An international perspective on young stroke incidence and risk factors: a scoping review.

BACKGROUND: Stroke among younger age groups is increasing globally. While there is a focus on research conducted on people under 65 years who have had a stroke, there is a paucity of data on the incidence and risk factors of stroke among younger people (≤ 30 years). This scoping review examines evidence on incidence and risk factors for perinatal, paediatric and young adult stroke globally. METHODS: The review was guided by the Joanna Briggs Institute's scoping review methodology. A systematic search was conducted on 23rd March 2022 across Medline Ovid, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The eligibility criteria included all study designs providing information on the incidence and risk factors of stroke among young people (≤ 30 years) in the last ten years. RESULTS: A total of 5750 articles were identified. After screening, 471 articles (224 cohort studies (47.6%), 164 case studies/case series (34.8%), 35 reviews (7.4%), 30 case-control (6.4%) and 18 combinations of designs (3.8%) were included. There was data from 50 different countries, 199 studies were from high-income countries, upper and middle income (n = 38), lower middle-income (n = 39), low-income (n = 3) countries, international study (n = 7) and a further 185 articles did not state the country of research. Most of the studies (63%) focused on risk factors while incidence constituted 37%. Incidence data were reported heterogeneously across studies, leading to an inability to synthesise data. The three most frequently reported risk factors for perinatal stroke were infections, cardiac conditions, and intrapartum factors. Vasculopathies, infection and cardiac conditions accounted for most reported risk factors for paediatric stroke, while chronic conditions such as diabetes mellitus, vasculopathies and cardiac conditions accounted for the most reported risk factors among young adults. CONCLUSION: This review has highlighted different stroke risk factors for each age cohort of people under 30 years. The low number of epidemiological studies suggests that further research of this type is needed to fully understand the incidence and risk factors in young stroke. A standardised reporting of age groupings of incidence data is imperative to enable the comparison of data from different geographical locations.

Exploring the Unmet Needs of Young Adults with Stroke in Australia: Can Technology Help Meet Their Needs? A Qualitative Study.

The post-stroke needs of young adults with stroke are not being met, as most resources are tailored to older people with stroke. This includes technology-based applications, which are being used more frequently in stroke rehabilitation. There is limited data on technology usage to support the unique needs of young adults with stroke in Australia. This study aimed to explore the unmet needs of young adults aged 18-30 years with stroke and ascertain how technology can help meet those needs to improve quality of life and participation. Sixteen in-depth semi-structured interviews were conducted with young adults with stroke (n = 10), healthcare professionals (n = 3) and caregivers of young adults with stroke (n = 3). The interviews were transcribed verbatim and analyzed inductively. Five themes were generated: 'Support for recovery', 'Availability of specific resources', 'Continuity of care', 'Adjustment' and 'Knowledge'. This study revealed the unique needs of young adults under 30 years with stroke who requested more targeted post-stroke support, age-specific resources and improved awareness on young stroke, with technology playing a pivotal role in all these interventions. We suggest co-designing technology-based solutions with young people after stroke to maximize their effectiveness in improving quality of life and participation in this unique cohort.

Use of Social Determinants of Health Screening among Primary Health Care Nurses of Developed Countries: An Integrative Review.

The aims of the study are to evaluate and synthesise research that has investigated social determinants of health screening by primary healthcare nurses; how and when primary health care nurses perform social determinants of health screening; and implications for advancing nursing practice. Systematic searches in electronic databases identified fifteen published studies which met the inclusion criteria. Studies were synthesised using reflexive thematic analysis. This review found little evidence of primary health care nurses using standardised social determinants of health screening tools. Eleven subthemes were identified and collapsed into three main themes: organisation and health system supports are required to enable primary health care nurses; primary health care nurses are often reluctant to perform social determinants of health screening; and the importance of interpersonal relationships for social determinants of health screening. The social determinants of health screening practices of primary health care nurses are poorly defined and understood. Evidence suggests that primary health care nurses are not routinely using standardised screening tools or other objective methods. Recommendations are made for valuing therapeutic relationships, social determinants of health education and the promotion of screening by health systems and professional bodies. Overall, further research examining the best social determinant of health screening method is required.

Redesigning Rural Acute Stroke Care: A Person-Centered Approach.

