Exploring rural Nurses' preparedness and post-resuscitation experiences. An ethnographic study.

AIM: The focus of this paper is to provide a detailed ethnographic exploration of rural nurses' experiences of their resuscitation preparedness and the subsequent post-resuscitation period. DESIGN: An ethnographic study across two small rural hospital sites in New South Wales, Australia. METHODS: Fieldwork was undertaken between December 2020 and March 2022 and included over 240 h of nonparticipant observation, journalling and interviews. Data were analysed using reflexive thematic analysis. RESULTS: The first key theme-'Sense of Preparedness'-included three subthemes: 'Gaining experience', 'Issues with training and education' and 'Lack of warning'. The second key theme 'Aftermath' comprised two subthemes: 'Getting on with it' and 'Making sense of the resus'. CONCLUSION: This study has highlighted the intricate relationship between resuscitative preparedness and the post-resuscitation period in shaping rural nurse's experiences and their well-being. Rural nurses are asking for an authentic and contextually relevant training experience that mirrors the unique rural challenges they experience. In the absence of frequent resuscitation presentations, the post-resuscitation period should be viewed as a crucible moment that can be leveraged as a valuable learning opportunity enhancing rural nurses' sense of preparedness and the provision of quality resuscitation care. IMPACT: Having a greater level of insight into the challenges that rural nurses experience in the pre- and post-resuscitation period is critical. This insight opens the door for fortifying policies and work processes that will better support rural nurses in the resuscitation environment. REPORTING METHOD: Reporting complied with COREQ criteria for qualitative research. NO PATIENT OR PUBLIC CONTRIBUTION: This study explored the experiences of rural nurses. No patient data were collected.

Emergency clinicians' use of adult and paediatric sepsis pathways: An implementation redesign using the behaviour change wheel.

AIMS: To identify facilitators and barriers and tailor implementation strategies to optimize emergency clinician's use of adult and paediatric sepsis pathways. DESIGN: A qualitative descriptive study using focus group methodology. METHODS: Twenty-two emergency nurses and ten emergency medical officers from four Australian EDs participated in eight virtual focus groups. Participants were asked about their experiences using the New South Wales Clinical Excellence Commission adult and paediatric sepsis pathways using a semi-structured interview template. Facilitators and barriers to use of the sepsis pathways were categorized using the Theoretical Domains Framework. Tailored interventions were selected to address facilitators and barriers, and a re-implementation plan was devised guided by the Behaviour Change Wheel. RESULTS: Thirty-two facilitators and 58 barriers were identified corresponding to 11 Theoretical Domains Framework domains. Tailored strategies were selected to optimize emergency clinicians' use of the sepsis pathways including refinement of existing education and training programmes, modifications to the electronic medical record system, introduction of an audit and feedback system, staffing strategies and additional resources. CONCLUSION: The implementation of sepsis pathways in the Emergency Department setting is complex, impacted by a multitude of factors requiring tailored strategies to address facilitators and barriers and optimize uptake. IMPLICATIONS FOR PATIENT CARE: This study presents a theory-informed systematic approach to successfully implement and embed adult and paediatric sepsis pathways into clinical practice in the Emergency Department. IMPACT: Optimizing uptake of sepsis pathways has the potential to improve sepsis recognition and management, subsequently improving the outcome of patients with sepsis. REPORTING METHOD: The Consolidated Criteria for REporting Qualitative research guided the preparation of this report. PATIENT OR PUBLIC CONTRIBUTION: Nil.

The engagement of older people living with chronic lung disease in a peer support community-based exercise programme: A qualitative study.

BACKGROUND: Chronic lung disease is a common and complex condition. Pulmonary rehabilitation programmes-either hospital-based or in the community are recommended in evidence-based clinical practice guidelines. AIM: To explore the experience of older people with chronic lung disease involved in a peer support community-based exercise maintenance programme. DESIGN AND METHOD: Participants were a part of the Lungs in Action programme run in a local community leisure centre through Lung Foundation Australia. All the programme participants (n = 25) were invited by an independent person through email and/or letter to participate in the study and provided with a participant information and consent form. Participants who returned consent forms were scheduled for group interviews. Participants were recruited over a 2-week period between 30 August and 13 September 2022. We conducted qualitative group interviews using a semi-structured interview guide to explore the experiences of older people living with chronic lung disease. Data were analysed using reflexive thematic analysis. RESULTS: A total of 14 participants (eight female and six male) aged between 64 and 86 years were interviewed. Three themes emerged from the data: motivation, authentic social engagement, and sustainable achievement. Motivation stemmed from the participants' perceived health benefits, and from the trainers' motivation and encouragement. Participants discussed how sharing experiences created an environment of trust and understanding, fun and friendship. Social engagement and creating authentic relationships were key aspects raised by participants. Feeling more confident in themselves and being able to accomplish physical tasks, making activities of daily living more manageable featured highly in participants' responses. DISCUSSION AND CONCLUSION: Community-based peer support exercise groups enable environments for people with chronic lung disease to maintain physical fitness, and to connect with others to form friendships and have fun.

