One Year On: Cultural Competence of Australian Nursing Students Following International Service-Learning.

BACKGROUND: The effective delivery of health care to the growing multicultural population within Australia is a challenge for the nursing profession. A breakdown in cross-cultural communication and understanding, which stems from the tendency of nurses to project their own culturally specific values and behaviors onto patients and colleagues from other countries, can contribute significantly to non-compliance in migrant populations and conflict in collegial relationships. METHOD: The Inventory for Assessing the Process of Cultural Competence-Revised was administered to Australian undergraduate nursing students immediately before, immediately after, and 12 months after returning from international clinical placement. Data were analyzed using descriptive and inferential functions of SPSS. RESULTS: Overall cultural competence increased immediately following the placement and was sustained over time. However, there were significant differences among the five constructs measured. CONCLUSION: International clinical placements enhance cultural competence but targeted activities need to be undertaken pre-placement to develop specific aspects, in particular cultural desire. [J Nurs Educ. 2019;58(1):17-26.].

Personal emergency alarms: do health outcomes differ for purchasers and nonpurchasers?

The objective of this study was to assess whether purchasing a personal alarm service makes a difference in a range of health outcomes for community dwelling older adults. The prospective cohort study involved 295 individuals for whom data on emergencies experienced at home were collected over a period of 12 months. Purchasers of alarms, compared to nonpurchasers, benefitted in terms of feeling more safe and secure and being more active around their home. Outcomes experienced after an emergency were similar for both groups with no differences found in terms of time spent on floor, or hospitalizations.

'We didn't have to dance around it': opt-out HIV testing among homeless and marginalised patients.

This study explored opt-out HIV testing in an Australian general practice. The aims were to: (1) determine the effect of the opt-out approach on the number of HIV tests performed; and (2) explore the acceptability of opt-out HIV testing from the healthcare providers' perspective. A prospective mixed-methods study of opt-out HIV testing over a 2-year period (March 2014-March 2016) was conducted. Implementation was based on a theoretical framework that was developed specifically for this study. The setting was Homeless Healthcare, a health service in Perth, Western Australia. The number of HIV tests conducted during the control year (usual practice) was compared with the intervention year (opt-out testing). After the intervention, the healthcare providers (n=8) were interviewed about their experiences with opt-out HIV testing. Directed content analysis was used to explore the qualitative data. HIV testing rates were low during both the control year and the intervention year (315 HIV tests (12% of the patient cohort) and 344 HIV tests (10%) respectively). Opt-out HIV testing was feasible and acceptable to the participating healthcare providers. Other health services could consider opt-out HIV testing for their patients to identify people with undiagnosed infections and sustain Australia's low HIV prevalence.

Something has shifted: Nursing students' global perspective following international clinical placements.

AIMS: To examine understandings of global health issues among nursing students following participation in an international clinical placement during their pre-registration university education. BACKGROUND: Universities use international clinical placements, especially in developing countries, to develop cultural awareness in students; however, little is known about the longer term influences on students' understandings of global nursing. DESIGN: A retrospective cross-sectional design was used, using an exploratory, descriptive qualitative approach. METHODS: Individual semi-structured interviews were conducted in 2014 with a purposive sample of 25 pre-registration nursing students from four Western Australian universities who undertook clinical placements across five countries. Data were analysed using inductive thematic analysis. RESULTS: Findings highlight that students developed new understandings around health systems including fragility of resource access, differences in clinical practice and variances in nursing roles between settings. Students also experienced challenges but were able to appreciate alternative world viewpoints. CONCLUSION: International clinical placements can develop greater awareness and help students form realistic strategies for using their nursing skills globally. Pre-placement training in cultural awareness and health system realities, along with strong supervisory support, is critical to success.

Perceptions of Nursing and Physical Therapy Students Toward Peer-Led Interprofessional Education in Manual Handling.

Perceptions of first-semester BSN students (N = 220) who received education on patient moving and handling skills from either fourth-year physical therapy/physiotherapy student peer teachers (n = 8) or regular nurse educators were obtained via validated scales and focus groups. There was a significant increase in the mean scores of items concerning communication skills in both groups, with increased scores for all items in the peer-led group. The teaching skills of physical therapy/physiotherapy student peers were evaluated highly by the nursing students.

A comprehensive theoretical framework for the implementation and evaluation of opt-out HIV testing.

