Exploring the dark side of informal mentoring: Experiences of nurses and midwives working in hospital settings in Uganda.

Mentoring literature explores the dark side of mentoring as factors such as gender and race and how they affect the overall mentoring experience. The sociocultural context of the nursing and midwifery professions presents unique characteristics warranting a qualitative exploration of negative mentoring experiences. We aimed to characterise the dark side of mentoring based on informal mentoring relationships occurring among nurses and midwives working in hospitals. Utilising semistructured interviews in a qualitative descriptive design and reflexive thematic analysis, we examined the perceptions of 35 nurses and midwives from three public hospitals located in the Western, Northern and North-western regions of Uganda. Findings emerged in four overarching themes mentoring process deficits, mentoring relational problems, organisational challenges in mentoring and implications of negative mentoring experiences. Our study findings underscore that, while mentoring is frequently beneficial, it can also be interspersed with negative experiences arising from relational dynamics, particular mentoring processes and the overarching hospital environment. Notably, nurses and midwives actively transformed these challenges into opportunities for growth and self-improvement, while introspectively examining their roles in contributing to these negative experiences. Such a proactive approach highlights their resilience and steadfast commitment to professional development, even in the face of adversity.

The role of motivation in the initiation and maintening mentoring relationships among nurses and midwives.

AIM: To understand clinicians' motivations to engage in mentoring to support newly graduated nurses and midwives working in hospital settings. BACKGROUND: Nursing and midwifery literature has established the benefits of mentoring and challenges that affect the effectiveness of formal mentoring programmes. No studies have explored hospital nurses' and midwives' motivations to mentor in the absence of the obligatory status and associated rewards of institutionalised mentoring. METHODS: A qualitative descriptive study with 35 nurses and midwives working in three public hospitals in the western, northern and northwestern parts of Uganda. Data were collected using semistructured interviews. Reflexive thematic analysis was applied to interpret the data. We have adhered to COREQ reporting guidelines. RESULTS: The study revealed three salient themes that capture nursing and midwifery professionals' mentoring perspectives. Participants expressed confidence in their inherent mentoring capacities and were often motivated by a desire to reciprocate prior mentoring experiences. Their mentoring approaches varied between self-focused and other-focused motivations, with some overlap in perspectives on hierarchical versus relational mentoring. Across the board, there was a strong consensus on the need of mentoring for individual clinicians, healthcare institutions and the broader profession. The study highlights five opportunities that can be harnessed to design future mentoring programmes. CONCLUSIONS: The findings delineate a complex interplay between self-centred and altruistic mentoring motivations, aligning with hierarchical or mutually beneficial mentoring paradigms. IMPLICATIONS FOR NURSING POLICY: Nurse managers should tailor mentoring programmes to align with these intrinsic motivations, affirm the enduring need for mentoring, and leverage existing institutional resources to create both acceptable and efficient mentoring frameworks.

Evaluating psychometric properties of three mentoring scales among nurses and midwives in hospital settings: A methodological study.

BACKGROUND: Scales used to evaluate nurses' perspectives of mentoring programmes are mainly designed in developed countries, making them unsuitable for nurses and midwives working in resource-poor developing countries. AIM: To explore the psychometric properties of the perceived cost of mentoring (PCM) scale, negative mentoring experiences (NME) scale and relational mentoring index (RMI) for adaptation in hospital settings in Uganda. METHODS: A cross-sectional study design was used. In total, 303 hospital nurses/midwives in Ugandan participated in the study to evaluate the psychometric properties of the three mentoring scales. RESULTS: Revisions based on word choice were made in adapting the scales to the Ugandan context. The PCM showed three factors (risk to reputation, mentoring effort and nepotism) and had an intra-class correlation (ICC) of 0.609 (95% CI, 0.324-0.793) and Cronbach's alpha of 0.705. The NME scale had two factors (lack of mentor expertise and mismatch between the dyad) consistent with the original scale with an ICC of 0.568 (95% CI, 0.271-0.767) and Cronbach's alpha of 0.841. The RMI showed two factors (individual influence and relational quality) with an ICC of 0.664 (95% CI, 0.410-0.824) and Cronbach's alpha of 0.933. CONCLUSIONS: The initial psychometric assessment indicates satisfactory validity and reliability of the scales for implementation among nurses and midwives within Ugandan hospital contexts. Subsequent research is warranted to validate the factor structures of the scales on a different sample. IMPLICATIONS FOR NURSING AND HEALTH POLICY: In using mentoring programmes to develop the hospital workforce, nurse and midwifery policymakers need to use culturally adapted and validated PCM, NME, and RMI scales to evaluate the quality of these mentoring programmes to maximise the benefits while avoiding unintended consequences.

