discharge, 36 % needed more information, 19 % disliked hospital, 93 % agreed that family togetherness after birth was important. Most agreed that staff (76 %) and family (67 %) supported the pathway.CONCLUSION:This study indicated that a large percentage of women assessed as eligible did not complete EREC and that obstetric and medical factors, rather than psychosocial characteristics, largely explained this. This provides reassurance to clinicians and women that discharge home is working as intended and is useful for planning similar models of care. Higher stress levels in the antenatal period were demonstrated for women who did not complete EREC suggesting the need for further research into how to support these women.

Nurses are imperative for healthcare systems’ ability to effectively function during pandemics, yet multiple factors may affect their willingness and preparedness to work. The aim of the present cross-sectional survey was to identify factors associated with registered nurses’ (RN) willingness and preparedness to work during the novel coronavirus disease (COVID-19) pandemic. The study was reported following the STROBE guidelines. A total of 358 nurses completed a self-administered online questionnaire. The participants were a part of a COVID-19 task force at a Danish university hospital during spring 2020. The results showed that the majority of RNs felt a professional obligation to engage in clinical work during the pandemic; however, their willingness and preparedness to work were affected by multiple factors, such as being relocated voluntarily, being prepared for the task and feeling safe. This study highlights that these factors are essential for the hospital management and nurse leaders to take responsibility for.

Background There is sufficient and consistent international evidence of issues reported by nurses working in single-bed room environments, requiring a design that is not only comfortable for patients but meets nurses working needs. This paper presents a comparison of nursing staff and patients experience prior to a move to 100% single-bed room hospital in 2016 (Stage 1) and actual experiences after the move in 2021 (Stage 2) in South Australia. Method Mixed method case study design. Survey sample of forty-two nursing staff; twelve patient interviews of their experiences of current environment and; thirteen nursing staff interviews of their experiences delivering nursing care in 100% single bed-room environment. Results Nurses and patients highlighted single-bed rooms contributed to patients’ privacy, confidentiality, dignity and comfort. As anticipated in Stage 1, nurses in Stage 2 reported lack of patient and staff visibility. This impacted workload, workflow and concern for patient safety. Conclusion Patient and nursing staff experiences are interdependent, and implications of single-bed room accommodation are complicated. Future impacts on the health system will continue to affect hospital design, which must consider nurses working needs and patient safety and comfort.

Background: As a result of the increased number of Corona Virus Disease 2019 (COVID-19) cases in Indonesia in 2021, nurses as one of the front-liners have experienced extreme workload and stress. This has caused increased numbers of mental health problems in nurses. One of the most common problems is anxiety. Objective: This study aimed to measure the effectiveness of relaxation techniques to reduce nurses’ anxiety levels during COVID-19 pandemic. Methods: This is a quantitative study, using pre- and post- test design. Nurses’ anxiety levels were measured before and after the application of relaxation techniques, namely breathing, progressive muscle relaxation and guided imagery. A training was provided for the participants, along with module and a music video to guide their practices. Results: The application of relaxation technique for approximately two weeks after an online training significantly reduced nurses’ anxiety levels. The score of anxiety levels has significantly decreased from pre- (M= 56.51, SD= 15.80) to (M= 48.30, SD= 13.70) post- training and application, t(201) = 5.82, p < .001 (two-tailed). Conclusion: It is important to provide nurses with support that they need during pandemic or any other catastrophic events, in order to maintain their safety and well-being.