Conscientious Objection and Institutional Objection to Voluntary Assistance in Dying: An Ethico-legal Critique.

This column examines conscientious objection and institutional objection in Australian voluntary assistance in dying. It reviews the current legislative regimes and then examines these practices from an ethical perspective, and raises particular concerns and suggestions with how conscientious objection and institutional objection should be operationalised.

International nursing students' perceptions and experiences of transition to the nursing workforce - A cross-sectional survey.

OBJECTIVE: To investigate international nursing students' perceptions about their preparedness and experiences of transition from the educational settings to the host country's nursing workforce. BACKGROUND: Transition from a student to a registered nurse is a challenging phase for undergraduate nursing students. Undergraduate nursing students have reported concerns about their clinical preparedness and felt inadequately prepared as new graduates. One under-researched area is international nursing students' preparedness and experiences of transition from their undergraduate nursing program to the host country's nursing workforce. DESIGN: A descriptive cross-sectional study. SETTING: Online survey active from 26 October 2020-31 January 2021 in Australia. PARTICIPANTS: 110 eligible international nursing students (Mean age = 25.10 ± 3.32; 57.8% female) in the final year of their undergraduate nursing program Australian universities took part in the survey in 2020. METHODS: The survey used the Casey-Fink Readiness for Practice Survey as well as newly added questions to measure transition preparedness, clinical preparedness, facilitators and barriers that may affect transition and the impact of Coronavirus disease of 2019 on transition. Both descriptive and inferential statistics were used for data analysis. RESULTS: Over 90% of the respondents planned to transition to the Australian nursing workforce, with over 50% feeling prepared to transition as registered nurses. However, over 50% of the respondents did not feel ready to find nursing employment in Australia. When assessing clinical preparedness, participants reported their discomfort and lack of confidence in dealing with dying patients, delegating tasks to nursing assistants and communicating and interacting with physicians and interdisciplinary team members in the clinical area. They also reported clinical simulation activities helpful in clinical preparation, being comfortable in taking actions to solve problems and being confident in identifying actual or potential safety risks for patients. The major barriers for transition included temporary visa status, financial challenges, duration of clinical placements during the nursing program, inability to comprehend local colloquialism and knowledge of the Australian healthcare system. The main facilitators were clinical simulation experiences, the ability to speak languages other than English and interactions with people from diverse cultures. CONCLUSIONS: International nursing students had unique challenges related to their temporary visa status, knowledge of the Australian healthcare system and comprehension of colloquialism. Clinical simulation experiences, the ability to interact with diverse cultures and speak different languages contributed positively to their transition preparedness. They expressed their desire to have extended clinical placements in more acute care settings to improve their clinical experiences.

Historical Context of Custodial Health Nursing in New South Wales, Australia.

ABSTRACT: Australia's prison healthcare originated during the establishment of the colony of New South Wales by Britain in 1788. Initially managed by the Colonial Medical Service, the history and healthcare of the penal settlement has been well documented in government records, academic works, museum displays, and fictional dramatizations. This article explores the origins and historical development of the nursing care of prisoners in Australia, starting with the original Australian prisoners, the convicts of colonial New South Wales. Largely overlooked in historical and academic studies, custodial health nurses are rarely mentioned or acknowledged for their contribution to the health of the colony. However, their expertise as healthcare professionals has continued to grow and is explored within the context of today's health landscape.

International nursing students' and international nursing graduates' experiences of transition to the nursing workforce: A systematic review of qualitative evidence.