Is this the solution to wellbeing and burnout management for the critical care workforce? A parallel, interventional, feasibility and realist informed pilot randomized control trial protocol.

Critical care healthcare professionals are at high risk in developing burnout and mental health disorders including depression, anxiety, and post-traumatic stress disorder. High demands and the lack of resources lead to decreased job performance and organizational commitment, low work engagement, and increases emotional exhaustion and feelings of loneliness. Peer support and problem-solving approaches demonstrate promising evidence as it targets workplace loneliness, emotional exhaustion, promotes work engagement, and supports adaptive coping behaviors. Tailoring of interventions have also shown to be effective in influencing attitudes and behavior changes, attending to the individual experience and specific needs of end-users. The purpose of this study is to assess the feasibility and user-perceived acceptability of a combined intervention (Individualized Management Plan (IMP) and Professional Problem-Solving Peer (PPSP) debrief) in critical care healthcare professionals. This protocol was registered in the Australian and New Zealand Clinical Trials Registry (ACTRN12622000749707p). A two-arm randomized controlled trial, with pre-post-follow-up repeated measures intergroup design with 1:1 allocation ratio to either 1) treatment group-IMP and PPSP debrief, or 2) active control group-informal peer debrief. The primary outcomes will be conducted by assessing the recruitment process enrolment, intervention delivery, data collection, completion of assessment measures, user engagement and satisfaction. The secondary outcomes will explore preliminary effectiveness of the intervention using self-reported questionnaire instruments from baseline to 3-months. This study will provide the interventions' feasibility and acceptability data for critical care healthcare professionals and will be used to inform a future, large-scale trial testing efficacy.

Nonpharmacological interventions for agitation in the adult intensive care unit: A systematic review.

BACKGROUND: Person-centred nonpharmacological strategies should be used whenever possible to reduce agitation in the intensive care unit due to issues related to an overreliance on physical restraints and psychoactive drugs. However, the effect of nonpharmacological interventions to reduce agitation is unclear. OBJECTIVES: The objectives of this study were to systematically review studies that evaluate the effectiveness of nonpharmacological interventions designed to prevent and minimise or manage patient agitation in the adult intensive care unit. METHODS: This systematic review was conducted following the Joanna Briggs Institute's Systematic Review of Effectiveness method and a priori PROSPERO protocol. Quantitative studies were identified from seven databases, including MEDLINE, EmCare, CINAHL, Web of Science, PsycINFO, Scopus, and Cochrane Library. In addition, grey literature from several repositories and trial registers was searched. The primary outcome of interest was the effect on prevention, minimisation, and management of agitation. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS: Eleven studies were included (n = 882). Meta-analyses of two studies demonstrated significantly lower levels of agitation (measured with the Richmond Agitation Sedation Scale) in the group receiving a multicomponent nonpharmacological intervention than in those receiving usual care. Individual studies showed a significant effect of nature-based sounds, music, foot reflexology, healing touch, and aromatherapy. The type of the endotracheal suction system did not affect levels of agitation. Overall, the certainty of the findings was rated very low. Harms and adverse effects were not reported in any studies. CONCLUSIONS: Nonpharmacological interventions have the potential to reduce levels of agitation in the intensive care unit. However, inconsistencies in reporting, low quality of methodological designs, and small sample sizes impact the certainty of the results. Future trials must include larger sample sizes, use rigorous methods to improve knowledge in this field, and consider a range of other outcomes.

What are the essential components to implement individual-focused interventions for well-being and burnout in critical care healthcare professionals? A realist expert opinion.

