Implementation and use of the Safewards model in healthcare services: A scoping review.

Safewards is a multi-intervention mental health nursing model of practice improvement aimed at preventing and reducing conflict and containment. The use of Safewards has now extended beyond mental health settings. Implementation of Safewards has been reported to be challenging and therefore requires an evidence-informed and structured approach. This review's objectives were to: (i) Comprehensively map approaches used to implement Safewards interventions; (ii) Characterise the outcomes measured in Safewards implementation studies; and (iii) Identify the facilitators and barriers to Safewards training and its implementation in practice. All quantitative, qualitative and mixed-methods publications of Safewards, the interventions, evaluations, barriers and facilitators from all healthcare services internationally were included. The Joanna Briggs Institute scoping review and Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews were used to guide methodology. Data were reported according to the 12 items of the TIDieR. Twenty-seven publications reported the implementation of Safewards. Descriptions were limited for reporting items such as intervention descriptions, materials, resources, specific procedures and processes, modifications made to interventions and delivery of interventions and training. No consistent theoretical implementation framework was reported. Collaboration, leadership, feedback and co-design were strong drivers for staff buy-in, engagement and success for implementation in mental health and acute settings. Transparency, replicability and generalisation require a detailed description of all elements of an intervention being implemented. Without adequate information, only assumptions can be drawn about the clinical governance and process of the implementation and training, and it is difficult to conclude when attempting to replicate the interventions.

Inpatients' experiences of falls: A qualitative meta-synthesis.

OBJECTIVES: Identify and synthesize published qualitative research reporting inpatient experiences of a fall to determine novel insights and understandings of this longstanding complex problem. RESEARCH DESIGN: Qualitative meta-synthesis. METHODS: Online databases were searched to systematically identify published research reporting inpatient experiences of a fall. The included studies were inductively analysed and interpreted then reported as a meta-synthesis. DATA SOURCES: Databases Ovid MEDLINE, Embase, Ovid Emcare, CINAHL Complete, Scopus and ProQuest Dissertations and Theses Global were searched on 3rd August, 2023. RESULTS: From 10 included publications, four new themes of inpatients' experiences of a fall were constructed. Themes one, two and three related to antecedents of patient falls, and theme four related to consequences. Theme one, 'My foot didn't come with me: Physiological and anatomical changes', encompassed patients' experiences of medical conditions, medication, and anatomical changes. These aspects contributed to alterations in balance and strength, and misconceptions of capability in activities of daily (inpatient) living. Theme two, 'I was in a hurry: Help-seeking', encompassed patients' experiences striving for independence while balancing power and control, minimizing their own needs over care of others', and unavailability of support. Theme three, 'I couldn't find the call light: Environment and equipment', encompassed patients' experiences of not being able to reach or use equipment, and environment changes. Theme four, 'It was my fault too: Blame and confidence', encompassed patients' expressions of blame after their fall, blame directed at both themselves and/or others, and impacts on confidence and fear in mobilizing. CONCLUSIONS: Inpatient falls are embedded in a complexity of individual, relational, and environmental factors, yet there are potential ways forward both informed and led by the patient's voice. Strength-based approaches to address the tenuous balance between independence and support may be one opportunity to explore as a next step in complementing the existing multifaceted interventions. IMPACT: Inpatient falls are a complex and costly health safety and quality problem. Despite global initiatives in the prevention of inpatient falls, they remain intractable. This meta-synthesis provides an in-depth exploration of extant qualitative data on patients' experiences of falls in hospitals. Four themes were constructed expressing the inpatients' experiences: physiological and anatomical changes, help-seeking, environment and equipment, and blame and confidence. Novel considerations for future investigation are offered, drawing from self-determination theory and positive psychological interventions. IMPLICATIONS FOR PATIENT CARE: This meta-synthesis elicits new considerations for future interventions based on people's experiences of their fall in hospital, offering healthcare professionals novel directions in fall prevention. REPORTING METHOD: The review was reported according to the Enhancing transparency in reporting the synthesis of qualitative research statement (ENTREQ; Tong et al., 2012). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. REGISTRATION: PROSPERO CRD42023445279.

Agitation during anaesthetic emergence: An observational study of adult cardiac surgery patients in two Australian intensive care units.

