Paramedics' experiences of barriers to, and enablers of, responding to suspected or confirmed COVID-19 cases: a qualitative study.

BACKGROUND: Paramedics' work, even pre-pandemic, can be confronting and dangerous. As pandemics add extra stressors, the study explored paramedics' lived experience of the barriers to, and enablers of, responding to suspected or confirmed Coronavirus Disease 2019 (COVID-19) cases. METHODS: This exploratory-descriptive qualitative study used semi-structured interviews to investigate Queensland metropolitan paramedics' experiences of responding to cases during the COVID-19 pandemic. Interview transcripts were analysed using thematic analysis. Registered Paramedics were recruited by criterion sampling of staff who experienced the COVID-19 pandemic as active officers. RESULTS: Nine registered paramedics participated. Five themes emerged: communication, fear and risk, work-related protective factors, leadership, and change. Unique barriers included impacts on effective communication due to the mobile nature of paramedicine, inconsistent policies/procedures between different healthcare facilities, dispatch of incorrect information to paramedics, assisting people to navigate the changing healthcare system, and wearing personal protective equipment in hot, humid environments. A lower perceived risk from COVID-19, and increased empathy after recovering from COVID-19 were unique enablers. CONCLUSIONS: This study uncovered barriers and enablers to attending suspected or confirmed COVID-19 cases unique to paramedicine, often stemming from the mobile nature of prehospital care, and identifies the need for further research in paramedicine post-pandemic to better understand how paramedics can be supported during public health emergencies to ensure uninterrupted ambulance service delivery.

Supporting learners in prison healthcare work-integrated learning settings through simulation: a cross-sectional study.

BACKGROUND: Nursing students and nurse preceptors indicate that a comprehensive orientation is vital to successful work-integrated learning placements in Prison Health Services. The aim of this study was to implement and evaluate a Prison Health Service orientation package that included innovative asynchronous online video simulations with branched decision-making and feedback opportunities to stimulate learning and improve students' feelings of preparedness for a placement in this setting. METHODS: A cross-sectional pre and post design was used to evaluate the resource. Students were given access to the package and invited to complete a pre-placement survey evaluating the resource and their feelings of preparedness for placement. Following placement, they re-evaluated the resource in terms of how well it prepared them for the placement and how well prepared they felt. Third year Australian undergraduate nursing students from one university who completed a Prison Health Service work-integrated learning placement in 2018, 2021, and 2022 were invited to participate. Placements were unavailable in 2019 and 2020. Independent t-tests were used to determine differences in scale means and level of preparedness between pre- and post-survey responses. RESULTS: Twenty-three of 40 (57.5%) eligible nursing students completed the pre-placement survey and 13 (32.5%) completed the post placement survey. All respondents to the pre-placement survey indicated that they felt satisfactorily, well, or very well prepared after completing the orientation package prior to their clinical placement. Students were significantly more likely to consider themselves well prepared by the package after they had attended placement (p < .001). All students post placement indicated that overall, the simulation resources and the specific simulation scenario about personal boundaries and management of manipulative behaviours was useful for their placement. The majority of students would recommend the orientation package to other students. Suggestions for improvement included streamlining the resource to reduce the time to complete it. CONCLUSIONS: Asynchronous online simulation with the capacity for branched decision making and feedback along with a comprehensive online orientation package were perceived as useful to prepare undergraduate students for placement in the Prison Health Service work-integrated learning setting.

A program quality framework: a collaborative teaching team approach to quality assurance, quality enhancement and staff capacity building.

A global shortage of registered nurses provides a further impetus to retain nursing students and graduate safe nurses. While various frameworks support curriculum design and describe the need for ongoing curriculum evaluation and monitoring, there is little in the literature to support the enactment and ongoing quality enhancement of curricula. Translation of the curriculum plan into the delivered curriculum relies on academics who may or may not be adequately prepared for course writing and teaching in higher education settings, despite their discipline expertise. Additionally, there are well recognized issues of curriculum drift where curriculum innovations and changes are whittled away over time by incremental changes to courses that interfere with the integrity of the accredited curriculum. We propose an evidence-based Program Quality (ProQual) Framework that takes a holistic, collaborative, and systematic approach to monitoring and enhancing curriculum quality and program delivery over the life of the curriculum while developing staff capability and scholarship.