Stroke service delivery in rural areas in Australia lacks evidence-based, best practice care protocols as a result of limited resources and opportunity. Healthcare redesign is an approach to improving health services by understanding barriers and enablers to service provision and work with users to develop solutions for improvement. This research aimed to qualitatively evaluate stroke care in rural Tasmania using a person-centered approach, as part of a larger healthcare redesign initiative to improve acute stroke care. Semi-structured interviews, aimed at gaining insight into experiences of healthcare staff and users, were conducted. Thematic analysis revealed three global themes (communication, holistic care, and resourcing) that demonstrated some consistency between healthcare staff and user experience, highlighting that some needs and expectations were not being met. Results of this experiential study provide important perspectives for delivering needs-based improvements in service provision for acute stroke care. Overall, this study showed that systems of stroke care in rural areas could be improved by utilizing a redesign approach including healthcare staff and users in the development of solutions for health service improvement.

Graduate nurses' capability upon entering the workforce: An integrative review.

OBJECTIVES: To clarify capability for work readiness in newly graduated registered nurses as viewed from the perspective of clinicians in practice, educators in tertiary institutions, and graduates. DESIGN: Integrative review. DATA SOURCES: Databases searched for peer-reviewed studies included PubMed, MEDLINE, ERIC, Campbell collaboration, Google Scholar, and Cochrane databases. REVIEW METHODS: Pragmatism informed this integrative review. The five-stage method described by Whittemore and Knafl was used to enable rigorous examination of the expected capability of graduate nurses. A comprehensive database search was conducted using PRISMA guidelines. Eighteen articles were appraised and analysed for this review. The capability concept was used as a framework for analysis. RESULTS: Eighteen articles met the inclusion criteria. Findings revealed that although there is no definition for graduate nurses' work readiness, there is a common theme. Graduate nurses are expected to have broad theoretical knowledge (knowing) along with practical knowledge (doing). They are also expected to demonstrate integrity, honesty, respect, compassion, and a moral compass. A list of personal attributes and organisational acumen was also reflective of graduate readiness upon entering the workforce and identified as necessary capabilities for graduates. CONCLUSIONS: A picture of the perfect employee is illustrated in the definition of work readiness by the participants of the original studies. Yet there is a lack of stakeholder consensus on the capabilities expected from a graduate nurse.

The mental health impact of COVID-19 on pre-registration nursing students in Australia: Findings from a national cross-sectional study.

AIM: The study aimed to measure and describe the mental health impact of COVID-19 on Australian pre-registration nursing students. BACKGROUND: The COVID -19 pandemic has had a swift and significant impact on nursing students across the globe. The pandemic was the catalyst for the closure of schools and universities across many countries. This necessary measure caused additional stressors for many students, including nursing students, leading to uncertainty and anxiety. There is limited evidence available to identify the mental health impact of COVID-19 on Australian pre-registration nursing students currently. DESIGN: A cross-sectional study was conducted across 12 Australian universities. METHODS: Using an anonymous, online survey students provided demographic data and self-reported their stress, anxiety, resilience, coping strategies, mental health and exposure to COVID-19. Students' stress, anxiety, resilience, coping strategies and mental health were assessed using the Impact of Event Scale-Revised, the Coronavirus Anxiety Scale, the Brief Resilience Scale, the Brief Cope and the DASS-21. Descriptive and regression analyses were conducted to investigate whether stress, anxiety, resilience and coping strategies explained variance in mental health impact. Ethical Approval was obtained from the University of New England Human Research Ethics Committee (No: HE20-188). All participating universities obtained reciprocal approval. RESULTS: Of the 516 students who completed the survey over half (n = 300, 58.1%) reported mental health concerns and most students (n = 469, 90.9%) reported being impacted by COVID-19. Close to half of students (n = 255, 49.4%) reported signs of post-traumatic stress disorder. Mental health impact was influenced by students' year level and history of mental health issues, where a history of mental health and a higher year level were both associated with greater mental health impacts. Students experienced considerable disruption to their learning due to COVID-19 restrictions which exacerbated students' distress and anxiety. Students coped with COVID-19 through focusing on their problems and using strategies to regulate their emotions and adapt to stressors. CONCLUSION: The COVID-19 pandemic has considerably impacted pre-registration nursing students' mental health. Strategies to support nursing students manage their mental health are vital to assist them through the ongoing pandemic and safeguard the recruitment and retention of the future nursing workforce. IMPACT STATEMENT: This study adds an Australian understanding to the international evidence that indicates student nurses experienced a range of negative psychosocial outcomes during COVID-19. In this study, we found that students with a pre-existing mental health issue and final-year students were most affected. The changes to education in Australian universities related to COVID-19 has caused distress for many nursing students. Australian nursing academics/educators and health service staff need to take heed of these results as these students prepare for entry into the nursing workforce. PATIENT OR PUBLIC INVOLVEMENT: The study was designed to explore the impact of COVID-19 on the mental health of undergraduate nursing students in Australia. Educators from several universities were involved in the design and conduct of the study. However, the study did not include input from the public or the intended participants.

eHealth Literacy of Australian Undergraduate Health Profession Students: A Descriptive Study.