BACKGROUND: Anaesthetic emergence agitation among adult patients being recovered after open cardiac and/or thoracic aorta surgery has not been described. OBJECTIVES: The objective of this study was to characterise emergence agitation in terms of incidence, clinical features, and consequences in a cohort of cardiac surgery patients being recovered in the intensive care unit (ICU). METHODS: A prospective, observational pilot study was implemented. Over a 5-week period, the study was conducted in two metropolitan hospitals in Victoria, Australia. The cohort comprised all patients admitted to the ICUs aged ≥18 years, who had undergone cardiac surgery via an open sternotomy with general anaesthetic, and whose emergence was directly observed. Emergence agitation was defined as a Richmond Agitation and Sedation Scale score of ≥+2. RESULTS: Fifty patients were observed. Emergence agitation occurred in 24/50 (48%) of patients. Patients with emergence agitation experienced more clinical consequences than patients with calm emergence, including a significantly greater number of episodes of airway compromise (12/24, 50%, p < 0.001); ventilator dyssynchrony (23/24, 96%, p = 0.004); and hypertension (13/24, 54%, p = 0.004). Significant treatment interference (potentially dangerous patient movements such as pulling tubes) occurred with 23/24 patients (96%, p < 0.0001). Patients who underwent emergence agitation required significantly more interventions during anaesthetic emergence than patients who underwent a calm emergence. Interventions included extra nursing measures (16/24, 67%, p = 0.001) administration of sedative and/or opioid intravenous boluses (22/24, 92%, p = 0.001) and vasoactive agents (15/24, 63%, p = 0.05). CONCLUSIONS: In patients recovering from cardiac surgery in the ICU, emergence agitation was clinically important. Immediate interventions were required to prevent and manage complications.

Entry to practice nursing students' experiences of debriefing during clinical practice: A qualitative meta-synthesis.

OBJECTIVES: The objectives of this review were to identify, explore and synthesize existing evidence in the literature of nursing students' experiences of debriefing in their clinical practice placements. DESIGN: Qualitative meta-synthesis. DATA SOURCES: Databases included Cumulative Index of Nursing and Allied Health Literature, Education Resources Information Centre, Medical Literature Analysis and Retrieval System Online, and Scopus. Qualitative studies were considered for inclusion if published in English, reporting primary data analysis including experiences of nursing students. The final search was conducted on 22 October 2021, no time limit was applied. REVIEW METHODS: Qualitative studies were identified and appraised. Across the included studies, authors' themes and metaphors, and participant quotes were inductively analysed and interpreted, then expressed in the synthesis. RESULTS: Three new themes representing nursing students' experiences of debriefing were constructed. Theme one, 'It didn't happen formally, but I needed it', included students expressing the value of, and wanting to be involved in, debriefing to gain validation, reassurance, and guidance. Theme two, 'I had to release it and it helped' included students' positive experiences of debriefing with another student, nurse, or confidant, through various modalities. These experiences affirmed they were not alone in their feelings, which provided relief, confidence, and new ways of thinking and practicing. Theme three, 'Strengthened clinical experience and learning', included students feeling debriefing supported their awareness and understanding of practice and increased participation in clinical experiences. This awareness and understanding provided an opportunity for students to explore, and reflect on, the impact of patient care. CONCLUSIONS: Through debriefing student nurses found relief, confidence, and new ways of thinking through a shared understanding. Debriefing supported student learning and the clinical-academic education team had a key role in creating this opportunity.

Wellbeing measures for workers: a systematic review and methodological quality appraisal.