Exploring leadership in health professionals following an industry-based leadership program: A cross-sectional survey.

AIM: To evaluate the self-reported leadership practices and behaviours of health professionals following a leadership program and explore factors that impacted leadership style. DESIGN: An online cross-sectional survey was conducted from August to October 2022. METHODS: The survey was disseminated via email to leadership program graduates. The Multifactor Leadership Questionnaire Form-6S was used to measure leadership style. RESULTS: Eighty completed surveys were included in the analysis. Participants scored highest on transformational leadership and lowest on passive/avoidant leadership style. Participants with higher qualifications scored significantly higher in the inspirational motivation scores (p = 0.03). As years in their profession increased, there was a significant decrease in contingent reward scores (p = 0.04). The younger participants scored significantly higher on the management-by-exception than older participants (p = 0.05). There were no significant associations with the year the leadership program was completed, gender or profession and Multifactor Leadership Questionnaire Form - 6S scores. Most participants (72.5%) strongly agreed that the program enhanced their leadership development and 91.3% strongly agreed or agreed that they routinely apply the skills and knowledge learnt in the program in their workplace. CONCLUSION: Formal leadership education is important in developing a transformational nursing workforce. This study found that program graduates had adopted a transformational leadership style. Education, years of experience and age impacted the specific leadership elements. Future work needs to incorporate longitudinal follow-up to relate changes in leadership with impact on clinical practice. IMPLICATIONS FOR THE PROFESSION: Transformational leadership as a dominant style can contribute to nurses and other disciplines positively contributing to innovative and person-centred approaches to health service delivery. SUMMARY STATEMENT: What already is known-Leadership amongst nurses and other health professionals impacts patients, staff, organizations and ultimately healthcare culture. What this paper adds-Formal leadership education is important in developing a transformational healthcare workforce. Implications for practice/policy-Transformational leadership can enhance nurses and other disciplines commitment to innovative and person-centred approaches. IMPACT STATEMENT: This research identifies that lessons learnt from formal leadership education are retained over time by healthcare providers. This is important for nursing staff, and other healthcare providers, who are leading teams and overseeing care delivery, can ensure leadership behaviours and practices are enacted to influence a transformational workforce and culture. REPORTING METHOD: This study adhered to STROBE guidelines. No Patient or Public Contribution.

Nurses and nature; Does green space make a difference?

How we engage in and with nature is of growing interest in relation to our health and well-being. For nurses with stressful workloads that are contributing to fatigue, psychological burden, insomnia, and decreased coping strategies, interactions with nature or green space are essential as it has been demonstrated to facilitate better environments and outcomes for nurses. Evidence of the impact of nature is limited. However, the value of interactions with nature has been prioritised by the World Health Organization and so healthcare organizations should be considering overt and practical ways to ensure nurses, and other healthcare providers, are exposed to nature to contribute towards healthier environments.

Adaption of the Cancer Information Overload Scale for pandemics and assessment of infodemic levels among nurses and midwives.

AIM: This study was conducted in three phases. Phase 1 aimed to adapt the Cancer Information Overload Scale and conduct content validity testing. Phase 2 aimed to conduct factorial validity testing of the scale. Phase 3 aimed to assess information overload and the sources of information used by nurses and midwives to keep up-to-date about COVID-19. DESIGN: A cross-sectional survey of nurses and midwives working in a metropolitan Local Health District in Sydney, Australia, was conducted from May to June 2020. METHODS: Adaptation of the Cancer Information Overload Scale and content validity of the modified scale (as the Pandemic Information Overload Scale) was undertaken by an expert panel comprising of senior nurses and researchers. Factorial validity and reliability of the Pandemic Information Overload Scale were evaluated using exploratory factor analyses using one subsample of the data. Using the second subsample of the data, information overload and sources of information used by nurses and midwives to keep up-to-date about COVID-19 were examined. RESULTS: The Pandemic Information Overload Scale is a reliable and valid instrument for measuring information overload among nurses during a pandemic. Its internal consistency was high (α = 0.81, M = 3.84). CONCLUSION: The 8-item PIO scale is a brief, reliable and psychometrically sound instrument for measuring nurses' and midwives' perceptions of information overload during COVID-19. Mean scores across this study indicated that participants were experiencing above average information overload. Implementing strategies to reduce this overload would optimize clinical decision making and promote patient safety.

