Milestones in the journey: The story of refugees becoming registered nurses in Australia.

AIMS: To explore the experiences of refugees who became registered nurses after arriving to Australia. DESIGN: Qualitative description using a naturalistic inquiry framework. METHODS: Between February 2018 and September 2019, the lead author conducted semi-structured interviews with employed registered nurses (RNs) that are former refugees and English-speaking. Interviews were 45-90 min' duration and digitally recorded. Participants provided voluntary informed consent and were sent questions beforehand. Data were collected and coded into themes. Rigor was achieved with multiple transcript readings by the research team to confirm common themes. RESULTS: Twelve participants discussed their story. Three major themes were identified: (1) Milestone of being a refugee; (2) Milestone of resettling in Australia; (3) Milestone of becoming a RN. CONCLUSION: Each participant's story started at a place of disadvantage. They progressed successfully through the three milestones; despite living with traumatic experiences, they learned new skills, developed English literacy, became a RN and juggled the demands of life. This paper highlights the poorly understood pockets of the current Australian RN workforce. IMPACT STATEMENT: The nuanced stories of RNs with refugee backgrounds in this study move beyond trauma and struggle and demonstrate the important journey this particular group of health professionals undertake. Increasing the contextual knowledge of the complex lives of former refugees turned nursing professionals will raise public awareness of the diversity of life experiences of RNs working in Australia.

Experiences of registered nurses from a refugee background: A scoping review.

AIMS AND OBJECTIVES: This scoping review presents an exploration of international literature on the factors that impact refugees' personal and professional experiences during their journey to being registered nurses in a new host country. BACKGROUND: Governments of host countries receiving refugees seek to develop strategies that facilitate the successful resettlement, employment and enculturation of refugees that arrive as skilled professionals. There is a scarcity of studies focussing on issues faced by refugees that are RNs or those pursuing nursing registration and employment in a new host country. This study is relevant for resettlement services, nursing registration authorities and education providers and informs the international nursing workforce. DESIGN: Scoping review. METHODS: Databases such as MEDLINE, EMBASE, Cochrane Library, CINAHL; Google Scholar; PubMed; Scopus and Web of Science were searched for qualitative studies published up to and including 2017. Articles that did not specify explicitly the participants as registered nurses and/or refugees were excluded. All eligible articles were analysed for collective findings, and impact factors were extracted, synthesised and illustrated diagrammatically. RESULTS: This review explored six eligible articles and six impact factors were identified. The challenging impacts were as follows: loss of control; shock in a new environment and bleak employment prospects. Equally three impact factors: reconciling new reality; establishing a new identity and hope for the future, facilitate positive experiences for nurses in their successful transition into society and the nursing workplace. CONCLUSIONS: This scoping review reports the small number of international studies on the experiences of refugees seeking to become registered and employed as registered nurses. The six impact factors identified influence the lives of the nurse participants socio-economically in and out of the workplace. RELEVANCE TO CLINICAL PRACTICE: Policymakers, managers and educators providing resettlement, registration and employment services could develop strategies that enhance integration and transition experiences of refugees aspiring to be registered nurses.

The process and challenges of obtaining and sustaining clinical placements for nursing and allied health students.

AIMS AND OBJECTIVES: To describe the process and challenges from a project that aimed to develop processes, source new placements and place students primarily in the discipline of nursing, but also occupational therapy, physiotherapy, podiatry, social work, and speech therapy. BACKGROUND: Clinical experience in health facilities is an essential element of health professional education, yet globally, there is a lack of clinical placements to meet demands. Educational providers are seeking placements in nontraditional facilities, yet little has been reported on the challenges in the process of procuring clinical placements. DESIGN: The project used a descriptive approach within a quality implementation framework. METHODS: The project was guided by the quality implementation framework that included four critical steps: considerations of the host setting, structuring the implementation, supporting the implementation and improving future applications. RESULTS: A total of 115 new student placements were finalised across six health disciplines, including elderly care, nongovernment organisations and general practice. Sixty-two nursing students were placed in the new placements during the project. Challenges included communication, the time-consuming nature of the process and 'gatekeeping' blocks to obtaining placements. Recommendations included the importance of personal interaction in developing and maintaining relationships, and the need for clear communication processes and documentation. Potential areas for research are also given. CONCLUSIONS: There is great potential for growth in establishing new placements outside the traditional placement facilities for nursing and allied health and for expanding already existing nonhospital placements. RELEVANCE TO CLINICAL PRACTICE: Clinical professional experiences are essential to any nursing or allied health programme. There is an increasing demand for, and global lack of, clinical placements for nursing and allied health students. The results provide nursing and allied health educators and managers a framework for planning clinical placement procurement, and assisting in decision-making and developing strategies and processes for practice.

Simulation as a learning strategy: supporting undergraduate nursing students with disabilities.