Introduction: Increasing attention on workplace wellbeing and growth in workplace wellbeing interventions has highlighted the need to measure workers' wellbeing. This systematic review sought to identify the most valid and reliable published measure/s of wellbeing for workers developed between 2010 to 2020. Methods: Electronic databases Health and Psychosocial Instruments, APA PsycInfo, and Scopus were searched. Key search terms included variations of [wellbeing OR "well-being"] AND [employee* OR worker* OR staff OR personnel]. Studies and properties of wellbeing measures were then appraised using Consensus-based Standards for the selection of health Measurement Instruments. Results: Eighteen articles reported development of new wellbeing instruments and eleven undertook a psychometric validation of an existing wellbeing instrument in a specific country, language, or context. Generation and pilot testing of items for the 18 newly developed instruments were largely rated 'Inadequate'; only two were rated as 'Very Good'. None of the studies reported measurement properties of responsiveness, criterion validity, or content validity. The three instruments with the greatest number of positively rated measurement properties were the Personal Growth and Development Scale, The University of Tokyo Occupational Mental Health well-being 24 scale, and the Employee Well-being scale. However, none of these newly developed worker wellbeing instruments met the criteria for adequate instrument design. Discussion: This review provides researchers and clinicians a synthesis of information to help inform appropriate instrument selection in measurement of workers' wellbeing. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79044, identifier: PROSPERO, CRD42018079044.

A rapid review of challenges and opportunities related to diversity and inclusion as experienced by early and mid-career academics in the medicine, dentistry and health sciences fields.

BACKGROUND: Early- and mid-career academics in medicine, dentistry and health sciences are integral to research, education and advancement of clinical professions, yet experience significant illbeing, high attrition and limited advancement opportunities. OBJECTIVES: Identify and synthesise published research investigating challenges and opportunities related to diversity and inclusion, as experienced by early and mid-career academics employed in medicine, dentistry and health sciences disciplines. DESIGN: Rapid review. DATA SOURCES: OVID Medline, Embase, APA PsycInfo, CINAHL and Scopus. METHODS: We systematically searched for peer reviewed published articles within the last five years, investigating challenges and opportunities related to diversity and inclusion, as experienced by early and mid-career academics employed in medicine, dentistry and health sciences. We screened and appraised articles, then extracted and synthesised data. RESULTS: Database searches identified 1162 articles, 11 met inclusion criteria. Studies varied in quality, primarily reporting concepts encompassed by professional identity. There were limited findings relating to social identity, with sexual orientation and disability being a particularly notable absence, and few findings relating to inclusion. Job insecurity, limited opportunities for advancement or professional development, and a sense of being undervalued in the workplace were evident for these academics. CONCLUSIONS: Our review identified overlap between academic models of wellbeing and key opportunities to foster inclusion. Challenges to professional identity such as job insecurity can contribute to development of illbeing. Future interventions to improve wellbeing in academia for early- and mid-career academics in these fields should consider addressing their social and professional identity, and foster their inclusion within the academic community. REGISTRATION: Open Science Framework ( https://doi.org/10.17605/OSF.IO/SA4HX ).

Factors contributing to nurse resignation during COVID-19: A qualitative descriptive study.

AIMS: To explore and describe registered nurses' perceptions and experiences of work well-being extending from what inspired them to join the healthcare organization, what created a great day at work for them, through to what may have supported them to stay. DESIGN: Qualitative descriptive study. METHODS: Thirty-nine Australian nurses who resigned in 2021 from two metropolitan healthcare organizations in Victoria were interviewed in 2022, each for 30-60 min. The semi-structured interview transcripts were transcribed verbatim and analysed inductively and thematically. RESULTS: Four themes were constructed for each of the key research questions. Inspiration to join the organizations transpired through organizational reputation, recruitment experiences, right position and right time, fit and feel. A great day at work was created through relationships with colleagues, experiences with managers, adequate resourcing and delivering quality care. Factors contributing to nurses resigning included COVID-19, uncertainty of role, workload and rostering, and finally, not feeling supported, respected and valued. Factors that may have supported the nurses to stay included flexible work patterns and opportunities, improved workplace relationships, workload management and support, and supportive systems and environments. Cutting across these themes were five threads: (1) relationships, (2) communication, (3) a desire to learn and develop, (4) work-life balance and (5) providing quality patient care. CONCLUSIONS: Novel ways of working and supporting individuals, teams and organizations are needed to maintain and sustain nurses. The nurses' inspiration, what created a great day at work, and support needed to stay highlighted the importance of workplace initiatives to build nursing career pathways, provide equitable opportunities for professional development, workload and roster flexibility and implement professional relationship-enhancing actions to foster authentic civility. IMPACT: This study contributes an in-depth exploration of the perceptions and experiences of nurses who resigned from two healthcare organizations and provides a description of (1) what inspired these nurses to initially join the organization, (2) what they perceived created a great day at work for them, (3) the factors contributing to their resignation and (4) what may have supported them to stay. The reasons nurses resign from an organization were identified as complex and multi-factorial, with opportunities for promoting nursing career pathways, addressing equity in opportunities and implementing professional relationship-enhancing actions. These contributions add both context and opportunity to strengthen organizational initiatives to attract, sustain and retain nurses.