Rapid growth in digital health technologies has increased demand for eHealth literacy of all stakeholders within health and social care environments. The digital future of health care services requires the next generation of health professionals to be well-prepared to confidently provide high-quality and safe health care. The aim of this study was to explore the eHealth literacy of undergraduate health profession students to inform undergraduate curriculum development to promote work-readiness. A cross-sectional survey was undertaken at an Australian university using the seven-domain eHealth Literacy Questionnaire (eHLQ), with 610 students participating. A one-way Multivariate Analysis of Variance (MANOVA) with follow-up univariate analysis (ANOVA) was used to determine if there were differences in eHLQ scores across 11 sociodemographic variables. Students generally had good knowledge of health (Scale 2); however, they had concerns over the security of online health data (Scale 4). There were also significant differences in age and ownership of digital devices. Students who were younger reported higher scores across all seven eHLQ scales than older students. This research provided an understanding of eHealth literacy of health profession students and revealed sub-groups that have lower eHealth literacy, suggesting that digital health skills should be integrated into university curriculums, especially related to practice-based digital applications with special focus to address privacy and security concerns. Preparation of health profession students so they can efficiently address their own needs, and the needs of others, is recommended to minimise the digital divide within health and social care environments.

Mobility-Focused Physical Outcome Measures Over Telecommunication Technology (Zoom): Intra and Interrater Reliability Trial.

BACKGROUND: Rehabilitation provided via telehealth offers an alternative to currently limited in-person health care. Effective rehabilitation depends on accurate and relevant assessments that reliably measure changes in function over time. The reliability of a suite of relevant assessments to measure the impact of rehabilitation on physical function is unknown. OBJECTIVE: We aimed to measure the intrarater reliability of mobility-focused physical outcome measures delivered via Zoom (a commonly used telecommunication platform) and interrater reliability, comparing Zoom with in-person measures. METHODS: In this reliability trial, healthy volunteers were recruited to complete 7 mobility-focused outcome measures in view of a laptop, under instructions from a remotely based researcher who undertook the remote evaluations. An in-person researcher (providing the benchmark scores) concurrently recorded their scores. Interrater and intrarater reliability were assessed for Grip Strength, Functional Reach Test, 5-Time Sit to Stand, 3- and 4-Meter Walks and Timed Up and Go, using intraclass correlation coefficients (ICC) and Bland-Altman plots. These tests were chosen because they cover a wide array of physical mobility, strength, and balance constructs; require little to no assistance from a clinician; can be performed in the limits of a home environment; and are likely to be feasible over a telehealth delivery mode. RESULTS: A total of 30 participants (mean age 36.2, SD 12.5 years; n=19, 63% male) completed all assessments. Interrater reliability was excellent for Grip Strength (ICC=0.99) and Functional Reach Test (ICC=0.99), good for 5-Time Sit to Stand (ICC=0.842) and 4-Meter Walk (ICC=0.76), moderate for Timed Up and Go (ICC=0.64), and poor for 3-Meter Walk (ICC=-0.46). Intrarater reliability, accessed by the remote researcher, was excellent for Grip Strength (ICC=0.91); good for Timed Up and Go, 3-Meter Walk, 4-Meter Walk, and Functional Reach (ICC=0.84-0.89); and moderate for 5-Time Sit to Stand (ICC=0.67). Although recorded simultaneously, the following time-based assessments were recorded as significantly longer via Zoom: 5-Time Sit to Stand (1.2 seconds), Timed Up and Go (1.0 seconds), and 3-Meter Walk (1.3 seconds). CONCLUSIONS: Untimed mobility-focused physical outcome measures have excellent interrater reliability between in-person and telehealth measurements. Timed outcome measures took approximately 1 second longer via Zoom, reducing the reliability of tests with a shorter duration. Small time differences favoring in-person attendance are of a similar magnitude to clinically important differences, indicating assessments undertaken using telecommunications technology (Zoom) cannot be compared directly with face-to-face delivery. This has implications for clinicians using blended (ie, some face-to-face and some via the internet) assessments. High intrarater reliability of mobility-focused physical outcome measures has been demonstrated in this study.