Opt-out HIV testing (in which patients are offered HIV testing as a default) is a potentially powerful strategy for increasing the number of people who know their HIV status and thus limiting viral transmission. Like any change in clinical practice, implementation of opt-out HIV testing in a health service requires a change management strategy, which should have theoretical support. This paper considers the application of three theories to the implementation and evaluation of an opt-out HIV testing programme: Behavioural Economics, the Health Belief Model and Normalisation Process Theory. An awareness, understanding and integration of these theories may motivate health care providers to order HIV tests that they may not routinely order, influence their beliefs about who should be tested for HIV and inform the operational aspects of opt-out HIV testing. Ongoing process evaluation of opt-out HIV testing programmes (based on these theories) will help to achieve individual health care provider self-efficacy and group collective action, thereby improving testing rates and health outcomes.

Motivations and Expectations of Undergraduate Nursing Students Undertaking International Clinical Placements.

BACKGROUND: International clinical placements are common in preregistration nursing programs in Australian universities to enhance awareness of cultural needs and global health issues. Yet, little is known about the motivations and expectations of nursing students who choose to participate. METHOD: Using a qualitative exploratory design, individual semistructured interviews were undertaken with 52 preregistration final-year nursing students from four Western Australian universities 2 weeks prior to departure to the developing countries of Tanzania, Thailand, the Philippines, Cambodia, and India. Data were analyzed using thematic analysis. RESULTS: The interviews revealed that students were motivated by cultural inquisitiveness and a desire to help. They expected to gain cultural learning, to be challenged, to be fulfilled, to experience professional growth, and to feel gratitude. Developing an understanding of culture was a crucial outcome. CONCLUSION: By understanding the impetus and personal motivations of students, educators can guide students toward a more transformative experience whereby a more multicultural perspective on health care can be developed. [J Nurs Educ. 2016;55(9):487-494.].

Exploring risk profiles and emergency frequency of purchasers and non-purchasers of personal emergency alarms: a prospective cohort study.

BACKGROUND: Personal alarms support independent living and have the potential to reduce serious consequences after a fall or during a medical emergency. While some Australian states have government funded personal alarm programs, others do not; but user-pays services are available. Although several studies have examined the profiles of alarm users, little is known about the risk profile of non-users. Specifically, whether there are "at risk" individuals who are unable, or choose not to purchase a service, who experience a home-based emergency in which an alarm could have mitigated an adverse outcome. This study aimed to describe the 'risk profile' of purchasers and non-purchasers of alarms; explore the reasons behind the decision to purchase or not to purchase and identify how often emergency assistance was needed and why. METHODS: Purchasers and non-purchasers were followed for one year in this prospective cohort study. Demographic, decision-making and risk factor data were collected at an initial face-to-face interview, while information about emergencies was collected by monthly calls. RESULTS: One hundred and fifty-seven purchasers and sixty-five non-purchasers completed the study. The risk profiles between the groups were similar in terms of gender, living arrangements, fall history and medical conditions. Purchasers (Mean = 82.6 years) were significantly older than non-purchasers (Mean = 79.3 years), (t(220) = -3.38, p = 0.000) and more functionally dependent on the IADL (z = -2.57, p = 0.010) and ADL (z = -2.45 p = 0.014) function scores. Non-purchasers (Mean = 8.04, SD = 3.57) were more socially isolated with significantly fewer family networks than purchasers (Mean = 9.46, SD = 3.25) (t(220) = -2.86, p = 0.005). Both groups experienced similarly high numbers of emergencies, 38.2 % of purchasers and 41.5 % of non-purchasers had at least one emergency where an alarm could have assisted. Main reasons for non-purchase were: cost (77 %), limited alarm range (51 %), no need (39 %) and lack of suitable contacts (30 %). CONCLUSION: There are older individuals who are at high risk of an emergency who are choosing, often for financial and lack of family support reasons, not to purchase a personal alarm service. Greater availability of government funded subsidy schemes would enable these individuals to access a service. Increasing the range over which alarms work could increase their appeal to a broader range of older persons living in the community. Future research should consider how strategies that improve social isolation from family and challenge clients' beliefs about their own health and independence can support increased access to personal alarm services.

Australian health care providers' views on opt-out HIV testing.