General well-being of intensive care nurses: A prototype analysis.

BACKGROUND: Prototype analyses of well-being have identified central characteristics and prototypicality for New Zealand teachers, lawyers, adolescents, and work well-being of nurses. What has not yet been explored is the broad construct of well-being in intensive care nurses. AIMS: To identify intensive care nurses' conceptions of general well-being and investigate whether their general well-being is prototypically organized. DESIGN: Prototype analysis. METHODS: Three linked studies conceptualize well-being in this prototype analysis. In study 1, nurses reported features of well-being. Study 2 investigated the organization of these features. Study 3 sought confirmation of prototypical organization. RESULTS: Sixty-five New Zealand nurses participated. For study 1 (n = 23), the most frequently reported elements of well-being included physical health (n = 26), work-life balance (n = 20), and personal relationships (n = 18). For study 2 (n = 25), the highest rated elements included mental and emotional health, [general] health, work-life balance, and love. Work-life balance, physical health, and personal relationships were in the top five most frequently reported and were rated in the top 12 most central. Overall, ratings of centrality and the number of times reported were positively correlated (r = 0.33, P < .005). For study 3 (n = 17), confirmatory analyses did not reach statistical significance (P = .15). CONCLUSIONS: Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. Mental, emotional, and general health and work-life balance were considered most important for well-being. RELEVANCE TO CLINICAL PRACTICE: Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. These characteristics of the broad construct of well-being are helpful in both defining and identifying conceptual models of well-being that may be used to inform the development and measurement of well-being programmes.

Nurses' well-being during the coronavirus (2019) pandemic: A longitudinal mixed-methods study.

AIM: To determine prevalence, predictors and change over time of nurses' and student nurses' mental health and well-being, and explore nurses' perceptions, barriers and enablers of well-being. DESIGN: Longitudinal mixed-methods survey. METHODS: Forty-nine students and registered nurses participated from Victoria, Australia. Data were collected from December 2019 to July 2020. Validated psychometrics and free-text response questions were employed. Analysis used latent growth curve modelling, Pearson product-moment correlations and thematic analysis. RESULTS: A strong positive correlation was found between self-determination and work well-being, and a strong negative correlation between work well-being and flight risk. Several moderate relationships were found; a moderate positive correlation between work well-being and nurse manager ability, leadership and support, and a moderate negative correlation between burnout and staffing and resource adequacy. Collegial nurse-physician relationships deteriorated. Three themes, physical health, psychological well-being and social connection, were identified as important for nurses' well-being.

Strengthening Community End-of-Life Care through Implementing Measurement-Based Palliative Care.

The increasing demand for palliative care in New Zealand presents a potential threat to the quality of service delivery. One strategy to overcome this is through the implementation of valid and reliable patient-reported outcome measures. This mixed-methods study aimed to (1) implement measurement-based palliative care (MBPC) in a community palliative care service in Auckland, New Zealand; (2) evaluate the clinical utility of MBPC perceived by clinicians; (3) describe patient characteristics as measured by the Integrated Palliative Care Outcome Scale (IPOS), the Australasian Modified Karnofsky Performance Scale (AKPS), and Phase of Illness (POI); and (4) evaluate the internal consistency of the IPOS. Participants were over 18 years of age from a community outpatient palliative care service. In a phased approach to implementation, healthcare staff were educated on each instrument used for patient assessment. Uptake and internal consistency were evaluated through descriptive statistics. An interpretive descriptive methodology was used to explore the clinical utility of MBPC through semi-structured interviews with seven clinical staff members. Individual patient assessments (n = 1507) were undertaken predominantly on admission, with decreasing frequency as patients advanced through to the terminal phase of their care. Mean total IPOS scores were 17.97 (SD = 10.39, α = 0.78). The POI showed that 65% of patients were in the stable phase, 20% were in the unstable phase, 9% were in the deteriorating phase, and 2% were in the terminal phase. Clinicians reported that MBPC facilitated holistic and comprehensive assessments, as well as the development of a common interdisciplinary language. Clinicians expressed discomfort using the psychosocial and spiritual items. Measurement-based palliative care was only partially implemented but it was valued by staff and perceived to increase the quality of service delivery. Future research should determine the optimal timing of assessments, cultural responsivity for Maori and Pacific patients, and the role of MBPC in decision support for clinicians.