Australian First-Year Nursing Student Knowledge and Attitudes on Pressure Injury Prevention: A Three-Year Educational Intervention Survey Study.

Pressure injury prevention is a significant issue as pressure injuries are difficult to heal, painful, and create clinical complications for patients. The aim of this study was to investigate knowledge and attitudes of first-year nursing students to pressure injury prevention, and to explore whether additional educational interventions augmented learning. A previously validated online survey was administered to three cohorts of first-year nursing students in 2016, 2017 (after additional online education), and 2018 (after further simulation education), and a subsequent comparative analysis was undertaken. Overall, the knowledge of students about pressure injury was low with measures to prevent pressure injury or shear achieving the lowest score (<50%). Students aged over 25 years (p < 0.001) and men (p = 0.14) gained higher attitude scores. There were significant differences for mean knowledge scores between the 2016 and 2018 cohorts (p = 0.04), including age group (p = 0.013) and number of clinical training units undertaken (p = 0.23). The 2016 cohort scored consistently lower in the attitude survey than both other cohorts (p < 0.001). Online resources and simulation experiences marginally improved knowledge and improved attitudes towards prevention of pressure injury. Nursing curricula should include targeted education to ensure student nurses are adequately prepared to prevent pressure injury through understanding of aetiology and risk assessment.

Using COMPASS (Context Optimisation Model for Person-Centred Analysis and Systematic Solutions) Theory to Augment Implementation of Digital Health Solutions.

Digital health research is an emerging discipline that requires easy-to-understand theoretical frameworks and implementation models for digital health providers in health and social care settings. The COVID-19 pandemic has heightened the demand for digital health discipline-specific instruction on how to manage evidence-based digital health transformation. Access to the use of these models guarantees that digital health providers can investigate phenomena using safe and suitable approaches and methods to conduct research and identify answers to challenges and problems that arise in health and social care settings. The COMPASS theory is designed to aid transformation of health and social care environments. A navigational rose of primary quadrants is divided by four main compass points, with person-centred care being central to the philosophy. Two axes produce Cartesian planes that intersect to form a box plot, which can be used to discover human and physical resource weightings to augment digital health research design and implementation. A third continuum highlights stakeholders' capabilities, which are critical for any multidisciplinary study. The COMPASS mnemonic guides end users through the process of design, development, implementation, evaluation, and communication of digital health transformations. The theory's foundations are presented and explained in context of the 'new normal' of health and social care delivery.

Enabling Digital Professionalism: Analysis of the Australian and United Kingdom Nursing Education Standards.

Growth in use of digital technology for leisure and learning has created challenges for healthcare environments globally. Its rapid evolution in nursing continues to outpace the more sporadic updating of registered nurse standards, guidelines and codes of professional conduct. Revised standards in Australia and the United Kingdom establish the contemporary governance context for the educational preparation of registered nurses. A document analysis of these standards reveals an omit of guidance regarding the expected knowledge, skills, attitudes and behaviour of undergraduate nurses about when and how to access and use of digital technology on campus, and during work integrated learning. Documents governing nursing do not currently foster the development of digital professionalism, an essential component of professional identity formation, which is necessary to acquire prior to graduation as a registered nurse.

Lessons for Workforce Disaster Planning from the First Nosocomial Outbreak of COVID-19 in Rural Tasmania, Australia: A Case Study.

The identification and announcement of the COVID-19 pandemic has been a global issue. Disaster preparedness for internal and external threats is inherent within health care environments and requires agile thinking and swift remediation. Nosocomial infection is a risk for recipients of care, especially in hospital settings, which has implications for workforce planning. The aim of this case study was to examine the community response to the internal disaster of the first nosocomial COVID-19 outbreak within an Australian rural health care environment. A critical discourse analysis method was adopted to generate and analyse data collected from three different media platforms during a six-week period. Four main themes were distilled: actions and intent, loss, well-being and recognising choice, and community action. Phase two of the study interrogated these themes to expose the power positioning of speakers and their relationships to the audiences. Strengthening communication with local communities within health care environments must be a priority in any future rural workforce disaster preparedness planning. Maintenance of trust with health service provision and delivery in rural communities is imperative. The inclusion of a robust communication plan within any risk management strategy that meets the needs of the local users of health services is mandatory.

Healthcare Professional Presenteeism during a COVID-19 Outbreak in an Australian Rural Healthcare Environment: A Case Analysis.