OBJECTIVE: The objective of this systematic review was to identify and synthesise existing evidence on the experiences of international nursing students' and international nursing graduates' transition to the host country's nursing workforce. BACKGROUND: International students' experiences of transition to the host country has been extensively explored by researchers. International students experience unique challenges related to communication and language, socialisation, finance, and temporary student visa. One under-researched area is the experiences of transition for international nursing students and international nursing graduates. This systematic review examined the existing evidence on international nursing students' and international nursing graduates' experiences of transition to the host country's nursing workforce. INCLUSION CRITERIA: This review considered published and unpublished studies-qualitative, quantitative, mixed methods, evidence syntheses, and grey literature-that included international nursing students enrolled in an undergraduate nursing programme outside their home country and international nursing graduates, either employed or not yet employed in nursing and within their first year of completing an undergraduate nursing programme outside their home country. METHODS: A three-step search strategy was utilised in this review. The search strategy aimed to find published and unpublished literature in English from January 2000 to April 2020. The databases searched were Ovid Medline, Scopus, Emcare, ERIC, PsycINFO, ProQuest Central, ProQuest Dissertations and Theses Global, JBI Evidence-based Practice Database, and ScienceDirect. Two reviewers independently screened the titles/abstracts and full texts of studies for inclusion and appraised the methodological quality of the included studies. Findings and accompanying illustrations were extracted by one reviewer, assigned a level of credibility, and checked by the others. Results were analysed using JBI's approach to qualitative meta-aggregation. RESULTS: This review included three qualitative papers published between 2011 and 2018. All included studies were appraised as of moderate quality. Sixty-five study findings and nineteen categories were aggregated into the following six synthesised findings: international nursing graduates developed confidence and satisfaction through challenges; personal challenges; clinical challenges; discrimination and justice; academic barriers to success; and what international nursing students liked and wanted. CONCLUSION: The synthesised findings revealed ongoing anxiety, lack of preparedness and role uncertainty that was experienced by international nursing students and international nursing graduates as they transition to the host country's nursing workforce. They expressed the need for information about professional role expectations, guidance, and support to transition. University transition programmes and services could provide support to address the workforce transition challenges faced by international nursing students and international nursing graduates. TWEETABLE ABSTRACT: Systematic review shows international nursing students and international nursing graduates experience anxiety, limited preparedness and role uncertainty when transitioning to the host country's nursing workforce.

International nursing students' and new graduates' experiences of transition to the nursing workforce: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify and examine the available evidence of domestically trained international nursing students' and new graduates' experiences of transition to the nursing workforce. INTRODUCTION: International students' workforce transition experiences are attracting researchers globally. One under-researched area relates to the workforce transition experiences of domestically trained international nursing students and new graduates. This scoping review will focus on identifying studies that examine factors that can directly or indirectly affect experiences of workforce transition. INCLUSION CRITERIA: This review will consider studies that include domestically trained international nursing students enrolled in an undergraduate/baccalaureate nursing program (outside their country of origin) and new graduates within their first year of completing an undergraduate/baccalaureate nursing program (outside their country of origin). Participants may be either employed or not employed in the host country's nursing workforce. Studies that include participants from any other nursing programs will be excluded. METHODS: The JBI approach for conducting and reporting scoping reviews will be followed. The review will include both published and unpublished literature. Research from 2000 onward that is available in English will be included. Searches will be conducted in MEDLINE, Scopus, Emcare, ERIC, PsycINFO, ProQuest Central, ProQuest Dissertations and Theses Global, and ScienceDirect. An assessment of methodological quality will be included, with results presented in the final report. One reviewer will carry out the data extraction process independently, which will be checked by another reviewer. Data will be presented in tabular form accompanied by a narrative summary that aligns with the objective of this scoping review.

How COVID-19 Highlights an Ongoing Pandemic of Neglect and Oppression When It Comes to Women's Reproductive Rights.

The coronavirus disease-19 (COVID-19) pandemic has exposed an underlying pandemic of neglect affecting women's reproductive rights, particularly in the provision of abortion services and maternity care. The systemic neglect in the Australian context has resulted in a rise in demand for the services provided by privately practising midwives (PPMs) that is not matched by systemic support for, nor recognition of, women choosing to birth at home. As a result, PPMs are unable to meet the rise in demand, which in itself reflects decades of limited State support for the choice to birth at home and opposition by incumbent stakeholders in the provision of maternity care to healthy women with low-risk pregnancies. We discuss the historical backdrop to these currently erupting issues, along with the real reasons for the opposition to PPMs in Australia. Finally, we offer solutions to this ongoing issue.

Recency of Practice and the Maintenance of Professional Competence for Nurses and Midwives: A Scoping Review Protocol.

Australian and international nursing regulators have specific requirements for continuing competence and the professional, safe practice of nurses and midwives. Requirements can dictate duration of practice, time away from/recency of practice, revalidation policies, and time between study program completion and practice commencement. Requirements vary between contexts and are periodically updated. To identify and examine Australian and international evidence for best regulatory practices relating to recency and the maintenance of professional competence among nurses and midwives, a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be undertaken. This protocol details the scope, inclusion criteria, and methodology that will guide the scoping review, which will inform an update to the Nursing and Midwifery Board of Australia's Registration Standard: Recency of Practice.

The misuse of "duty of care" as justification for non-consensual coercive treatment.

