Unit Warm-up: Jump start into tertiary studies.

Background: A high level of preparedness for engagement is essential for a smooth transition into tertiary studies. Regardless, many first-year nursing students appear underprepared, a situation likely exacerbated by today's increasingly diverse student population. Students' preparedness to begin tertiary education can be hampered by factors such as environmental changes, technical issues and paid work demands. For first year students, this period is frequently marked by apprehension and a sense of unpreparedness. Objectives: To report the difference in first-year nursing students' pre- and post-subject preparedness and understanding after participating in a Unit Warm-Up. Design: A quantitative survey. Settings: An online pre- and post-survey prior to the commencement of a subject. Participants: First-year, first-semester nursing students. Methods: Students could choose to participate in a "Unit Warm-Up" strategy before commencing a subject. Those who participated were invited to complete the pre- and post-survey created with the Qualtrics survey software. Survey questions focused on students' subject preparedness, level of anxiety about the subject's content, level of motivation and understanding of the subject's learning outcomes. Data was collected over a four-year period. Results: The findings revealed that participating in the Unit Warm-Up from 2019 to 2021 had a significant impact on students' preparedness and understanding of the subject's learning outcomes. In 2022, no significant changes were observed, which could have been influenced by extreme flooding in the regions. Anxiety levels among students decreased from 2019 to 2021, but not in 2022. Motivation remained consistent over time. When compared to overall pass rate and student satisfaction trends, such a Unit Warm-Up strategy may have a positive impact. Conclusion: A Unit-Warm-Up strategy has merit as a jump start into tertiary studies. Nevertheless, external factors such as the Covid pandemic and environmental disasters can disrupt students' anxiety and readiness for participating in a subject.

Tone as a health concept: An analysis.

STUDY DESIGN: Concept analysis. INTRODUCTION: This paper is a report on the analysis of the concept of tone in chiropractic. PURPOSE: The purpose of this paper is to clarify the concept of tone as originally understood by Daniel David Palmer from 1895 to 1914 and to monitor its evolution over time. METHODS: Data was sourced from Palmer's original work, published between 1895 and 1914. A literature search from 1980 to 2016 was also performed on the online databases CINHAL, PubMed and Scopus with key terms including 'tone', 'chiropractic', 'Palmer', 'vitalism', 'health', 'homeostasis', 'holism' and 'wellness'. Finally hand-searches were conducted through chiropractic books and professional literature from 1906 to 1980 for any references to 'tone'. Rodgers' evolutionary method of analysis was used to categorise the data in relation to the surrogates, attributes, references, antecedents and consequences of tone. RESULTS: A total of 49 references were found: five from publications by Palmer; three from the database searches, and; the remaining 41 from professional books, trade journals and websites. MAJOR CONCLUSIONS: There is no clear interpretation of tone in the contemporary chiropractic literature. Tone is closely aligned with functional neurology and can be understood as an interface between the metaphysical and the biomedical. Using the concept of tone as a foundation for practice could strengthen the identity of the chiropractic profession.

Duelling Ontologies: Might Vitalism Offer Balance and Value?

This article is part of a project investigating chiropractors' beliefs on the role of vitalism in their philosophical and practice approaches and how that might contribute to addressing current epidemics of non-communicable diseases. It aims to present atomism, reductionism, materialism and mechanism as fundamental ontologies in biomedicine and to examine what role these might play in its struggle to deal with these epidemics; to present vitalism as a fundamental ontology existing in chiropractic along with these ontologies of biomedicine; and to discuss how imbalances in the use of these ontologies and practices stemming from them might be contributing to difficulties in addressing these epidemics. The use of more balanced approaches by chiropractors involving not only mechanistic biomedical ontologies but also an increased focus on vitalism might offer value in addressing these epidemics and should be investigated.

Students' perceptions of the use of eportfolios in nursing and midwifery education.

ePortfolios have been introduced into many higher education degrees in the past decade in an effort to help students to link theory, practice and personal experiences. This pilot study used a survey to examine ePortfolio use from the perspective of undergraduate nursing and postgraduate midwifery students. Fifty-seven students from a regional Australian university completed an online questionnaire which contained questions about the following areas of ePortfolio use: understanding of the tool; psychological perceptions; challenges around use; assessment; outcomes of use; benefits; maintenance of the ePortfolio; and enhanced learning. The majority of respondents were female, undergraduate students, aged 21-30 years. Results indicated that many students found ePortfolio use frustrating; in particular, technological and logistical challenges in using ePortfolios were highlighted. Most students, however, noted ePortfolios could be useful repositories for documents, reflections and learning experiences. Undergraduate students were more likely than postgraduate students to see the positive potential of ePortfolio use. The findings, coupled with the literature, raise questions about the effectiveness of ePortfolio use in nursing and midwifery education and, particularly, whether ePortfolios have been implemented with misguided and misinformed good intention. Further research is required to better understand the logistical and technological aspects of successful implementation of ePortfolios and fully capitalise on their benefits for nursing and midwifery education.