The assessment of undergraduate bachelor of nursing students in the collaborative clusters education model: A qualitative descriptive design.

BACKGROUND: Worldwide, undergraduate Bachelor of Nursing students are required to complete experiential learning placements in health care settings as part of the curriculum. There are a variety of facilitation models that support student learning and assessment on clinical placement. As workforce pressures increase globally, innovative approaches to clinical facilitation are required. In the Collaborative Clusters Education Model of clinical facilitation, hospital-employed clinical facilitators work collaboratively within peer groups (clusters) to collectively participate in a process of facilitating student learning and conducting assessment and moderation of student performance. The assessment process in this collaborative clinical facilitation model is not well described. AIM: To describe how the assessment of undergraduate nursing students is achieved in the Collaborative Clusters Education Model. DESIGN: A qualitative descriptive approach was employed. METHODS: In March 2021 individual and group interviews were conducted with seven clinical facilitators working in the Collaborative Clusters Education Model in one health service in southeast Queensland, Australia. Content analysis of transcribed interviews was performed. RESULTS: Assessment was achieved through two processes, situational scoring and moderation. In the process of situational scoring, clinical facilitators balanced the students' perception of their role in assessment, accounted for the type of experiences available, considered multiple sources of evidence and used the Australian Nursing Standards Assessment Tool. In the process of moderation, clinical facilitators communicated with their cluster colleagues to determine a shared understanding of student history, considered data from multiple evidence sources and collaboratively evaluated the trustworthiness of student performance evaluation decisions. CONCLUSIONS: In the Collaborative Clusters Education Model, the input of multiple assessors, working in a small team, ensured transparency in assessment processes. Furthermore, this transparency in assessment practices normalised on-going moderation, an in-built quality-check and, as such, an innovative component of assessment in the Collaborative Clusters Education Model. As nursing directors and managers seek to ameliorate the impact of nursing workforce pressures, this innovative model of collaborative assessment may serve as a valuable addition to nursing clinical assessment toolkits. TWEETABLE ABSTRACT: The Collaborative Clusters Education Model of Clinical Facilitation enables transparency in assessment processes and normalises moderation.

Paramedic insertion of peripheral intravenous catheters, unused catheter rates, and influencing factors: A retrospective review.

BACKGROUND: Peripheral intravenous catheters (PIVCs) are associated with adverse events such as bloodstream infections; thus clinically appropriate practice is important. However, there is limited research on PIVC use in ambulance settings. This study investigated the incidence of paramedic-inserted PIVCs, unused PIVCs, and factors that influenced practice. METHODS: Electronic patient care records for Western Australian ambulance service patients who attended between January 1 and December 31, 2020 were retrospectively reviewed. Patient, environmental, and paramedic characteristics were explored. Binominal logistical regression models were used to identify factors associated with PIVC insertion and unused PIVCs. RESULTS: A total of 187,585 records were included; 20.3% had a PIVC inserted and 44% remained unused. Factors associated with PIVC insertion were gender, age, problem urgency, chief complaint, and operational region. Age, chief complaint, and paramedic years of experience were associated with unused PIVCs. DISCUSSION: This study identified multiple modifiable factors for the unnecessary insertion of PIVCs, which may be addressed through better education and mentoring of paramedics supported by clearer clinical guidelines. CONCLUSIONS: This is, to our knowledge, the first Australian state-wide study to report unused paramedic-inserted PIVC rates. As 44% remained unused, clinical indication guidelines and intervention studies to reduce PIVC insertion are warranted.

Pre-hospital peripheral intravenous catheter insertion practice: An integrative review.

BACKGROUND: Peripheral intravenous catheters (PIVCs) are widely used within healthcare settings. There is substantial hospital-based research, particularly in Emergency Departments, supporting the need to reduce inappropriate PIVCs due to associated risks. However, there is limited research into pre-hospital practice. This review aims to determine the rates of pre-hospital PIVC insertions, how many remain unused, and to explore paramedic PIVC decision-making. METHODS: A systematic search of research databases was undertaken using an integrative review methodology. Articles published between 2011 and April 2022 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. RESULTS: Fifteen studies were included. Rates of PIVC insertions ranged from 21% to 58%. Up to 72% of PIVCs remained unused in the pre-hospital setting. Paramedic decision-making was not well reported, though erring of the side of caution and inserting a "just in case" PIVC was identified. CONCLUSION: There are limited articles on pre-hospital PIVC practice, particularly in Australian settings. Research is required to understand factors influencing practice and provide contemporary evidence to inform the development of guidance specific to the pre-hospital setting to reduce the numbers of inappropriate PIVCs.