Observing resuscitative practice. A novice researcher's experience of obtaining ethics approval.

Undertaking research involving vulnerable groups, such as those requiring resuscitation involves careful analysis during the ethical review process. When a person lacks the capacity to make an informed choice about their participation in a research study, a waiver of consent offers an alternative. This paper is based on a doctoral research study using ethnography to explore the resuscitative practices and experiences of rural nurses through observation and interviews. This paper aims to explore the ethical issues raised by the Human Research Ethics Committee relating to consent of vulnerable patients requiring resuscitation within a rural context. In particular, the challenges of addressing risk (privacy) vs benefit (public) associated with a waiver of consent. This paper will consider why the rural context should be championed during the ethical review process, when decisions about public benefit are being deliberated. Utilising a communitarianism approach that advocates for greater rural representation during the ethical review processes will ensure that rural research involving vulnerable groups can be addressed safely and benefit not only the experiences and practices of rural nurses but also the wider rural communities they serve.

Career optimism and job-related well-being of Australian nurses during COVID-19: A cross-sectional study.

BACKGROUND: Australia has been confronted with a severe nursing deficit, making it difficult to maintain a strong healthcare workforce capable of meeting the mounting demands of healthcare organizations. AIMS: This study aimed to understand how personal and organizational resources influence career optimism and job-related affective well-being of Australian nurses during a pandemic using the Conservation of Resource Theory. METHODS: A cross-sectional online survey was emailed to 123 Australian nurses from January to February 2021. The survey consisted of self-reported measures, including mindfulness, career optimism, job-related affective well-being, personal and job resources measures, and the Dirty Dozen scale. Correlations, independent sample t-test, and a series of hierarchical regressions were conducted on the cross-sectional data with SPSS Version 27. The STROBE checklist was used to report the results. RESULTS: Findings suggested that mindfulness, perceived supervisor support, and job autonomy were significant predictors of job-related well-being, whereas mindfulness, perceived supervisor support, and opportunities for professional growth contributed more to career optimism of nurses during a health crisis. Male nurses in this study reported significantly higher mindfulness, career optimism, and job-related well-being levels than female nurses. LINKING EVIDENCE TO ACTION: Developing mindfulness among nurses, allocating organizational resources to facilitate more supervisor support, and providing job autonomy may enhance career optimism and job-related well-being of nursing staff who work in disruptive and high-demand work environments such as those experienced during the COVID-19 health crisis. Supervisors should also facilitate and encourage nurses to reflect and be mindful of their behaviors with their peers and patients which can help to reduce exploitative or arrogant behaviors in the workplace.

The experience of staff utilizing data to evaluate and improve person-centred practice: An action research study.

AIM: Explore how nurses and midwives use patient experience data collected from a mobile health app to influence the development of person-centred practice. DESIGN: Participatory action research, underpinned by the Person-Centred Nursing Framework and Practice Development principles. METHODS: Six clinical units in a large health district engaged in three action cycles from 2018 to 2020 using a mobile health app. Nursing/midwifery staff on the units (N = 177) utilized data collected via the app to evaluate and improve person-centred practice. A pre-post survey using the PCPI-S was conducted to evaluate staff perceptions of person-centredness. Data from the surveys (n = 101 in 2018 and n = 102 in 2020) and 17 semi-structured interviews were used to understand the influence working with these data had on person-centred practice. The Guidelines for Best Practices in the Reporting of Participatory Action Research have been used to report this study. RESULTS: Improvements in person-centred practice were noted across both data sets. There was a statistically significant increase in two domains of the PCPI-S in the independent t-test and across all three domains in the paired t-test results. Thematic analysis resulted in the identification of six themes: Getting everyone on board, once we understood, keeping on track, there's a person in the bed, knowing you're doing a good job and improving over time. CONCLUSION: Engaging with the data collected from the app in a facilitated and collaborative way results in increases in person-centredness. IMPACT: This study provides insight into how nurses and midwives used data from a mHealth app to evaluate and improve person-centred practice. Utilizing the data generated by the app resulted in increased person-centredness amongst staff and changes to practice and culture. Nursing and midwifery teams who are supported to engage with patient experience data in an action-oriented way will see person-centred practice improvements, affecting patients and staff.