Predictors of Life Satisfaction in New Zealand: Analysis of a National Dataset.

The study aim was to determine prevalence and predictors of life satisfaction in New Zealand. In this observational cross-sectional study, a sample of 10,799 participants from NZ were drawn from the Gallup World Poll from 2006 to 2017. Data were analysed using regression analysis and ANOVA. Prevalence of life satisfaction across time varied little from a high of 7.61 (SD = 1.6) in 2007 to a low of 7.23 (SD = 1.73) in 2011 (range 0-10). Satisfaction with standards of living predicted life satisfaction regardless of age or gender. For males across all age groups and females up to age 40 years, positive experiences and satisfaction with household income were important predictors. Being married was an important predictor for males over 40 years and feeling satisfied with their current city was important for females across all ages and for men under 40. The levels of life satisfaction changed over time, possibly due to major national events. Satisfaction with standards of living was found to predict life satisfaction regardless of age or gender. These results provide a path for policy focus towards increased life satisfaction.

Nurse wellbeing during the coronavirus (2019) pandemic: A qualitative descriptive study.

BACKGROUND: The wellbeing of individuals influences organisational outcomes. Insight into nurses' wellbeing is crucial to a sustaining a high-quality workforce. AIM: To describe nurses' perceptions and experiences of wellbeing, work wellbeing, and mental health. METHOD: Using a qualitative descriptive design, semi-structured interviews were conducted, transcribed verbatim, analysed inductively and thematically, and reported per consolidated criteria for reporting qualitative research. FINDINGS: Nine Australian nurses were interviewed in 2020, each for 60 to 90 minutes. These nurses had a broad range of clinical roles and years of experience in metropolitan healthcare organisations. Six themes, each related to nurse wellbeing, depicted: (i) value and sense of purpose from nursing, yet also negative consequences of losing sight of oneself within the nursing role; (ii) work nurses did to disengage from their job and create a balance within their life; (iii) significance of the team and senior team as a source of both strength and opportunity for wellbeing; (iv) a range of wellbeing initiatives with a perception these were often developed, and for use, in response to crisis as opposed to preventative or proactive measures; (v) value of additional nurse wellbeing education and promotion of available support; and (vi) novel challenges and ways to wellbeing during times where resources were stretched and usual support systems impacted. DISCUSSION: Identified positive and negative consequences of nursing must be addressed when developing targeted wellbeing interventions. CONCLUSION: New ways of working and supporting individual, team and organisational wellbeing are needed for flourishing working environments. Potential strategies to either leverage or mitigate the positive and negative consequences of nursing are offered.

Exploring the experiences and perceptions of students in a graduate entry nursing programme: A qualitative meta-synthesis.

BACKGROUND: Students commencing graduate entry fast-tracked nursing programmes leading to registration are highly motivated and characterised by rich life experiences. Given their unique motivations and characteristics, gaining insight into their experiences of graduate entry programmes will inform strategic directions in education. OBJECTIVE: To synthesise graduate entry nursing students' self-reported experiences and perceptions of their accelerated programme. DESIGN: Qualitative meta-synthesis. DATA SOURCES: Databases included Cumulative Index of Nursing and Allied Health Literature, Emcare, Education Resources Information Centre, Medical Literature Analysis and Retrieval System Online, Psychological Information and Scopus. Qualitative studies published in English and reporting primary data analysis including experiences and perceptions of graduate entry nursing students were considered. REVIEW METHODS: Qualitative studies were systematically identified and critically appraised. The meta-synthesis used an open card sort technique to organise data into a matrix of graduate entry nursing students' experiences and perceptions. RESULTS: Fourteen studies were included. The analysis revealed three primary themes: what I bring and what I come with, developing a sense of self and nursing self, and what I need. Within these themes we found potential enablers of student success in learning; space, working together, and balancing work and life and learning to bridge two worlds. Students reflected on the benefits of academic support and shared their experiences of learning in clinical placement. In addition, students acknowledged the importance of clinical educators and preceptors who provided bridging that was further scaffolded by simulated learning experiences. CONCLUSIONS: Findings indicate graduate entry nursing students have important needs and expectations of support in transition. The experiences and perceptions of graduate entry nursing students differentiated into what students arrived with, what support they need in their journey to become a nurse, alongside their experience of building a sense of self and their nursing self. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42020220201.