Barriers to, and enablers of, paramedics responding to suspected or confirmed COVID-19 cases: An integrative review.

BACKGROUND: The coronavirus pandemic (COVID-19) has focused attention on healthcare workers' concerns about working during a pandemic, yet research on the effect of the pandemic specifically on paramedics is lacking. This literature review aims to critically examine the current knowledge of paramedics' experience of barriers to, and enablers of, responding to suspected or confirmed COVID-19 cases. METHODS: An integrative review was undertaken using articles found by a systematic search of four research databases. Inclusion criteria included paramedics or emergency medical technicians who had experience of barriers or enablers responding to patients during the coronavirus pandemic. RESULTS: Nine articles met the inclusion and exclusion criteria. Barriers included communication and poor leadership, fear of infection to self and family, frequent changes in guidelines and inconsistencies across agencies, stress/burnout, and concerns with personal protective equipment. Enablers included job security, perceived social support, solidarity with other paramedics, and use of modern technologies for communication. CONCLUSIONS: There are unique experiences of working during the COVID-19 pandemic in the prehospital environment. Particular challenges occurred with leadership, communication within the organisation and between agencies, and working in an unpredictable environment.

The influence of an educational intervention on nursing students' domestic violence knowledge and attitudes: a pre and post intervention study.

BACKGROUND: Nurses, as the largest group of health professionals, have a key role in recognising, mitigating and preventing domestic violence. However, studies demonstrating effective undergraduate educational interventions are lacking. The research aim was to compare undergraduate nursing students' knowledge and attitudes about domestic violence before and after an educational intervention on domestic violence and explore their views on the most useful teaching strategies. METHODS: A quasi-experimental pre and post design was used to determine the impact of an educational intervention. Australian nursing students enrolled in a first-year undergraduate subject were invited to participate. The educational intervention included a 40-min pre-recorded lecture on domestic violence, and a two-hour face-to-face workshop facilitated by an expert, supported by readings. Students completed a pre- and post-intervention online anonymous survey using a validated instrument, the Inventory on Beliefs and Attitudes towards Domestic Violence. Wilcoxon signed rank tests were used to compare pre and post intervention results. RESULTS: Approximately 400 students completed the voluntary workshop; 198 students completed the pre survey, 176 completed the post survey and 59 (13.1%) completed both. Post intervention, participants indicated stronger agreement on 15 of 22 items. The inventory score became significantly more positive (Z = -3.196, p = .001, CI -.206--0.067) post intervention. Of the 173 students who indicated post intervention which forms of education they found useful, 38.2% considered face-to-face tutorials to be the most useful education modality. CONCLUSIONS: This study demonstrates the effectiveness of even a small educational intervention in changing attitudes, and creating awareness and knowledge of the context, prevalence, perpetrators, and significant associated burden of illness related to domestic violence, and nurses' responsibility to support victims.

Indigenous-led First Peoples health interprofessional and simulation-based learning innovations: mixed methods study of nursing academics' experience of working in partnership.