The duty of care concept is a common law legal principle which underpins all healthcare interactions. However, evidence within the Australian context suggests misuse of this common law principle as a justification for non-consensual coercive treatment. Misuse seems to occur particularly where patients have impaired decision-making capacity and/or refuse treatment. In this article, we discuss the emerging evidence of misuse, which arguably reflects healthcare practitioner confusion between the doctrines of 'duty of care' and 'necessity', and posit that cognisance of lawful substitute consent processes are lacking. We then discuss the concept of duty of care as an obligation, as opposed to a power, before presenting the elements of a valid consent and legislation relating to substitute consent, which allow health practitioners to proceed with treatment. We conclude this article with a discussion of the circumstances where treatment may be given without consent.

Liability and collaborative arrangements for nurse practitioner practice in Australia.

The purpose of this paper is to clarify the relationship between medical practitioners (MPs) and nurse practitioners (NPs) in general, and privately practising NPs (PPNPs) in particular, in relation to collaboration, control and supervision in Australia, as well as to explore the difficulties reported by PPNPs in establishing mandated collaborative arrangements with MPs in Australia. In order for the PPNPs to have access to the Medicare Benefit Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) in Australia, they are required, by law, to establish a collaborative arrangement with an MP or an entity that employs MPs. This paper begins by describing the history of and requirements for collaborative arrangements, then outlines the nature of successful collaboration and the reported difficulties. It goes on to address some of the commonly held misconceptions in order to allay medical concerns and enable less restrictive access to the MBS and PBS for PPNPs. This, in turn, would improve patient access to highly specialised and expert PPNP care.

Integrative Review of Parents' Perspectives of the Nursing Role in Neonatal Family-Centered Care.

OBJECTIVES: To identify the perceptions of mothers and fathers of newborns admitted to NICUs regarding the role of neonatal nurses in the provision of family-centered care and how neonatal nurses were able to interpret and meet parents' needs. DATA SOURCES: We conducted literature searches in the CINAHL, MEDLINE, Embase, PsycINFO, Dissertations and Theses Global, and Maternity and Infant Care databases. STUDY SELECTION: Articles on qualitative and quantitative studies were selected if they were published in English from 2009 to 2018; they were set in countries with similar health care resources in Australasia, Canada, Europe, Scandinavia, the United Kingdom, and the United States; and the data were collected from parents. We identified 31 studies for analysis. DATA EXTRACTION: We used the thematic analysis method of Braun and Clarke to extract data elements that were grouped and coded into themes and subthemes. DATA SYNTHESIS: Through ongoing iterative analysis, we generated six themes from the 18 subthemes that in combination presented the experiences of parents in the context of family-centered care provided by neonatal nurses: Process of Becoming a Parent, Neonatal NursesSupportingParents, Infant Safety, Communication, Barriers to Parenting, and Parenting Inhibited by Neonatal Nurses. CONCLUSION: The six themes reflected the contribution made by neonatal nurses to family-centered care in the NICU. The parents' perspectives of nurses were mostly positive, but some negative aspects attributed to nurses identified in earlier studies persisted.

Privately practising nurse practitioners' provision of care subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme in Australia: results from a national survey.

Objective Since legislative changes in 2010, certain health care services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for reimbursement under the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). The aim of the present study was to describe survey results relating to the care provided by PPNPs subsidised through the MBS and PBS. Methods PPNPs in Australia were invited to complete an electronic survey exploring their practice activities. Quantitative data were analysed using descriptive statistics and 95% confidence intervals were calculated for percentages where relevant. Free text data were analysed using thematic analysis. Results Seventy-three PPNPs completed the survey. The most common form of payment reported (34%; n=25) was payment by direct fee for service (MBS rebate only, also known as bulk billing). Seventy-five per cent of participants (n=55) identified that there were aspects of care delivery not adequately described and compensated by the current nurse practitioner (NP) MBS item numbers. 87.7% (n=64) reported having a PBS prescriber authorisation number. Themes identified within the free text data that related to the constraints of the MBS and PBS included 'duplication of services' and 'level of reimbursement'. Conclusion The findings of the present study suggest that PPNPs are providing subsidised care through the MBS and PBS. The PPNPs in the present study reported challenges with the current structure and breadth of the NP MBS and PBS items, which restrict them from providing complete episodes of patient care. What is known about the topic? Since the introduction of legislative changes in 2010, services provided by PPNPs in Australia have been eligible for subsidisation through the MBS and PBS. What does this paper add? This paper provides data on PPNPs' provision of care subsidised through the MBS and PBS. What are the implications for practitioners? Eligibility to provide care subsidised through the MBS and PBS has enabled the establishment of PPNP services. The current breadth and structure of the NP MBS and PBS item numbers have restricted the capacity of PPNPs to provide complete episodes of patient care.

Capacity and consent: Knowledge and practice of legal and healthcare standards.