Health related quality of life across the perinatal period among Australian women.

AIMS AND OBJECTIVES: To investigate the significant features in health-related quality of life and to examine the changes over time during the perinatal period. BACKGROUND: Health-related quality of life during the perinatal period is significant for women. Screening or surveillance during the perinatal period is inconsistent and often not part of continued assessment. DESIGN: Prospective. METHODS: Setting involved antenatal clinics at three public hospitals in metropolitan Brisbane, Australia. A total of 363 participants out of a cohort of 605 women completed all items of the Short Form-12 Health Survey in late pregnancy and again at 6 and 12 weeks postpartum. RESULTS: There was a significant difference across the three perinatal time periods in all the health-related quality-of-life subscales. Significant improvements were noted from late pregnancy to 6 weeks following childbirth and again at 12 weeks particularly in physical health, role physical, bodily pain, vitality, role emotional and mental health. Even when confounding variables such as maternal ages, partner status, parity, delivery type and ethnicity were introduced, significant improvements were noted. Maternal distress significantly related to almost all quality-of-life factors over time even when all possible confounding factors were controlled. CONCLUSION: Significant changes occur in health-related quality of life across the perinatal period. All dimensions of health-related quality of life except for social functioning and maternal distress showed marked improvement following childbirth. During this period, maternal distress was negatively related to health-related quality of life. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be mindful of the broader view of health as encompassed in health-related quality-of-life measures and the potential these have for alerting health professionals when providing care. More rigorous health assessment for mothers at risk is useful so that appropriate support and follow-up can be given.

Relationship between social support and quality of life in childbearing women during the perinatal period.

OBJECTIVE: To explore demographic and social support predictors of health-related quality of life (HRQoL) (mental and physical) for childbearing women in the perinatal period. DESIGN: Longitudinal. SAMPLE: Three public hospitals in metropolitan Brisbane, Australia. PARTICIPANTS: Four hundred seventy-three (473) women recruited at 36 weeks of pregnancy, and 6 and 12 weeks following childbirth. METHODS: The Short Form-12 (SF-12) Version 2 Health Survey was used to measure the mental and physical domains of HRQoL. Social support was measured using the Maternal Social Support Scale (MSSS). RESULTS: Mean scores for the mental and physical domains of HRQoL were lower than population norms. Social support was found to be a significant and consistent predictor of higher HRQoL scores, particularly in the physical domain at 12 weeks following child birth and mental domain during the perinatal period. The relationship between social support and HRQoL was found to be independent of other factors including education, length of relationship with partner, age, parity, and antenatal visit. The only other significant predictor was length of relationship with partner in the mental domain at 36 weeks of pregnancy. CONCLUSION: Social support is a significant and consistent predictor of a mother's HRQoL during the perinatal period. Nurses and midwives need to assess social support, rather than making assumptions based on demographic factors.

Report of an evaluation of a nurse-led dementia outreach service for people with the behavioural and psychological symptoms of dementia living in residential aged care facilities.

BACKGROUND: This paper describes the implementation and evaluation of a Dementia Outreach Service (DEMOS). The service is led by the first Nurse Practitioner in Dementia Care in the State of Queensland in Australia and is highly innovative in terms of its mode of delivery. The evaluation took place due to a perception that new models such as the DEMOS often fail to gain momentum due to a lack of data on their effectiveness and efficiency. METHOD: The parameters of the project were to evaluate the extent to which the DEMOS met its key deliverables, focusing specifically on outcomes for residential aged care facilities (RACF) residents and staff. The study involved both quantitative and qualitative data collection. Qualitative data was collected through interviews, focus groups and reflective journals. A survey which was administered at three stages of the 12 months of the study was the main source of quantitative data. Additional statistical data was collected from relevant healthcare providers. FINDINGS: Twenty RACFs within a specific health service district participated in the study. This included an intervention group of 7 facilities (which received the service) and a control group of 13. A total of 320 RACF staff participated in Stage 1 of the study, although due to staff attrition this had reduced to 153 (54.6%) at Stage 3. Attrition rates were much lower in the 7 intervention facilities, with 67.9% of the original sample remaining at Stage 3. To augment the quantitative data collected as above, drawing on a range of qualitative techniques the researchers canvassed the perceptions, thoughts and opinions of differing stakeholders. The qualitative data proved extremely valuable in confirming the success of DEMOS. KEY SUCCESS AREAS: Increased self-confidence among staff in dealing with residents with dementia; reduced stress among staff; reductions in the instances of difficult behaviours; reduced referrals to acute sector services; high levels of satisfaction among RACF management regarding DEMOS; and a process of continuous improvement of DEMOS based on stakeholder feedback. IMPLICATIONS FOR PRACTICE: Recommendations for the future directions of the service include: The continued support and expansion of DEMOS; An increase in the DEMOS service portfolio to actively assist facilities to change the culture of care amongst RACF carers; and Showcasing of DEMOS as an example of 'best practice' in dementia care to argue the need for provision of additional Nurse Practitioners specializing in dementia care.