Background: Collaborative, Indigenous-led pedagogical and research approaches in nursing education are fundamental to ensuring culturally safe curriculum innovations that address institutional racism. These approaches privilege, or make central, Indigenous worldviews in the ways healthcare practices are valued and assessed. With the aim of informing excellence in cultural safety teaching and learning, and research approaches, this study draws on the experiences and key learnings of non-Indigenous nursing academics in the collaborative implementation of First Peoples Health interprofessional and simulation-based learning (IPSBL) innovations in an Australian Bachelor of Nursing (BN) program.Methods: An Indigenous-led sequential mixed method design was used to investigate non-Indigenous nursing academics' experiences in the design, development and delivery of two IPSBL innovations. A validated survey (the Awareness of Cultural Safety Scale, (ACSS)) was administered to nursing academics before and after the innovations were delivered. Phenomenological interviews were also conducted following the implementation of the innovations.Results: Of the 27 staff involved in the delivery of the innovations, six nursing academics completed both pre-and post-surveys (22%). Nine (33%) participated in phenomenological interviews. There was a non-significant trend towards improved scores on the ACSS following the delivery of the innovations. Nursing academics' perceptions of the innovations' relevance to their practice were enhanced. An increased awareness of culturally safe academic practices was reported among those actively involved in innovations.Impact statement: Indigenous-led approaches in teaching and research promote excellence within mandatory cultural safety education for nurses and midwives.Conclusions: This study confirms the importance of educating the educators about cultural safety in teaching and learning, and research approaches. It also provides important insights into how non-Indigenous nursing academics can work within Indigenous-led pedagogical and research approaches to design culturally safe curriculum innovations.

Developing intersubjectivity and teamwork skills through learning circles on clinical placement: A mixed methods study.

AIM: To determine the efficacy of learning circles on developing intersubjectivity and teamwork skills and determine barriers to and facilitators of, learning circles as a learning tool. BACKGROUND: Teamwork skills are vital for safe, effective nursing care and are dependent on individual team members' shared understandings or intersubjectivity. Work-based learning circles offer a potential pedagogic strategy to promote teamwork. METHODS: In work-based learning circles conducted in 2018, students drew a concept map based on a clinical case and discussed an element of it with the group. Using a convergent parallel mixed methods design, a cross-sectional survey of students using a student clinical experience questionnaire and a qualitative descriptive approach for interviews with clinical facilitators was conducted. RESULTS: Overall, 128 Bachelor of Nursing students (88.9% response) completed the survey and five facilitators (50%) attended group interviews. Students agreed that core teamwork skills were developed during their placement and clinical facilitators reported (1) student engagement in the learning circle processes; (2) learning much about students' abilities; and (3) developing subtle teaching skills to enhance discussion. Sharing experiences from different wards and clinical experiences was a platform for developing intersubjectivity. CONCLUSIONS: To promote intra-professional teamwork skills, conducting learning circles with students from different disciplines may further enhance intersubjectivity and is an area for further research.

Applying team-based learning in a transnational post registration bachelor of nursing program in Singapore.

BACKGROUND: Team-Based Learning (TBL) is growing in popularity as a method to create active learning within larger group lectures. It is facilitated through phases of individual work, teamwork with immediate feedback and an application exercise, to develop students' understanding and assessment of conceptual knowledge. A single facilitator can manage many groups within larger lectures. The study aim was to evaluate the impact of TBL on the engagement, learning and satisfaction of students enrolled in a transnational post registration Bachelor of Nursing (BN) program in Singapore. METHODS: A cross-sectional design was employed. The TBL approach was delivered during lecture sessions within a post registration BN program delivered in a Higher Education Institution in Singapore. A sample of BN students was drawn from 305 students undertaking the program. An online anonymous university-delivered student evaluation of course (SEC) survey and an online anonymous survey using the Student Assessment Instrument, were used to collect quantitative and qualitative data. Survey participation was voluntary with informed consent protocols followed. Student performance in the course was also reviewed. RESULTS: Eighty-two students (27%) completed the SEC scoring a median of 4/5 for satisfaction, and 68 (22%) completed the online survey. As 93 was the neutral score for the survey, there was a moderately positive evaluation with an overall score of 108.5/155 for TBL in accountability for learning, TBL preference and satisfaction with TBL compared to traditional lecture approaches. CONCLUSIONS: Implementation of TBL with this cohort demonstrated evidence of moderately positive engagement, learning and satisfaction when compared to traditional didactic lectures.

Facilitating learning on clinical placement using near-peer supervision: A mixed methods study.