BACKGROUND: Opt-out HIV testing is a novel concept in Australia. In the opt-out approach, health care providers (HCPs) routinely test patients for HIV unless they explicitly decline or defer. Opt-out HIV testing is only performed with the patients' consent, but pre-test counselling is abbreviated. Australian national testing guidelines do not currently recommend opt-out HIV testing for the general population. Non-traditional approaches to HIV testing (such as opt-out) could identify HIV infections and facilitate earlier treatment, which is particularly important now that HIV is a chronic, manageable disease. Our aim was to explore HCPs' attitudes toward opt-out HIV testing in an Australian context, to further understanding of its acceptability and feasibility. METHODS: In this qualitative study, we used purposeful sampling to recruit HCPs who were likely to have experience with HIV testing in Western Australia. We interviewed them using a semi-structured guide and used content analysis as per Graneheim to code the data. Codes were then merged into subcategories and finally themes that unified the underlying concepts. We refined these themes through discussion among the research team. RESULTS: Twenty four HCPs participated. Eleven participants had a questioning attitude toward opt-out HIV testing, while eleven favoured the approach. The remaining two participants had more nuanced perspectives that incorporated some characteristics of the questioning and favouring attitudes. Participants' views about opt-out HIV testing largely fell into two contrasting themes: normalisation and routinisation versus exceptionalism; and a need for proof versus openness to new approaches. CONCLUSION: Most HCPs in this study had dichotomous attitudes toward opt-out HIV testing, reflecting contrasting analytical styles. While some HCPs viewed it favourably, with the perceived benefits outweighing the perceived costs, others preferred to have evidence of efficacy and cost-effectiveness.

Health-care providers' experiences with opt-out HIV testing: a systematic review.

HIV is now a manageable chronic disease with a good prognosis, but early detection and referral for treatment are vital. In opt-out HIV testing, patients are informed that they will be tested unless they decline. This qualitative systematic review explored the experiences, attitudes, barriers, and facilitators of opt-out HIV testing from a health-care provider (HCP) perspective. Four articles were included in the synthesis and reported on findings from approximately 70 participants, representing diverse geographical regions and a range of human development status and HIV prevalence. Two synthesized findings emerged: HCP attitudes and systems. The first synthesized finding encompassed HCP decision-making attitudes about who and when to test for HIV. It also included the assumptions the HCPs made about patient consequences. The second synthesized finding related to systems. System-related barriers to opt-out HIV testing included lack of time, resources, and adequate training. System-related facilitators included integration into standard practice, support of the medical setting, and electronic reminders. A common attitude among HCPs was the outdated notion that HIV is a terrible disease that equates to certain death. Some HCPs stated that offering the HIV test implied that the patient had engaged in immoral behaviour, which could lead to stigma or disengagement with health services. This paternalism diminished patient autonomy, because patients who were excluded from opt-out HIV testing could have benefited from it. One study highlighted the positive aspects of opt-out HIV testing, in which participants underscored the professional satisfaction that arose from making an HIV diagnosis, particularly when marginalized patients could be connected to treatment and social services. Recommendations for opt-out HIV testing should be disseminated to HCPs in a broad range of settings. Implementation of system-related factors such as electronic reminders and care coordination procedures should be considered, and a social-justice commitment among HCPs should be encouraged.

Comparing effectiveness of generic and disease-specific self-management interventions for people with diabetes in a practice context.

BACKGROUND: The effectiveness of self-management interventions has been demonstrated. However, the benefits of generic vs. disease-specific programs are unclear, and their efficacy within a practice setting has yet to be fully explored. OBJECTIVE: To compare the outcomes of the diabetes-specific self-management program (Diabetes) and the generic chronic disease Self-management Program (Chronic Condition) and to explore whether program characteristics, evaluated using the Quality Self-Management Assessment Framework (Q-SAF), provide insight into the results of the outcome evaluation. METHODS: A pragmatic pretest, post-test design with 12-week follow up was used to compare the 2 self-management interventions. Outcomes were quality of life, self-efficacy, loneliness, self-management skills, depression, and health behaviours. People with diabetes self-selected attendance at the Diabetes or Chronic Condition program offered as part of routine practice. RESULTS: Participants with diabetes in the 2 programs (Diabetes=200; Chronic Condition=90) differed significantly in almost all demographic and clinical characteristics. Both programs yielded positive outcomes. Controlling for baseline and demographic characteristics, random effects modelling showed an interaction between time and program for 1 outcome: self-efficacy (p=0.029). Participants in the Chronic Condition group experienced greater improvements over time than did those in the Diabetes group. The Q-SAF analysis showed differences in program content, delivery and workforce capacity. CONCLUSIONS: People with diabetes benefited from both programs, but participation in the generic program resulted in greater improvements in self-efficacy for participants who had self-selected that program. Both programs in routine care led to health-related improvements. The Q-SAF can be used to assess the quality of programs.