New graduate nurse wellbeing, work wellbeing and mental health: A quantitative systematic review.

BACKGROUND: The contribution of work to positive mental health is increasingly apparent. Transition into the workplace causes a range of stressors for new graduate nurses who experience both psychological wellbeing and illbeing in their first year of practice. OBJECTIVE: To determine published prevalence, predictors, barriers and enablers of new graduate registered nurse wellbeing, work wellbeing and mental health. DESIGN: Systematic review of quantitative research. DATA SOURCES: Databases included Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database, Medical Literature Analysis and Retrieval System Online and Psychological Information. Quantitative and mixed-methods studies were considered for inclusion if published in English from 2009 to 2019 reporting primary data analysis including new graduate nurses' wellbeing, work wellbeing and mental health. REVIEW METHODS: Quantitative studies were systematically identified then screened and appraised against pre-determined inclusion criteria. Analysis was conducted by grouping according to analytical methods and results reported as a narrative synthesis. RESULTS: Thirty-four studies were included. The quality of the evidence was variable with just a quarter of the studies being assessed as meeting the quality criteria on all nine measures. For the new graduate nurses prevalence of wellbeing, levels of resilience, optimism, and hope were found to be high. For work wellbeing, most reported higher job satisfaction by 12-months. For work illbeing, levels of burnout were moderately high, predominantly in terms of emotional exhaustion, and stress was initially high, particularly in terms of workload, but decreased over time. For the predictors, job satisfaction was positively predicted by structural empowerment and career satisfaction, and negatively predicted by co-worker incivility, supervisor incivility and emotional exhaustion. For work illbeing, stress was a positive predictor for intent to leave. Stress reductions were associated with momentary levels of high task mastery, social acceptance and role clarity. CONCLUSIONS: For new graduate nurses, levels of emotional exhaustion, workload and stress were moderately high to high initially, decreasing over time as the graduate nurses' job satisfaction increased. Most studies focused on the nurses' intent to resign or stay and both psychological capital and work engagement positively predicted intent to stay whereas work stress positively predicted intent to resign. Resilience and group cohesion moderated the negative effects of some variables, thus may be potential enablers of work wellbeing. The standards of research reporting or design were generally sub-optimal according to quality indicators. Systematic review registration number: (CRD42020148812).

What Motivates People to Start a Graduate Entry Nursing Programme: An Interpretive Multi-Centred Case Study.

INTRODUCTION: While graduate entry nursing programmes are well established in the United Kingdom and the United States of America (USA), they are relatively new to New Zealand and Australia. These programmes have been developed to meet the demands of the health workforce and provide graduates an alternative pathway to becoming a RN. Nursing is viewed as an attractive career option for this growing market of graduate entry students. OBJECTIVE: This study explored the motivations underpinning students choosing a graduate entry MNSc degree over a traditional undergraduate nursing programme. METHODS: A qualitative, longitudinal single case study design, informed by Yin was used. The first phase of the study is reported here. All students commencing a MNSc degree at the beginning of 2020 across four education providers (3 in New Zealand & 1 in Australia) were eligible to take part in the study. Ten students agreed to take part and undertake an interview. Braun and Clarke's approach to thematic analysis was used to analyse the interview data. RESULTS: Three key themes of motivation were identified from the data: the attraction of nursing; the clarity nursing offers in terms of career progression; and the design of the intensive programme. CONCLUSIONS: The motivations to choose a MNSc degree were deeply considered, multifaceted, and influenced by nursing role models. Students wanting to engage with a graduate entry MNSc programme did so through a reflective process of assessing their current career status and future career values. Participants in this study believed nursing would provide a secure and sustainable career path, potentially creating new horizons or possibilities beyond their previous work and life experiences. Having insight into what motivates individuals to enrol in such programmes may assist both education providers and the health sector with RN graduate recruitment and graduate entry programme enrolment.