BACKGROUND: Graduating nursing students report lower competence in leadership and delegation skills, which may be due to lack of sufficient opportunities to practice leadership skills such as delegation and supervision. A near-peer clinical supervision model, in which third-year students supervise first-year students on placement, may provide a mechanism to develop graduating students' leadership skills while improving the learning experience for junior students. OBJECTIVES: To evaluate nursing students' experiences and perceptions of participating in a near-peer clinical supervision model. DESIGN: A mixed methods design including an anonymous post-placement survey of students, and a group interview. SETTINGS: Medical and surgical wards in three Australian hospitals. METHOD: Forty-three first-year nursing students were supervised by 92 third-year nursing students on clinical placement under the supervision of a registered nurse in a near-peer supervision model. RESULTS: Twenty-seven first-year (69.2%) and 43 third-year (46.7%) students completed the questionnaire. First-years reported that being supervised by a senior student was a positive experience and would recommend it to other students (4.49/5 ± 0.71), and indicated that third-year students behaved professionally, were knowledgeable, and provided opportunities to ask questions (4.52-4.81/5). Third-year students reported gaining confidence, teaching, delegation and leadership skills (4.21-4.49/5). Qualitative responses supported the quantitative findings. Additional findings were the need for greater preparation of ward registered nurses to work in the model. CONCLUSIONS: Both groups enjoyed working in a near-peer clinical supervision model. The model provided opportunities for senior students to develop leadership and delegation skills and a positive experience of placement for junior students. Further attention to preparation of ward registered nurses would improve model delivery.

Clinical facilitators' experience of near peer learning in Australian undergraduate nursing students: A qualitative study.

BACKGROUND: To mitigate escalating costs in clinical supervision of undergraduate nursing students and alleviate clinical facilitators' teaching burden, the near-peer learning model has become popular. Studies on near-peer learning have been on students' views of the model with a paucity of literature on clinical facilitators' experiences. AIM: To explore clinical facilitator experiences of the near-peer learning model. DESIGN: A qualitative descriptive design was used with a purposeful sample of clinical facilitators involved in near-peer learning of nursing students. SETTING: Two teaching hospitals participated. Two medical and two surgical wards were selected from each. PARTICIPANTS: Eleven clinical facilitators who had experienced using near-peer learning. METHODS: Focus group and individual interviews were conducted with clinical facilitators using a semi-structured interview guide following ethics approval. Data were analysed using content analysis. RESULTS: Four themes emerged: 1) Congruent student dyad characteristics 2) Clinical facilitator attributes of confidence in students' knowledge and effective time and conflict management, 3) Availability of suitable skills, and 4) Facilitator support and preparation on the model. These themes appear to promote optimum learning outcomes of the near-peer model including empowering students, junior students gaining practice in foundation skills and senior students gaining competence in leadership, mentoring and nurturing skills. Barriers included incongruent student characteristics resulting in conflict and trust issues, senior student not knowing how to teach, give feedback or teaching inaccurate information; facilitator's lack of confidence in students' knowledge level, inadequate time to manage the student dyad and resolve conflict; inadequate support and preparation from university staff; and unavailability of suitable skills. CONCLUSION: Successful implementation requires careful selection of student dyads, appropriate clinical environment and support for clinical facilitators. Our findings provide a better understanding of the near-peer model for future implementation.

Supporting Australian clinical learners in a collaborative clusters education model: a mixed methods study.

BACKGROUND: Nursing student numbers have risen in response to projected registered nurse shortfalls, increasing numbers of new graduates requiring transitional support and pressure on clinical placements. A Collaborative Clusters Education Model, in which Entry to Practice facilitators coach ward-based registered nurses to support students' and new graduates' learning, may address placement capacity. The research aim was to evaluate the acceptability of the Collaborative Clusters Education Model to stakeholders by examining their perceptions of the facilitators and barriers to the model in its implementation. METHODS: A convergent mixed methods evaluation approach was adopted. The study took place in a large Australian health service in south-east Queensland. Participants included Bachelor of Nursing students, Entry to Practice facilitators, ward-based registered nurses, academics and new graduates. A mixed methods design was used. Elements included an online survey of nursing students, and interviews with new graduates, Entry to Practice facilitators, ward-based registered nurses, and academics. Descriptive statistics were calculated on quantitative data. Thematic analysis was conducted on qualitative data. RESULTS: Participants included 134 (of 990) nursing students (response rate 13.5%), five new graduates, seven Entry to Practice facilitators, four registered nurses, and three nurse academics. Students rated facilitators' effectiveness highly (4.43/5 ± 0.75), although this finding is tempered by a low response rate (13.5%). For learners, the model provided access to learning experiences, although preferences for sources of support differed between students and new graduates, and further clarification of responsibilities was required. For other stakeholders, three themes emerged: students' and new graduates' integration into the workplace can promote learning; tensions arise in new ways to approach performance assessment; and aligning expectations requires high levels of communication. CONCLUSIONS: This evaluation found that acceptability was good but at risk from limited clarity around roles and responsibilities. Further research into this model is recommended.