Client satisfaction as a driver of quality improvement in services for older people: a Western Australian case study.

This paper aims to describe a practical example of the use of adapted versions of a resident satisfaction questionnaire for quality improvement purposes in a large aged care service organisation. Residential care and home care questionnaires each covered 11 aspects, the 'housing' questionnaire nine. Each aspect included Likert scale-type satisfaction questions. Questionnaires were distributed for completion by residents or by a friend/family member where a resident was unable to self-complete (e.g. because of dementia). Over the six separate customer satisfaction surveys conducted by the organisation since 1999, the analysis scheme has been refined and forms the basis of a report to the Board highlighting major findings and making recommendations regarding future actions. Most recently, the Board has decided to focus on three main areas, with actions identified for each, namely satisfaction with staff (e.g. enhanced staff training), social activities and involvement (e.g. increased occupational therapy), and opportunities for enhanced feedback.

Physical activity preferences of older home care clients.

BACKGROUND: Physical activity contributes to an older person's health and well-being by maintaining strength, balance and mobility, all of which are important for older people who wish to remain living in their home for as long as possible. It is therefore essential that community nurses and those working with home care clients promote being physically active. To do this effectively requires an understanding of the type of physical activity older home care clients prefer to engage in. AIM: The aims of this study were to identify the physical activity preferences of older people who received a home care service and to determine whether being physically active is important to this population. METHODS: Twenty older home care clients were interviewed using a semi-structured interview schedule. Data were analysed using a descriptive qualitative methodology. RESULTS: Walking, housework and gardening were identified as the activities of choice. The majority of interviewees suggested that it was important to be physically active. CONCLUSION: Structured exercise programmes are not the activity of choice for older home care clients. Therefore, when community nurses and allied health workers promote physical activity to their clients, they should suggest activities such as walking, housework and gardening and also endorse the benefits of physical activity for well-being and staying independent. IMPLICATION FOR PRACTICE: Health and community nurses and organisations should routinely encourage home care clients to increase their activity levels, especially utilising those activities they most enjoy.

Development of Australian clinical practice outcome standards for graduates of critical care nurse education.

AIMS AND OBJECTIVES: To develop critical care nurse education practice standards. BACKGROUND: Critical care specialist education for registered nurses in Australia is provided at graduate level. Considerable variation exists across courses with no framework to guide practice outcomes or evidence supporting the level of qualification. DESIGN: An eDelphi technique involved the iterative process of a national expert panel responding to three survey rounds. METHODS: For the first round, 84 statements, organised within six domains, were developed from earlier phases of the study that included a literature review, analysis of critical care courses and input from health consumers. The panel, which represented the perspectives of four stakeholder groups, responded to two rating scales: level of importance and level of practice. RESULTS: Of 105 experts who agreed to participate, 92 (88%) completed survey round I; 85 (92%) round II; and 73 (86%) round III. Of the 98 statements, 75 were rated as having a high level of importance - median 7 (IQR 6-7); 14 were rated as having a moderate level of importance - median 6 (IQR 5-7); and nine were rated as having a low level of importance - median 4 (IQR 4-6)-6 (IQR 4-6). The majority of the panel rated graduate level of practice as 'demonstrates independently' or 'teaches or supervises others' for 80 statements. For 18 statements, there was no category selected by 50% or more of the panel. The process resulted in the development of 98 practice standards, categorised into three levels, indicating a practice outcome level by the practitioner who can independently provide nursing care for a variety of critically ill patients in most contexts, using a patient- and family-focused approach. CONCLUSION/RELEVANCE TO CLINICAL PRACTICE: The graduate practice outcomes provide a critical care qualification definition for nursing workforce standards and can be used by course providers to achieve consistent practice outcomes.

A Systematic Review of Physical Activity Programs for Older People Receiving Home Care Services.