The recruitment and retention of health professionals in rural Australia is well documented. The COVID-19 pandemic has further exposed the precariousness of human healthcare resources within small rural communities. The external disaster of the COVID-19 outbreak described in this case analysis exacerbated the frail balance of sustaining adequate staffing levels and skill mix, which exposed behaviours of presenteeism within rural healthcare teams. An analysis of the complex of factors that led to the first nosocomial outbreak of COVID-19 within a healthcare environment in Australia demonstrates how rural healthcare environments are ill-equipped to meet the demands of unexpected external disasters. Using the Haddon Matrix to examine the factors that led to this outbreak provides us with the opportunity to learn from the case analysis. Health professional presenteeism contributed to the North West Tasmania COVID-19 outbreak and affected the hospital and health service provision within the region. Recommendations to mitigate risk for future disaster planning in rural healthcare environments include improved infection control strategies and a whole-community approach.

Moral distress in community health nursing practice.

Contemporary sociopolitical circumstance impedes the delivery of primary health care in keeping with its underlying philosophy and tenets. Skills to negotiate the maintenance of best practice and quality care in an evolving practice environment are fundamental to nursing. Nurse education needs to incorporate the ideals of best practice ideology to ensure that all are prepared to negotiate the realities of nursing practice. In this discussion paper the experience of moral distress by community health nurses is used to illustrate why skills in political advocacy and action are equally essential as clinical skills in nurse education and professional practice.

Whole of Community Facilitators: An Exemplar for Supporting Rural Health Workforce Recruitment through Students' Professional Experience Placements.

The Whole of Community Facilitator model provides support for healthcare students' professional experience placements (PEP) in rural regions in Tasmania. In Tasmania, rural PEP is challenged as healthcare facilities are often small and have limited capacity for staff to devote considerable time to supervising students during PEP. Recruitment and retention of the rural health workforce in Tasmania is sometimes difficult because the island State is geographically distant from mainland Australia, and predominantly classified as a regional, rural, or remote area. The University of Tasmania, College of Health and Medicine (the College) explored various initiatives to support rural workforce sustainability, and the project discussed addresses this issue by promoting rural healthcare facilities as potential employment destinations for students upon completion of their course. The model supports the delivery of high-quality supervision to students whilst undertaking rural PEP, to foster positive experiences and potentially influence their future career choices. A successful exemplar was trialled in 2012 and implemented statewide in 2017 using a Whole of Community Facilitation (WOCF) model. The initiative supports host facilities, supervisors, host staff, and students and promotes positive placement experiences. The initiative was designed in consideration of Tasmania's rurality, and uses a flexible and responsive framework.

An academic perspective of participation in healthcare redesign.

Healthcare redesign, based on building collaborative capacity between academic and clinical partners, should create a method to facilitate flow between the key elements of health service improvement. However, utilising the skills and resources of an organisation outside of the health facility may not always have the desired effect. Accountability and mutually respectful relationships are fundamental for collaborative, sustainable and successful completion of clinical research projects. This paper provides an academic perspective of both the benefits of academic involvement in facilitating healthcare redesign processes as well as the potential pitfalls of involving external partner institutions in internal healthcare redesign projects.

Developing and sustaining digital professionalism: a model for assessing readiness of healthcare environments and capability of nurses.

INTRODUCTION: Technological change in healthcare demands new ways of working. Access to, and use of, digital technology by nurses in Australia lags behind other professions. Governance frameworks and professional standards guide scopes of practice; however, there is an urgent need for current registered nurses to master using digital technology and model digital professionalism to the next generation. Sustaining digital professionalism requires organisational readiness to accommodate changing technological environments. METHODS: Previous original research findings investigating the nature and scope of digital technology use by nurses were systematically analysed. With reference to current understandings of capability, a matrix for assessing organisational readiness of capability of digital technology use by nurses was developed. RESULTS: The 4E3P digital professionalism model articulates the elements necessary for establishing organisational readiness and assessing the capability development of individuals and groups. When the physical and social environment is conducive and the 4E elements of equipment, electronic access, engagement and education are present, preparedness, proficiency and professional behaviours can be nurtured and supported. DISCUSSION: The model describes the physical and social attributes that enable capability development for sustaining digital professionalism to advance nursing practice. When elements of the matrix are lacking, both individuals and groups miss opportunities to develop and sustain digitally professional behaviour. CONCLUSION: It is imperative that healthcare environments in Australia support the development of digital professionalism. Deployment of the 4E3P digital professionalism model will enable identification and remediation of challenges, barriers or risks to promote sustainability found within physical and social healthcare environments.