Barriers associated with mandatory influenza vaccination policies for healthcare workers: an integrative review.

BACKGROUND: Uptake of influenza vaccination reduces staff absenteeism as well as mortality of patients and healthcare workers (HCWs); however, adherence of HCWs to annual influenza vaccination is poor and some healthcare facilities are now considering mandatory influenza vaccination policies. AIM: The purpose of this study was to identify the perceived and reported barriers to the implementation of a mandatory influenza vaccination policy for HCWs. METHODS: An integrative review of the literature was conducted. Databases including CINAHL, Cochrane Library, Medline and PubMed were searched using key terms. The quality of papers was assessed utilising the Standard Quality Assessment Criteria for Evaluating Primary Research papers for a Variety of Fields which consisted of 10 questions with a possible total score of 20. PRISMA guidelines were used to report the search outcomes. RESULTS: A total of 68 papers were identified from the database search. Seven papers were relevant, following screening. The quality scores of these were in the range of 15-20. A number of barriers are reported to prevent the effective implementation of mandatory influenza vaccination policies including ethical and legal considerations, logistics, healthcare burden, leadership and management, and human factors such as HCWs' perspectives. CONCLUSIONS: By comprehensively identifying these, barriers can be addressed to allow effective implementation of such policies in healthcare facilities to ensure improved outcomes. The results of the review indicated the need for further research to ensure that barriers are addressed cohesively.

A cross-sectional study of domestic violence instruction in nursing and midwifery programs: Out of step with community and student expectations.

BACKGROUND: Domestic violence is a global health concern. Nurses and midwives must respond to those who experience domestic violence, although many are not prepared to do this. The World Health Organization recommend that domestic violence content be included in all pre-registration training as a matter of urgency. OBJECTIVES: To examine self-reported undergraduate student perceptions of domestic violence content in their programs of study and student attitudes and beliefs about domestic violence. DESIGN: A cross-sectional research design with online survey was employed from June to October 2017. METHODS: Using convenience sampling, 1076 students were recruited to the study from a total population sample of just over 6000 undergraduate nursing and midwifery students; a response rate of 17.9%. Survey data reported the nature and frequency of teaching and learning along with student attitudes and beliefs about domestic violence. Open ended responses were examined via thematic analysis. SETTINGS: Nine Australian universities offering undergraduate nursing and midwifery degrees. PARTICIPANTS: Undergraduate university nursing and midwifery students. RESULTS: Over half of students surveyed (53.7%, n = 578) reported that domestic violence was not addressed in their program of study. A direct correlation was found between students' perceived preparedness to assess and respond to domestic violence, and the amount of taught content in their program of study. CONCLUSION: This major gap in curricula has significant implications for professional practice preparedness. Further research should focus on examining the reasons why quality domestic violence content is lacking in undergraduate nursing and midwifery programs and how prioritisation of domestic violence content can be improved.

Hand hygiene beliefs and behaviours about alcohol-based hand rub use: Questionnaire development, piloting and validation.

BACKGROUND: Behavioural theories are crucial to the development and success of effective hand hygiene interventions. Research demonstrates that hand hygiene behaviours can also be influenced by religious and cultural beliefs. In this paper we detail the processes undertaken to develop a valid and reliable questionnaire to examine healthcare workers' beliefs and behaviours related to the use of alcoholbased hand rub (ABHR), with particular emphasis on associated religious and cultural factors. METHODS: Using the Theory of Planned Behaviour, an existing questionnaire was modified and pilot-tested on 35 staff in the Quality Department. Cronbach's alpha values and mean inter-item correlations of the scale items were the main outcome measures. A Pearson correlation was conducted to assess for social desirability response bias. RESULTS: The questionnaire demonstrated high content and face validity and satisfactory internal consistency in most scales, except for the religious beliefs, cultural beliefs and perceived behavioural control scales, where the inter-item correlations were 0.10, 0.13, and 0.14, respectively. There was a significant correlation between scores on the social desirability scale and the attitude scale. Partial correlation should be used to control the effect of social desirability responding when analysing data from the attitudes scale. CONCLUSIONS: A validation process allowed the introduction and subsequent modification of religious and cultural belief scales to an existing questionnaire examining behavioural and attitudinal influences on hand hygiene using ABHR. Such processes should be considered for questionnaire development and modification when considering religious and cultural factors as drivers of behaviour.