Reducing stress, anxiety and depression in undergraduate nursing students: Systematic review.

OBJECTIVE: Undergraduate nursing students may experience high levels of stress, anxiety or depression. This can not only influence their personal wellbeing and academic performance, but also communication with patients during clinical placement and the quality and safety of the healthcare delivered. The objective of the review was to identify interventions that target stress, anxiety or depressed mood in undergraduate nursing students during their undergraduate course. REVIEW METHOD: A quantitative systematic review, guided by the Joanna Briggs Institute methodology, was conducted. The review considered studies that included undergraduate nurses, and which evaluated interventions targeting stress, anxiety and depressed mood. The review included experimental studies published in English from 2008 to 2018. A tabulated and narrative summary was utilised to present the results. RESULTS: A total of 1579 studies were identified following a systematic search and 931 studies were screened by title and abstract. A total of 44 studies were critically appraised resulting in 22 studies for inclusion in the systematic review. The studies focused on stress (10 studies), anxiety (14 studies) and depression (7 studies). The majority of the studies (18 of 22) reported a statistically significant reduction in the stress, anxiety or depression experienced by nursing students who participated in interventions targeting these symptoms. Interventions that sought to improve coping management skills, such as mindfulness-based interventions, were most reported. CONCLUSION: There are a range of effective interventions that target stress, anxiety or depressed mood among nursing students. The quality of the studies reporting these interventions was found to be variable and generally samples were small with limited follow-up. Studies of mindfulness interventions comprised the largest sample sizes, displayed the highest levels of evidence, and transcended stress, anxiety and depressed mood. Future research would benefit from a co-ordinated approach to build the strength of the body of evidence.

ICU nurse preceptors' perceptions of benefits, rewards, supports and commitment to the preceptor role: A mixed-methods study.

This paper explores Intensive Care nurses' perceptions of benefits, rewards, supports and their commitment to the role of preceptor. A questionnaire, consisting of Likert-scales and open-ended questions was used to collect data during October 2018. Preceptors were committed to their role. Correlations were found between preceptors' perceptions of benefits or rewards and commitment to the role (p = 0.003, r2 = 0.39) and perceptions of support and commitment to the role (p = .001, r2 = 0.46). Altruistic benefits were perceived to be of the greatest importance. Participants who recognised the importance of preceptorship for the organisation were more likely to be committed to the role. Eighty-three percent of respondents reported a lack of consistency in allocation to work with their preceptee. Qualitative results elucidated themes of helping, personal professional development, the opportunity to teach, and organisational improvement. Supports as barriers and enablers to successful preceptorship were discussed in terms of peer and leadership support, role preparation, the logistics of the environment, role conflict, and consistency of allocation to work in a preceptorship dyad. Commitment to the preceptor role may be increased by highlighting organisational benefits of preceptorship, increasing consistency of contact between preceptorship dyads, and increasing access to supports and preparation.

Registered Nurses' experiences of psychological well-being and ill-being in their first year of practice: A qualitative meta-synthesis.

AIM: To synthesize Registered Nurses' self-reported perceptions and experiences of psychological well-being and ill-being during their first year of practice. DESIGN: Qualitative meta-synthesis. DATA SOURCES: Databases included Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database, Medical Literature Analysis and Retrieval System Online and Psychological Information. Qualitative studies were considered for inclusion if published in English, from 2009-2019, reporting primary data analysis including psychological well-being and ill-being experiences of graduate nurses in first year of practice. REVIEW METHODS: Qualitative studies were systematically identified and critically appraised. A meta-synthesis was applied using an open card sort technique to organize empirical data into a matrix of graduate nurses' voices of psychological well-being and ill-being. RESULTS: Twenty-two studies were included. Analysis revealed patterns of positive experiences and emotions. These included feeling valued and part of the team and learning from and feeling supported by other nurses. Negative experiences and emotions such as feeling overwhelmed, stressed, alone and inadequately prepared were also identified. CONCLUSION: Graduate nurses' perceptions and experiences of their psychological well-being and ill-being revealed both positive and negative dimensions during this transition period. Specific examples of strategies that may promote transition nurses' well-being and prevent ill-being were identified such as social connection and support. IMPACT: Increasing the numbers of new nursing graduates world-wide is required to strengthen health systems. Developing strategies to retain these graduates in the workforce is paramount. This review found some graduate nurses experience the transition period as a time of personal growth and fulfilment, for others this period was a stressor. These findings were illustrated in a model of 'ways to well-being'. The potential for knowledge translation of this model extends from graduate nurses as individuals, to nurse entry to practice programs and graduate nurse programs, to organizational policy targeting future health workforce. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42020148812.