Maternal role development: the impact of maternal distress and social support following childbirth.

OBJECTIVE: to explore the relationship between maternal role development (MRD), maternal distress (MD) and social support following childbirth. DESIGN: prospective longitudinal survey. SETTING: three public hospital maternity units in Brisbane, Australia. PARTICIPANTS: 630 pregnant women were invited to participate in the study, with a 77% (n=473) completion rate. MEASUREMENTS: to measure MRD, the Prenatal Maternal Expectation Scale was used at 36 weeks of pregnancy, and the revised What Being the Parent of a New Baby is Like (with subscales of evaluation, centrality and life change) was used at six and 12 weeks post partum. At all three data collection points, the Edinburgh Postnatal Depression Scale was used to measure MD, and the Maternal Social Support Scale was used to measure social support. FINDINGS: at 36 weeks of gestation, optimal scaling for MRD produced a parsimonious model with MD providing 39% of predictive power. At six weeks post partum, similar models predicting MRD were found (evaluation: r(2)=0.14, MD providing 64% of predictive power; centrality: r(2)=0.07, MD providing 11% of predictive power; life change: r(2)=0.26, MD providing 59% of predictive power). At 12 weeks post partum, MD was a predictor for evaluation (r(2)=0.11) and life change (r(2)=0.26, 54% of predictive power). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: there is a statistically significant but moderate correlation between MRD and MD. The transition to motherhood can be stressful, but may be facilitated by appropriate acknowledgement and support with an emphasis on MRD.

Maternal distress: a concept analysis.

AIM: This paper is a report of an analysis of the concept of maternal distress. BACKGROUND: Although not well-developed, the concept of maternal distress has offered an important viewpoint in nursing and midwifery practice since the mid-1990s. Traditionally, understanding of maternal distress has been based on the medical model and dysfunction. The concept of maternal distress needs development so that it describes responses ranging from normal stress responses to those indicating mental health problem/s. DATA SOURCES: The SCOPUS, CINAHL and Medline databases were searched for the period from 1995 to 2009 using the keywords 'psychological distress', 'emotional distress' and 'maternal distress'. REVIEW METHODS: Steps from Rodgers' evolutionary concept analysis guided the conduct of this concept analysis. RESULTS: Four attributes of maternal distress were identified as responses to the transition to motherhood, with the level of each response occurring along a continuum: stress, adapting, functioning and control, and connecting. Antecedents to maternal distress include becoming a mother, role changes, body changes and functioning, increased demands and challenges, losses and gains, birth experiences, and changes to relationships and social context. The consequences of maternal distress are compromised mental health status, maternal role development, quality of life, ability to function, quality of relationships and social engagement. The extent of the impact depends on the level of maternal distress. CONCLUSION: Clearer interpretation of maternal distress offers a comprehensive approach to understanding maternal emotional health during the transition to motherhood. Acknowledging women's experiences and providing more appropriate support could alleviate some of the struggles and hardships experienced by mothers.

My face, a window to communication: using creative design in learning.

Creative art as part of assessment in nursing is a powerful alternative to traditional methods of promoting engagement for students who have different learning styles, and who value engagement in creative activities. This paper describes an innovative assessment approach for first year nursing students which addressed the development of a beginning knowledge base in therapeutic communication as well as critical thinking and writing skills. Each student was asked to design a wearable mask to display an abstract interpretation of the therapeutic communication skills required as a nursing student, followed by a discussion about therapeutic nursing communication. Results from an evaluation of the assessment are described using Bigg's (1995) structure of observed learning outcome (SOLO) taxonomy. Seventy percent of students (n=35) found the new assessment to be an effective learning strategy. As a creative exercise, 82% (n=41) found the assessment to have engaged them at a personal level. More effort is needed for innovative assessment strategies to promote student engagement. Use of a creative assessment approach that incorporates art creation shows much promise in bridging the gap from a superficial understanding of concepts to an understanding characterised by deeper learning.

A Nurse Practitioner initiated model of service delivery in caring for people with dementia.

The increasing number of people with dementia in aged care facilities is reported to have a high burden of care among staff. The Nurse Practitioner role can be beneficial in the provision of dementia care particularly when difficult and aggressive behaviour is being displayed. The model of service described in this paper is designed in such a way to make the outreach team contribute to staff sustainability. Such a service is different to other outreach services and focuses on a number of key deliverables. In practice, the service ensures that recommendations made by the team at the initial assessment are implemented. In addition, they work with the staff in managing the resident's behaviour, train and model suggestions for practice in interventions. Evaluation of the service is a work in progress and will highlight important aspects about the workforce for the improvement of quality of life for residents with dementia.