Australian nursing and midwifery student beliefs and attitudes about domestic violence: A multi-site, cross-sectional study.

Nurses and midwives have a professional responsibility to identify and provide effective care to those experiencing domestic violence. Pre-registration preparation may develop this capability. In order to inform curriculum development, this study explored Australian nursing and midwifery students' attitudes and beliefs about domestic violence. Data were collected between June and October 2017. Descriptive statistics were calculated and comparative analysis performed on independent variables. Thematic analysis was performed on open-ended qualitative responses. Participants included 1076 students from nine Australian universities. The majority were enrolled in nursing programs (88.4%), followed by midwifery (8.6%), and combined nursing/midwifery (2.4%) programs. There was no statistically significant difference in scores by year level across all subscales, suggesting there was no developmental change in beliefs and attitudes toward domestic violence over the course of study. Nursing students held views that were more violence-tolerant than midwifery students. Australian and Chinese-born males were more likely to refute that domestic violence is more common against women. Students had a limited understanding of domestic violence suggesting a critical need to address undergraduate nursing and midwifery curricula.

Learning through structured peer discussion: An observational study.

BACKGROUND: Clinical experiences are an essential foundation of nursing education. While there have been many significant investigations into models of clinical education and student learning, how students 'make sense' of their experiences is less well investigated. Senior nursing staff in a tertiary health service partnered with nurse researchers to explore how students can learn more about practice through structured discussions with peers to promote shared understandings. OBJECTIVES: The study aimed to evaluate the contributions to student learning from structured peer discussions about patient care. DESIGN: Exploratory observational study of the effects of learning circle discussions on individual understanding of patient care. SETTING: A metropolitan health service in southeast Queensland, Australia. PARTICIPANTS: 72 Bachelor of Nursing students in Years 2 and 3. METHODS: Students developed concept maps about patient care prior to peer discussions, and subsequently added further concepts (in another colour of text) after those discussions. Researchers' review of student generated concept maps and coded concepts indicated a five a priori ways of knowing categories: empirical, aesthetic, ethical, personal and socio-political. Descriptive analysis of categories was then conducted. RESULTS: Empirical knowing was high in both groups, with more concepts included in Year 3 student maps. Aesthetic knowing was relatively high in both groups. Socio-political knowing was lower than anticipated overall. Personal and ethical forms of knowing were rarely included on the concept maps. CONCLUSIONS: While clinical placement is valued for developing empirical and aesthetic forms of knowing, the other forms of knowing have value for patient and family care and warrant strategies to improve their further development. Developing strategies to support student learning of ethical and personal forms of knowing deserves further investigation.

The experiences of the agency registered nurse: An integrative literature review.

AIM: To examine experienced registered nurses' motivations for choosing agency work, their experiences and perceptions of agency nursing and how they meet their regulatory professional development obligations. BACKGROUND: Agency registered nurses are employed by healthcare organizations to meet staffing shortfalls and contain costs. METHODS: Using an integrative review framework, four databases (CINAHL, Medline, Embase and Scopus) were systematically searched between 2000 and 2017: study selection followed the Preferred Reporting Items for Systematic reviews and Meta-analyses. RESULTS: Our search identified 491 sources. From these, two primary qualitative sources were included in this review. Four themes were identified: orientation, allocation of the agency nurse, isolation in clinical practice and lack of education opportunities. CONCLUSION: Given the limited literature on agency nurses and how to support them, further research is required on this subject. IMPLICATIONS FOR NURSING MANAGEMENT: Support for agency nurses is necessary, so they can seamlessly integrate with the healthcare team to provide safe patient care. This review may assist managers to identify strategies to effectively engage and support agency registered nurses in the acute care nursing team. The gaps identified highlight the need for further research to explore agency nurses' motivations, and support needs to inform future strategic workforce planning.