AIMS AND OBJECTIVES: To promote simulation as a learning strategy to support undergraduate nursing students with disabilities. BACKGROUND: Supporting undergraduate nursing students with disabilities has gained further momentum because of amendments to the Disability Discrimination Act in 2009. Providers of higher education must now ensure proactive steps to prevent discrimination against students with a disability are implemented to assist in course progression. Simulation allows for the impact of a student's disability to be assessed and informs the determination of reasonable adjustments to be implemented. Further suitable adjustments can then be determined in a safe environment and evaluated prior to scheduled placement. Auditing in this manner, offers a risk management strategy for all while maintaining the academic integrity of the program. DESIGN: Discursive. METHODS: Low, medium and high fidelity simulation activities critically analysed and their application to support undergraduate nursing students with disabilities assessed. RESULTS: With advancing technology and new pedagogical approaches simulation as a learning strategy can play a significant role. In this role, simulation supports undergraduate nursing students with disabilities to meet course requirements, while offering higher education providers an important risk management strategy. CONCLUSION: The discussion recommends simulation is used to inform the determination of reasonable adjustments for undergraduate nursing students with disabilities as an effective, contemporary curriculum practice. Adoption of simulation, in this way, will meet three imperatives: comply with current legislative requirements, embrace advances in learning technologies and embed one of the six principles of inclusive curriculum. Achieving these imperatives is likely to increase accessibility for all students and offer students with a disability a supportive learning experience. RELEVANCE TO CLINICAL PRACTICE: Provides capacity to systematically assess, monitor, evaluate and support students with a disability. The students' reasonable adjustments can be determined prior to attending clinical practice to minimise risks and ensure the safety of all.

Postnatal post-traumatic stress: An integrative review.

PROBLEM: Post-traumatic stress disorder and post-traumatic stress symptoms following birth occur amongst a small proportion of women but can lead to poor maternal mental health, impairment in mother-infant bonding and relationship stress. This integrative review aims to examine the associated risk factors and women's own experiences of postnatal post-traumatic stress in order to better understand this phenomenon. METHOD: Fifty three articles were included and critically reviewed using the relevant Critical Appraisal Skills Program checklists or Strengthening the Reporting of Observational studies in Epidemiology assessment tool. FINDINGS: Risk factors for postnatal post-traumatic stress symptoms and disorder include factors arising before pregnancy, during the antenatal period, in labour and birth and in the postnatal period. Potential protective factors against postnatal post-traumatic stress have been identified in a few studies. The development of postnatal post-traumatic stress can lead to negative outcomes for women, infants and families. DISCUSSION: Risk factors for post-traumatic stress symptoms and disorder are potentially identifiable pre-pregnancy and during the antenatal, intrapartum and postnatal periods. Potential protective factors have been identified however they are presently under researched. Predictive models for postnatal post-traumatic stress disorder development have been proposed, however further investigation is required to test such models in a variety of settings. CONCLUSIONS: Postnatal post-traumatic stress symptoms and disorder have been shown to negatively impact the lives of childbearing women. Further investigation into methods and models for identifying women at risk of developing postnatal post-traumatic stress following childbirth is required in order to improve outcomes for this population of women.

Australian student nurse's knowledge of and attitudes toward primary health care: A cross-sectional study.

BACKGROUND: Nurses have a pivotal role in changing the focus of the health system toward a primary health care approach, yet little is known about the effectiveness of nursing students' educational preparation for this role. OBJECTIVES: The aim of the study was to investigate undergraduate Australian nursing students' knowledge of and attitudes toward the primary health care approach. DESIGN: A cross-sectional, descriptive research design was applied. SETTING: Two Australian universities, one with a rural base and one in the metropolitan area of Sydney, were involved. Both universities offer undergraduate and postgraduate nursing courses on multiple campuses. PARTICIPANTS: A convenience sample of 286 undergraduate nursing students, each of whom had completed a unit of study on PHC. All provided consent to participate in the study. METHODS: Data was collected using the Primary Health Care Questionnaire via online survey platform SurveyMonkey for a period of three weeks in June 2015. RESULTS: Total knowledge scores ranged from 19.68 to 95.78 with the mean knowledge score being 69.19. Total attitude scores ranged from 33.12 to 93.88 with a mean score of 70.45. Comparison of knowledge scores showed mean scores of students born in Australia were significantly higher than those of students who were born overseas (p=0.01), and mean scores of students enrolled in the metropolitan university were also significantly higher than mean scores of students' enrolled in the rural university (p=0.002). In terms of attitudes scores, mean scores of Australian-born students were significantly higher than those of students born overseas (p=0.001), and older students' mean attitude scores were shown to be significantly higher than younger students' (p<0.005). CONCLUSIONS: Student's age, country of origin and university location were shown to be significant influences on student's knowledge of and attitudes toward primary health care.

Facilitating undergraduate nurses clinical practicum: the lived experience of clinical facilitators.

Clinical practicum experience for undergraduate nurses remains undisputed as an essential component of any program. Exposure to the reality of professional practice and its integration of explicit, with tacit knowledge, is invaluable in producing skilled clinicians. Currently there are many issues that have arisen regarding clinical practice education for undergraduate nurses in Australia including; ongoing financial support and resourcing of clinical placements. Developing an understanding of these issues is central to the provision of quality clinical education. The aim of this study is to reveal dimensions of the lived experience of being a clinical facilitator, a popular model of nursing clinical education, to come to an understanding of how facilitation actually takes place in the clinical environment. The Hermeneutic phenomenological approach used in this study has brought to light five essential themes that elucidate the phenomena of facilitation. Those themes have been identified as; knowing your own limitations, employing the notion of stepping in or stepping back, developing alliances, acknowledging the reciprocity of the learning experience, and identifying appropriate clinical buddies. The recommendations from this study will have an impact on current issues and will inturn, influence the quality of clinical education for all stakeholders.