Background: This study aimed to determine what, how, and under what circumstances individual-focused interventions improve well-being and decrease burnout for critical care healthcare professionals. Method: This realist approach, expert opinion interview, was guided by the Realist And Meta-narrative Evidence Synthesis: Evolving Standards II (RAMESES II) guidelines. Semi-structured interviews with critical care experts were conducted to ascertain current and nuanced information on a set of pre-defined individual interventions summarized from a previous umbrella review. The data were appraised, and relationships between context, mechanisms, and outcomes were extracted, which created theory prepositions that refined the initial program theory. Results: A total of 21 critical care experts were individually interviewed. By understanding the complex interplay between organizational and personal factors that influenced intervention uptake, it was possible to decipher the most likely implementable intervention for critical care healthcare professionals. The expert recommendation suggested that interventions should be evidence-based, accessible, inclusive, and collaborative, and promote knowledge and skill development. Unique mechanisms were also required to achieve the positive effects of the intervention due to the presence of contextual factors within critical care settings. Mechanisms identified in this study included the facilitation of self-awareness, self-regulation, autonomy, collaboration, acceptance, and inclusion (to enable a larger reach to different social groups). Conclusion: This validation of a theoretical understanding of intervention that addressed well-being and burnout in critical care healthcare professionals by expert opinion demonstrated essential mechanisms and contextual factors to consider when designing and implementing interventions. Future research would benefit by piloting individual interventions and integrating these new theoretical findings to understand better their effectiveness for future translation into the "real-world" setting.

Impact of Dual Intensive Care Unit and Rapid Response Team Nursing Roles on Service Delivery in the Intensive Care Unit.

BACKGROUND: Rapid response teams generally consist of multidisciplinary specialist staff members with advanced knowledge and skills to manage deteriorating patients outside of the intensive care unit. These teams consist predominantly of intensive care unit nurses, who often undertake intensive care unit and rapid response team duties concurrently. Little has been published on the impact of these nurses' absence while attending a rapid response call on the nursing workforce, patient care, and resource allocation in the intensive care unit. OBJECTIVE: To explore the impact of nurses' absence due to attending rapid response calls in other areas of the hospital on service delivery and resource allocation in the intensive care unit. METHODS: A comprehensive search of 3 databases was performed to identify studies on relationships among the rapid response team, the intensive care unit, and nursing staff. RESULTS: The search yielded 6 quantitative studies, 2 qualitative studies, and a mixed-methods study that were included for analysis. Four key themes were identified: (1) workforce, staffing processes, and resource allocation; (2) alterations to workload and resource allocation; (3) adverse events or incidents; and (4) funding variability of rapid response team models. Review of the studies indicated that dual intensive care unit and rapid response team nursing roles have negative effects on nurses' workload, increase the risk of adverse events, and may compromise patient safety. CONCLUSION: The staffing of both the intensive care unit and the rapid response team should be examined carefully with an eye toward sustainability, cost-effectiveness, and clear outcome measures.

Do nurses receive any support following incidents of workplace violence? A qualitative study.

AIM: We aim to investigate nurses' perceptions of support after incidences of Workplace Violence. BACKGROUND: Nurses experience workplace violence daily. Adequate support following incidents of violence can reduce adverse impacts. Current support systems for coping with workplace violence are lacking. METHODS: Focus group interviews were conducted with 23 nurses working in a regional Queensland Hospital. Qualitative data was transcribed and thematically analyzed to determine themes. The consolidated criteria for reporting qualitative research checklist was followed. RESULTS: The primary source of support after a violent incident was from other nurses. Support was needed immediately to empower nurses to be able to continue their caring role. Often the support was not provided nor were nurses aware of the support services available. Although personal family and friends were a valuable support, most nurses were reluctant to disclose their experiences to protect them. CONCLUSIONS: This paper discusses nurses' experience of support following violence incidents at work as part of findings from a more extensive study that explored the perceptions of nurses regarding violence, strategies and support in a regional Queensland Hospital. Hospital support following a violent incident was perceived as inadequate and nurses felt unsupported immediately following an incident. IMPLICATIONS FOR NURSING MANAGEMENT: After an incidence of workplace violence, appropriate effective support may mitigate the enduring impacts of experiencing violence. There is the need for hospital management to provide effective support services and improve staff awareness of available support services.

Exploring the shared experiences of people with stroke and caregivers in preparedness to manage post-discharge care: A hermeneutic study.