INTRODUCTION:: Healthcare practitioners have a legal, ethical and professional obligation to obtain patient consent for all healthcare treatments. There is increasing evidence which suggests dissonance and variation in practice in assessment of decision-making capacity and consent processes. AIMS:: This study explores healthcare practitioners' knowledge and practices of assessing decision-making capacity and obtaining patient consent to treatment in the acute generalist setting. METHODS:: An exploratory descriptive cross-sectional survey design, using an online questionnaire, method was employed with all professional groups invited via email to participate. Data were collected over 3 months from July to September 2015. Survey content and format was reviewed by the liaison psychiatry team and subsequently contained five sections (demographics, general knowledge and practice, delirium context, legal aspects and education/training). Descriptive, univariate and bivariate analysis of quantitative data and qualitative content analysis of qualitative data were undertaken. ETHICAL CONSIDERATIONS:: The study was approved by the institutional Human Research and Ethics Committee and informed consent was taken to be provided by participants upon completion and submission of the de-identified survey. RESULTS:: In total, 86 participants engaged the survey with n = 24, exiting at the first consent question. Almost two-thirds of respondents indicated that all treatments required patient consent. Knowledge of consent and decision-making capacity as legal constructs was deficient. Decision-making capacity was primarily assessed using professional judgement and perceived predominantly as the responsibility of medical and psychology staff. A range of patient psychological and behavioural symptoms were identified as indicators requiring assessment of decision-making capacity. Despite this, many patients with delirium have their decision-making capacity assessed and documented only sometimes. Uncertain knowledge and inconsistent application of legislative frameworks are evident. Many participants were unsure of the legal mechanisms for obtaining substitute consent in patients with impaired decision-making capacity and refusing treatment. CONCLUSION:: The legal context of decision-making capacity and consent to treatment appears complex for healthcare practitioners. Professional, ethical and legal standards of care in this context can benefit from structured education programmes and supportive governance processes. An understanding of why 'duty of care' is being used as a framework within the context of impaired decision-making capacity is warranted, alongside a review of the context of Duty of Care within health policy, guidance and faculty teaching.

Health care complaint journeys for system comparison.

PURPOSE: The "patient journey" technique is one that has been used by health care providers to investigate the strengths and weaknesses of their service delivery. The purpose of this paper is to discuss the experience of adapting this approach for use in an atypical context - the comparison of two systems for managing health care complaints and notifications. It highlights a number of relevant considerations and provides suggestions for similar studies. DESIGN/METHODOLOGY/APPROACH: The design and methods of the study are described, with commentary on the success of key aspects and challenges encountered. To enable comparison between the two systems, this study had a "paired" design, in which examples were selected from each system so that they matched on basic, prescribed, criteria. Data about each matter's journey were then collected from administrative records. FINDINGS: While, overall, the technique provided rich data on the processes of the systems under investigation, the type of data collected (related to administrative/communicative events) and the study's comparative purpose required consideration and management of a number of issues. These included the implications of using administrative records and the impact of differences between the systems on the paired design. ORIGINALITY/VALUE: This paper describes an attempt to apply the "journey" approach in a context that is uncommon in two ways: first, in its focus on regulatory processes (complaint/notification handling), rather than care provision to an individual patient; and second, in its objective of comparing two different systems. It is hoped this account will assist in further development of this technique.

Survey of Quasi-Judicial Decision-Makers in NSW and The National Registration Scheme for Health Practitioners.

This study is part of a larger, Australian Research Council-funded project studying comparative analyses of complaints and notification handling between the NSW system and National Registration and Accreditation Scheme (2010). This article explores the assessments and decisions made by Tribunal and other quasi-judicial decision-makers involved in the two schemes, including the key decision-management stages during a disciplinary process. Respondents recruited from both systems completed an online questionnaire comprising a series of closed and open-ended questions to case vignettes. While we found no significant difference between jurisdictions in relation to their decision-making processes in this case, the article provides insights into the rationales for their decisions and the outcomes or sanctions selected by decision-makers as being appropriate to the circumstances presented.

Privately practicing nurse practitioner services in Australia and patient access to care: Results from realist interviews.

BACKGROUND: To facilitate the expansion of nurse practitioners working in community and primary health settings, legislative changes were enacted in 2010. These led to privately practicing nurse practitioners (PPNPs) being enabled to provide care subsidized through the Australian Government Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. Little is known about the impact of this legislation on patient access to care in Australia. PURPOSE: To explore how, why and in which contexts PPNP services in Australia impact on patient access to care. METHODS: Semistructured interviews using realist evaluation were undertaken with 20 participants, selected through stratified sampling using geographic criteria (State/territory in which practicing) and dividing the sample representatively between those who worked solely in private practice and those who worked in both private and public practice. Thematic analysis of qualitative data was undertaken. CONCLUSION: Findings suggest that PPNPs have increased access to care for patients, predominantly in community and primary health settings. IMPLICATIONS FOR PRACTICE: In increasing access to care, PPNPs have the potential to reduce hospital and general practitioner attendance, thereby potentially reducing the ever-increasing demand for health care.