Intensive care nurses' well-being: A systematic review.

BACKGROUND AND PURPOSE: Unique work challenges of intensive care nurses can cause both stress and distress to nurses, evident in prevailing literature regarding burnout, compassion fatigue, and moral distress. Identifying factors contributing to intensive care nurses' well-being would complement this focus on nurse ill-being, supporting the development of workplace well-being initiatives. The review seeks to balance the existing negatively skewed evidence base by investigating intensive care nurses' well-being rather than ill-being. OBJECTIVES: The objective of this review was to systematically identify, appraise, and synthesise primary research reporting intensive care nurses' well-being. METHODS: The electronic search strategy included (1) bibliographic databases for published work and (2) forward and backward citation searches. Key search terms included [critical OR intensive] AND [nurs*] AND [well*]. Inclusion criteria were as follows: (1) population: critical or intensive care nurses working with adult or mixed adult and paediatric patients, (2) study type: primary research studies, (3) outcome: intensive care unit nurses' well-being, and (4) publication available in the English language. Studies were excluded if the group of intensive care nurses was not independently reported. Included studies were critically appraised, and results were synthesised and presented descriptively. Semantics of the included studies were explored to identify frequently used terms. RESULTS: Four primary research studies met the inclusion criteria, focussing on spiritual well-being, team commitment, emotional well-being, and the effects of a mindfulness programme. The studies were heterogeneous in terms of study focus, definitions, and measures, with small sample sizes, and of variable quality and generalisability. CONCLUSIONS: The well-being of intensive care nurses is currently understudied. Conceptualising intensive care nurses' well-being, understanding correlates of well-being, and testing workplace interventions to improve well-being remain significant opportunities for future research.

Conceptual model for intensive care nurse work well-being: A qualitative secondary analysis.

BACKGROUND: There had been little focus on the well-being of intensive care nurses until a recent programme of research found work well-being to be best described as a collection of elements, a multifaceted construct. Strengtheners of intensive care nurses' work well-being were found to extend across individual, relational, and organizational resources. Actions such as simplifying their lives, giving and receiving team support, and accessing employee assistance programmes were just a few of the intensive care nurses' identified strengtheners. AIMS AND OBJECTIVES: To synthesize intensive care nurse perceptions of work well-being characteristics and strengtheners to identify opportunities for job crafting and redesign. DESIGN: This was a qualitative secondary analysis. METHODS: Intensive care nurse work well-being characteristics and strengtheners were explored using applied thematic analysis and pre-design, open card-sort technique. RESULTS: Five facets were identified in the analysis: (a) healthy, (b) authentic, (c) meaningful, (d) connected, and (e) innovative. These five facets were described from a theoretical perspective and illustrated as a conceptual model for intensive care nurse job crafting and redesign. CONCLUSIONS: The proposed conceptual model contributes new knowledge to be explored in meaningful discussions about intensive care nurse work well-being and empirically investigated in terms of construct validity and theory development. Furthermore, the model provides practical opportunities to explore individual and collaborative ways to enhance intensive care nurse work well-being across a range of levels. RELEVANCE TO CLINICAL PRACTICE: Opportunities for job crafting and redesign were identified and presented in a conceptual model of intensive care nurse work well-being. This model provides individual nurses, intensive care teams, health care organizations, and workers' well-being programme and policy developers practical opportunities to explore individual and collaborative ways to enhance intensive care nurse work well-being.