AIMS AND OBJECTIVES: To explore the shared experiences of people with stroke and caregivers in preparedness to manage post-discharge care. BACKGROUND: People with stroke and caregivers show dyadic effects in dealing with post-discharge care challenges. However, few studies have explored their shared experiences and unique challenges for each dyadic member in preparedness to manage post-discharge care. This study addresses this research gap. DESIGN: An interpretive approach underpinned by Gadamer's philosophical hermeneutics. METHODS: Semi-structured interviews were conducted with people with stroke and caregivers in 5 days before hospital discharge (n = 26) or 2 weeks after discharge (n = 4) between July and December 2019. The study followed a five-step data analysis method aligning with Gadamerian hermeneutics. The study reporting followed the COREQ checklist. RESULTS: Three themes and six subthemes were identified. First, both people with stroke and caregivers experienced psychological stress, although the sources differed. Second, stroke dyads demonstrated resilience built on positive thoughts, confidence, and support from family and health professionals. Third, stroke dyads exhibited different levels of certainty about post-discharge care. They desired to be equal partners in co-developing and co-implementing discharge plans. CONCLUSIONS: Similarities and differences in perceived preparedness to manage post-discharge care existed between stroke dyadic members. A co-design approach to developing and implementing discharge plans would enhance planned post-discharge care. IMPACT: Hospital-to-home transition is a challenging time for people with stroke and their caregivers. Understanding the shared experiences of stroke dyads in preparedness for post-discharge care enables nurses to take proactive actions to enhance managing post-discharge care. Early identification of those at risk of developing psychological stress will enable nurses to co-develop stress-coping strategies. These will have a positive influence on the dyad when facing setbacks due to stroke-related complications.

Caring for patients displaying agitated behaviours in the intensive care unit - A mixed-methods systematic review.

BACKGROUND: Patient agitation is common in the intensive care unit (ICU), with consequences for both patients and health professionals if not managed effectively. Research indicates that current practices may not be optimal. A comprehensive review of the evidence exploring nurses' experiences of caring for these patients is required to fully understand how nurses can be supported to take on this important role. OBJECTIVES: The aim of this study was to identify and synthesise qualitative and quantitative evidence of nurses' experiences of caring for patients displaying agitated behaviours in the adult ICU. METHODS: A mixed-methods systematic review was conducted. MEDLINE, CINAHL, PsycINFO, Web of Science, Emcare, Scopus, ProQuest, and Cochrane Library were searched from database inception to July 2020 for qualitative, quantitative, and mixed-methods studies. Peer-reviewed, primary research articles and theses were considered for inclusion. A convergent integrated design, described by Joanna Briggs Institute, was utilised transforming all data into qualitative findings before categorising and synthesising to form the final integrated findings. The review protocol was registered with PROSPERO CRD42020191715. RESULTS: Eleven studies were included in the review. Integrated findings include (i) the strain of caring for patients displaying agitated behaviours; (ii) attitudes of nurses; (iii) uncertainty around assessment and management of agitated behaviour; and (iv) lack of effective collaboration and communication with medical colleagues. CONCLUSIONS: This review describes the challenges and complexities nurses experience when caring for patients displaying agitated behaviours in the ICU. Findings indicate that nurses lack guidelines together with practical and emotional support to fulfil their role. Such initiatives are likely to improve both patient and nurse outcomes.

Instruments to identify risk factors associated with adverse childhood experiences for vulnerable children in primary care in low- and middle-income countries: A systematic review and narrative synthesis.