The proportion of older people living in our communities is rising and, to live independently, some require assistance from home care services. Physical activity can improve and maintain function, strength, and balance, which are important for those receiving home care. This study reviewed the evidence on physical activity/exercise interventions trialed with older people receiving a home care service. A systematic review of studies published from January 1982 to September 2012, from five databases, was undertaken. Inclusion criteria were: aged 65+ years; community dwelling; no dementia diagnosis; receiving home care services; and a physical activity/exercise program. Eight articles were included and results show there were few consistencies between intervention types, groups, outcome measures, and follow-up. Study quality was mixed. Future studies should include pragmatic randomized controlled trials involving home care practitioners and their clients to gain "real-world" knowledge of what interventions are effective and can be delivered within this setting.

Developing and Testing the Standard of Practice and Evaluation of Critical-Care-Nursing Tool (SPECT) for Critical Care Nursing Practice.

BACKGROUND: Nurses working in critical care often undertake specialty education. There are no uniform practice outcomes for critical care programs, and consumer input to practice standards has been lacking. METHODS: A structured multiphase project was undertaken to develop practice standards and an assessment tool informed by critical care nursing stakeholders as well as patients and families-the Standards of Practice and Evaluation of Critical-Care-Nursing Tool (SPECT). RESULTS: Testing of the SPECT revealed adequate content validity index (CVI), domain CVI (range, 0.772 to 0.887), and statement CVI (range, 0.66 to 1.00). Reliability was adequate in terms of internal consistency (Cronbach's α > 0.864) and test-retest Spearman rank correlation (range, 0.772 to 0.887); intra-rater kappa agreement was significant for 102 of 104 statements with moderate agreement for 94.2% of statements. CONCLUSION: The SPECT appears to have clinical feasibility, preliminary validity and reliability, and provides a clear definition for the expected practice level for graduates of a critical care education program.

Older people's perceived causes of and strategies for dealing with social isolation.

OBJECTIVE: To explicate lay theories relating to social isolation and to identify instances of positive deviance to inform future efforts to encourage older people to participate in protective behaviors. METHOD: Twelve focus groups and 20 individual interviews were conducted with Australians aged 40 years and older. Data were collected in metropolitan and regional areas. The age threshold was based on the need to generate formative research to inform interventions to encourage people to engage in preventive behaviors prior to reaching older age when they become more susceptible to social isolation. RESULTS: Two primary lay theories were identified in the data. These are related to the recognized importance of social connection and the belief that forming new social connections becomes more difficult with age due to a range of individual and external factors. Examples of positive deviance that were identified included viewing overcoming social isolation as an incremental process, being prepared to be the instigator of social interaction, and adopting an external focus. CONCLUSION: The findings suggest that the provision of a broad range of group activities may need to be combined with a focused approach to targeting and approaching those most at risk to reduce the burden of social isolation at a population level.

A comparison of the home-care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home-care service.

Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure--the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50-0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50-0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72-0.96) over the 2-year follow-up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care.

An exploration of nursing research perceptions of registered nurses engaging in research activities at a metropolitan hospital in Western Australia.

AIM: To explore perceptions about nursing research of registered nurses (RNs) who were engaged in research activities at a metropolitan hospital in Western Australia. BACKGROUND: In order to improve RNs' research engagement and promote evidence-based practice, Nurse Research Consultants (NRCs) were appointed jointly by the study hospital and a local university. This joint appointment commenced in 2004 in the hospital's emergency department. Early findings indicated that the NRC role was effective in assisting registered nurses with research activities and hence the NRC role was expanded to all areas of the hospital. However, no formal investigation had been carried out to explore the effect of the NRC role on RNs' engagement with nursing research across the hospital. DESIGN: A qualitative interview process. METHODS: Ten RN participants from the adult and paediatric wards were interviewed. Audio-recorded data were transcribed verbatim and thematic analysis was undertaken. RESULTS: Four main themes were identified, namely: perceptions of nursing research, perceived enablers, perceived barriers and improving research engagement. There was some overlap with some sub-themes being linked with more than one theme. This appeared to be due to differing levels of research education and research engagement. CONCLUSION: 6pc some of the RNs that participated in this study were experienced in the conduct of research, finding adequate support from NRCs in the workplace, whilst others experienced barriers limiting their involvement in nursing research activities. These barriers could be reduced with additional education, support, improved communication, time and opportunities to undertake research activities.