Practice activities of privately-practicing nurse practitioners: Results from an Australian survey.

To facilitate expansion of privately-practicing nurse practitioners in community and primary care settings, a legislative amendment in 2010 made privately-practicing nurse practitioners eligible to provide services subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. To evaluate their practice activities, a national survey of privately-practicing nurse practitioners in Australia was conducted, and data analysed using descriptive statistics and thematic analysis (n = 73). As part of their role, 96% (n = 70) participants reported undertaking direct patient care, 95% (n = 69) patient education and health promotion, 95% (n = 69) prescribed medications, 92% (n = 67) referred patients for diagnostic investigations, and 88% (n = 64) reported making a diagnosis. Over 50% of participants saw up to 15 patients daily, and 80% (n = 58) treated the same patients on a regular basis. Of the participants, 59% (n = 43) perceived that they worked to their full scope of practice. The mainstay of privately-practicing nurse practitioner services is provision of direct patient care in community and primary healthcare settings, suggesting they have emerging potential in addressing the ever-increasing demand for healthcare in Australia.

Collaborative arrangements and privately practising nurse practitioners in Australia: results from a national survey.

Objective Since the introduction of legislative changes in 2010, services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for subsidisation through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). To provide eligible services, PPNPs must collaborate formally with a medical practitioner or an entity that employs medical practitioners. This paper provides data from a national survey on these collaborative arrangements in Australia. The aim of the study was to evaluate the impact of PPNP services on patient access to care in Australia. Methods PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed using thematic analysis. Seventy-three surveys were completed. Results Ninety-three per cent of participants reported having a collaborative arrangement in place. Frequency of communication ranged from daily (27%) to never (1%). Participants reported that collaborative arrangements facilitate learning, patient care and offer support to PPNPs. However, for some PPNPs, organising a formal collaborative arrangement is demanding because it is dependent on the availability and willingness of medical practitioners and the open interpretation of the arrangement. Only 19% of participants believed that collaborative arrangements should be a prerequisite for PPNPs to access the MBS and PBS. Conclusion Although there are benefits to collaborative arrangements, there is also concern from PPNPs that mandating such arrangements through legislation presents a barrier to establishing PPNP services and potentially reduces patient access to care. Collaboration with medical practitioners is intrinsic to nursing practice. Thus, legislating for collaborative arrangements is unnecessary, because it makes the normal abnormal. What is known about the topic? To access the MBS and PBS, PPNPs are required by law to have a collaborative arrangement with a medical practitioner or entity that employs medical practitioners. To date, the effects of these collaborative arrangements on PPNP services in Australia have not been known. What does the paper add? This paper provides unique data from a national survey on collaborative arrangements between PPNPs and medical practitioners in Australia. What are the implications for practitioners? Although there are benefits to collaborative arrangements, there is also concern that mandating such arrangements presents a barrier to establishing PPNP services and potentially reduces patient access to care.

Documentation of Capacity Assessment and Subsequent Consent in Patients Identified With Delirium.

BACKGROUND: Delirium is highly prevalent in the general hospital patient population, characterized by acute onset, fluctuating levels of consciousness, and global impairment of cognitive functioning. Mental capacity, its assessment and subsequent consent are therefore prominent within this cohort, yet under-explored. AIM: This study of patients with delirium sought to determine the processes by which consent to medical treatment was attempted, how capacity was assessed, and any subsequent actions thereafter. METHOD: A retrospective documentation review of patients identified as having a delirium for the twelve months February 2013 to January 2014 was undertaken. Inclusion and exclusion criteria were used; demographic and descriptive data collected. A total of n=1153 patients were identified with n=310 meeting inclusion criteria. RESULT: A random sample of one hundred patients were subsequently reviewed. One third of patients (n=33) had documentation relating to consent, while four patients had documentation relating to capacity. Median delirium duration was three days, with treatment refusal occurring in twenty-two patients and "duty of care" being used as an apparent beneficent related treatment framework in twelve patients. CONCLUSIONS: While impaired decision-making was indicated, the review was unable to indicate what patient characteristics flag the need for capacity assessment. Documentation relating to consent processes (whether patient or substitute) appeared deficient for this cohort.