Vulnerable children exposed to Adverse Childhood Experiences (ACEs) are lacking visibility in healthcare and social welfare support systems, particularly in countries where there are delays in integrating biopsychosocial care into traditional medical care. This review seeks to identify, evaluate, and summarise existing screening instruments used in measuring risks factors related to Adverse Childhood Experiences (ACEs) in vulnerable children in Primary Health Care (PHC) settings in low- and middle-income countries (LMICs). The target population in this research is children from age (05-18 years) living in poverty and extreme social disadvantage. First, a systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. A mixed-methods narrative synthesis analyzed the studies and instruments used to assess vulnerable children exposed to ACEs. Each instrument was scrutinized for quality, validity, and feasibility for use with vulnerable children in frontline clinical settings. There is a lack of suitable risk assessment instruments to identify biopsychosocial risk factors from exposure to ACEs in vulnerable children in LMIC primary healthcare settings. Among nine identified instruments from the reviewed studies, none were found suitable for rapidly identifying the effects of ACEs. This was due to issues on the reviewed instruments which could hinder their application in the rapid screening of ACEs in frontline clinical settings. This included the, retrospective nature of the instruments, decisional capacity of the rater, institutional capacity in implementation of the instruments and instruments capacity to assess individual risk factors in biopsychosocial dimensions. Therefore, currently, there is lack of instruments that can be used to identify biopsychosocial risk factors of ACEs in vulnerable children in primary care in limited-resource settings. Further development of an instrument for the rapid identification of ACEs in vulnerable children is required for an early recognition and referred for preventive care, treatment, and social support services.

Nurse-led health coaching programme to improve hospital-to-home transitional care for stroke survivors: A randomised controlled trial.

OBJECTIVE: To evaluate the effects of a nurse-led health coaching programme for stroke survivors and family caregivers in hospital-to-home transition care. METHODS: A total of 140 dyads of stroke survivors and their family caregivers were recruited and randomly assigned to either the intervention group (received a 12-week nurse-led health coaching programme) or the usual care group. The primary outcome was self-efficacy, and secondary outcomes were quality of life (QoL), stroke-related knowledge, and caregiver-related burden. The outcomes were measured at baseline, 12 and 24 weeks. RESULTS: Stroke survivors in the intervention group demonstrated a significant improvement in self-efficacy at 12 weeks (x̅: 24.9, 95%CI: 20.2-29.6, p < 0.001) and at 24 weeks (x̅: 23.9, 95%CI: 19.2-28.6, p < 0.001) compared to the usual care group. Findings also demonstrated significant increases in stroke survivors' QoL, stroke-related knowledge, and reduction in unplanned hospital readmissions and caregiver-related burden. There were no statistically significant changes in other outcomes between the two groups. CONCLUSION: The nurse-led health coaching programme improved health outcomes for both stroke survivors and their caregivers. PRACTICE IMPACTION: Findings from the study suggest that nurse-led health coaching should be incorporated into routine practice in hospital-to-home transitional care for stroke survivors and their caregivers.

Benefits and challenges for hospital nurses engaged in formal mentoring programs: A systematic integrated review.

AIMS: To explore the overall benefits and challenges for the mentee, the mentor, and the hospital (stakeholders) in hospital-sponsored mentoring programs. BACKGROUND: Formal mentoring programs are widely used to assist nurses to adapt to clinical practice, facilitate their career development, and improve workforce retention. However, the overall benefits and challenges for stakeholders involved in formal mentoring programs remain largely unknown due to a lack of systematic reviews to synthesize relevant studies in this important area. DESIGN: A systematic integrated review. DATA SOURCES: A systematic search of six databases including CINAHL, Web of Science, MEDLINE, Scopus, Science Direct, and ProQuest was undertaken. REVIEW METHODS: Studies that met the inclusion criteria were assessed for methodological quality using the Joanna Briggs Institute critical appraisal tools. Findings from qualitative, quantitative, and mixed-methods studies were extracted and synthesized thematically using a convergent synthesis method. RESULTS: Twenty-two original studies were included in the review. Findings are presented under five themes: the benefits for mentees, the benefits for mentors, the benefits for the hospital, challenges perceived by mentees and mentors, and mismatched mentor-mentee pairs. CONCLUSION: Mentoring programs that build on reciprocal relationships among mentees and mentors generate substantial benefits for all if mentees are able to navigate the challenges of the complex and dynamic nature of the clinical practice environment. Organizational support is important in overcoming these challenges.

What are the solutions for well-being and burn-out for healthcare professionals? An umbrella realist review of learnings of individual-focused interventions for critical care.

OBJECTIVE: To determine what, how, for whom and under what conditions individual-focused interventions are effective to improve well-being and decrease burn-out among critical care healthcare professionals. DESIGN: This study is an umbrella review that used the realist approach, using Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. PsycINFO, Web of Science, CINAHL, MEDLINE, Scopus, ClinicalTrials.gov and ISRCTN databases were searched for published and unpublished systematic reviews and meta-analyses literature between 2016 and 2020. The team appraised and extracted data and identified relationships between content, mechanism and outcomes (CMOs). Theory prepositions were developed using CMOs and were used to refine the existing programme. RESULTS: A total of 81 interventions from 17 reviews were mapped, including mindfulness interventions, cognitive-behavioural therapy, self-care and coping strategies. The revised programme theory determined that contextual factors such as ethnicity, workload, and work schedules play a crucial role in determining the effectiveness of interventions. Mechanisms including the interventions' interests, acceptance, and receptivity are also influential in determining engagement and adherence to the intervention. Findings suggest that the solution for burn-out is complex. However, it offers an optimistic view of tailoring and customising one or a combination of interventions, integrating structured education and components of emotional intelligence. Self-care, social support, awareness or mindfulness and self-efficacy are prime components to improve emotional intelligence and resilience for critical care healthcare professionals to improve well-being and decrease burn-out experience. CONCLUSIONS: These findings provide realistic and reliable reporting of outcomes to better support implementation within the 'real world'. Future research such as seeking validation using expert opinions can provide further in depth understanding of hidden contextual factors, mechanisms and their interactions to provide a greater depth of knowledge ready for application with the critical care population.

Identification of nutritional risk in the acute care setting: progress towards a practice and evidence informed systems level approach.

BACKGROUND: To improve nutritional assessment and care pathways in the acute care setting, it is important to understand the indicators that may predict nutritional risk. Informed by a review of systematic reviews, this project engaged stakeholders to prioritise and reach consensus on a list of evidence based and clinically contextualised indicators for identifying malnutrition risk in the acute care setting. METHODS: A modified Delphi approach was employed which consisted of four rounds of consultation with 54 stakeholders and 10 experts to reach consensus and refine a list of 57 risk indicators identified from a review of systematic reviews. Weighted mean and variance scores for each indicator were evaluated. Consistency was tested with intra class correlation coefficient. Cronbach's alpha was used to determine the reliability of the indicators. The final list of indicators was subject to Cronbach's alpha and exploratory principal component analysis. RESULTS: Fifteen indicators were considered to be the most important in identifying nutritional risk. These included difficulty self-feeding, polypharmacy, surgery and impaired gastro-intestinal function. There was 82% agreement for the final 15 indicators that they collectively would predict malnutrition risk in hospital inpatients. CONCLUSION: The 15 indicators identified are supported by evidence and are clinically informed. This represents an opportunity for translation into a novel and automated systems level approach for identifying malnutrition risk in the acute care setting.

Factors affecting the adoption of the Community of Inquiry Framework in Australian online nursing education: A transition theory perspective.

OBJECTIVES: This paper aims to understand the factors influencing the adoption of teaching, social and cognitive presence in online nursing education and explain the novice nurse academics journey in adopting these aspects. BACKGROUND: The quality of the online/blended courses is about the content and a need for suitable pedagogical design, clear instructions and a collaborative environment based on a valid and reliable theoretical framework. DESIGN AND SETTINGS: A qualitative study involves semi-structured interviews with 11 nurse academics from three Australian Universities and thematic analysis was conducted. RESULTS AND CONCLUSIONS: The Community of Inquiry framework informed three themes including several factors in each from the interviews: (1) Teaching Presence (TP): the lack of understanding of educational theory use, the inadequate course evaluation and the resources scarcity found to be the factors affecting the adoption of TP in online nursing education; (2) Social Presence: the engagement difficulty and creating a learning community affected the adoption of SP; and (3) Cognitive Presence: the variety in learning styles and formative assessment and discussion forums found to be affecting the adoption of CP. This study paper is unique because it uses the Community of Inquiry framework and Meleis's Transition Theory and provides insight on how to facilitate the transition [from role insufficiencies to role supplementation to role mastery] of nurse academics' journey in adopting teaching, social and cognitive presence for online higher education.

A Community of Inquiry lens into nursing education: The educators' experiences and perspectives from three Australian universities.

AIM: Nursing is a social and collaborative profession; therefore, nursing education requires a pedagogy that supports the establishment of a collaborative learning community. Despite the limited use of the Community of Inquiry framework in Australian nursing courses, the educators viewed it as applicable for course design. This paper aims to understand Australian nurse educators' current practices in designing and delivering courses using the Community of Inquiry lens. DESIGN AND METHODS: This paper represent the second phase of the explanatory mixed-methods approach-the data collected in October 2019 via semi-structured interviews with eleven nurse academics from 3 Australian universities. RESULTS: the deductive thematic analysis using the Community of Inquiry coding template confirmed that the 'cognitive presence' and its indicators are implicitly embedded in online/blended courses. But the 'social presence' and 'teaching presence' are faced with some challenges: the underuse of discussion forums by students, the use of social media pages with exclusion of educators and the educators' role of content development rather than course design. CONCLUSIONS: The study findings suggest that the Community of Inquiry framework's explicit application would strengthen 'social and teaching' presences in nursing courses design. Further studies on nursing students' evaluation and perspectives about courses design regarding Community of Inquiry are essential.

Enablers and barriers in hospital-to-home transitional care for stroke survivors and caregivers: A systematic review.

AIMS AND OBJECTIVES: To synthesise qualitative research evidence on the experience of stroke survivors and informal caregivers in hospital-to-home transitional care. BACKGROUND: Due to a shortened hospital stay, stroke survivors/caregivers must take over complex care on discharge from hospital to home. Gaps in the literature warrant a meta-synthesis of qualitative studies on perceived enablers and barriers during this crucial period. DESIGN: A systematic review and meta-synthesis. METHODS: A review was guided by Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist where six databases were searched from April to June 2020 including CINAHL Plus, MEDLINE, PsycINFO, Scopus, Web of Science and ProQuest and ProQuest Dissertations and Theses. There was no date limit to the search. Selected studies were critically appraised. A thematic synthesis approach was applied. RESULTS: The synthesis of 29 studies identified three major findings. First, partnerships with stroke survivors/caregivers empower discharge preparation, foster competence to navigate health and social care systems and activate self-management capabilities. Second, gaps in discharge planning and the lack of timely postdischarge support contribute to unmet care needs for stroke survivors/caregivers and affect their ability to cope with poststroke changes. Third, stroke survivors/caregivers expect integrated transitional care that promotes shared decision-making and enables long-term self-management at home. CONCLUSIONS: Hospital-to-home transition is a challenging period in the trajectory of poststroke rehabilitation and recovery. Further research is required to deepen understandings of all stakeholders' views and address unmet needs during transitional care. RELEVANCE TO CLINICAL PRACTICE: Protocols and clinical guidelines relating to discharge planning and transitional care need to be reviewed to ensure partnership approach with survivors/caregivers in the design and delivery of individualised transitional care. Stroke nurses are in a unique position to lead timely support for survivors/caregivers and to bridge service gaps in hospital-to-home transitional care.

Perceptions of care in patients from culturally and linguistically diverse background during acute and critical illness: A integrative literature review.

OBJECTIVES: The aim of this review was to provide a synthesis of research on perceptions of safety and quality of care of patients from culturally and linguistically diverse backgrounds during acute and critical illness. REVIEW METHOD USED: An integrative literature review based on the four-stage framework of Whittemore and Knafl was conducted including problem identification, a systematic literature search strategy, critical review of selected research articles, and integration of findings. DATA SOURCES: Primary research articles published between January 2008 and October 2020 were identified from seven databases: PubMed, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, Medical Literature Analysis and Retrieval System Online (Medline), PsycINFO, the Cochrane Library, and Scopus electronic databases. The comprehensive search also included a manual search of citations and references from the selected articles. REVIEW METHODS: Data extracted from studies included authors, year, country of origin, methodology and method, sample or participants, key findings, strengths, and limitations. The Critical Appraisal Skill Programme was used to evaluate the quality of studies. RESULTS: Sixteen studies were included in the final analysis after critical appraisal. Four themes were identified: communication; the influence of culture, spirituality, and religion on care expectations; end-of-life care; and organisational structure, policy, and culture. CONCLUSION: Research into patients from culturally and linguistically diverse backgrounds requiring care in acute and critical care areas is limited, in both the Australian and global context. There is an opportunity for future research in this area to inform the safety and quality of health care for this patient population and to enhance staff education and training programs.