Voices from the 'resus room': An integrative review of the resuscitation experiences of nurses.

BACKGROUND: Nurses are often the first responders to resuscitations. Understanding their experiences of resuscitation will highlight the resuscitative context nurses work within and identify the conditions that support or hamper their delivery of safe and effective resuscitative care. AIM: The aim of this integrative review is to develop an understanding of nurses' experience of resuscitation, to gain knowledge of their challenges and identify gaps in evidence. DESIGN: Integrative review. METHODS: The electronic databases CINAHL, MEDLINE, Scopus and Web of Science were systematically searched from 2000-2021. Methodological quality of the papers was evaluated using the Mixed Methods Appraisal Tool (MMAT). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist was used to guide and report the integrative review. RESULTS: Eleven articles met criteria for review. Four themes arose from the literature that addressed nurses experiences of resuscitation: Chaos (external/internal), ethical dilemmas, clinical confidence and need for support. CONCLUSION: Nurses' experiences of resuscitation are multifaceted. Addressing the challenges that nurses experience during resuscitation will help ensure that nurses' are supported in their professional growth and personal well-being. Relevance to clinical practice and research: Building nursing leadership capacity within resuscitations is an area of clinical practice/research that is gaining traction as a valid solution to address the challenges nurses experience during resuscitations. Whilst the barriers to debriefing requires a greater level of consideration within the workplace.

How nurses and midwives engage with patient experience data to inform person-centred quality and safety improvements.

AIMS AND OBJECTIVES: To explore how nurses and midwives engage with patient experience data collected via a mobile health app to inform person-centred practice improvements. BACKGROUND: A large amount of data is collected in healthcare, yet there is limited evidence outlining how nursing and midwifery staff utilise patient experience data to inform person-centred quality and safety improvements. METHODS: This study utilised action research, underpinned by Practice Development methodology and has been reported using the SQUIRE 2.0 checklist. Six clinical units (medical short stay, acute medical, surgical, oncology/haematology, day surgery and maternity) in a large health district in Australia engaged in three cycles of data collection using a mobile health app. The app captured patient experience data relating to the person-centred KPIs developed and tested by McCance et al. (2012). Staff used the data to develop and evaluate person-centred practice. RESULTS: A number of improvements in scores and practice occurred through engaging with the data in a cyclical way. All six clinical units saw an improvement in four or more of the KPIs in the patient survey results from cycle one to cycle three, with two clinical units improving in all eight. On average across the six units, there was also an increase in time nurses/midwives were visible to their patients, an increase in clinical documentation reflecting the patients' needs and what was important to them, an increase in positive comments and a decrease in negative comments in patient stories. CONCLUSION: This study shows that collecting and utilising data from the person-centred KPIs in a collaborative and cyclical way lead to enhanced patient experience and the development and implementation of person-centred quality and safety improvements. RELEVANCE TO CLINICAL PRACTICE: Capturing and utilising data that are meaningful to nursing/midwifery teams in a cyclical, action-orientated approach result in person-centred practice improvements that enhance the experience of those that are receiving and delivering patient care.

Development and Evaluation of the Altered Student Study Environment Tool: A Tool to Measure Nursing Student Concerns Relating to Academic Progression During the COVID-19 Pandemic.

BACKGROUND: Rapid alterations to study environments during COVID-19 raised concerns for nursing students about their academic progression. AIM: The study aim was to investigate the psychometric properties of the Altered Student Study Environment Tool (ASSET) and the relationship between students' concerns, demographics, COVID-19-related knowledge, and communication received from the university. METHOD: The 11-item ASSET and investigator-developed questions were administered to prelicensure nursing students using an anonymous online survey. RESULTS: Responses were obtained from 234 students. Exploratory factor analysis supported a three-factor structure, namely, attending clinical placement, completion of clinical placement, and grade attainment. Students with higher scores on knowledge had significantly lower concerns for the subscale attending clinical placement. Full-time students had significantly higher concerns for the subscale completion of clinical placement. CONCLUSION: The ASSET is a valid and reliable instrument that can be used to measure concerns relating to the effects of altered study environments on academic progression.

Nursing interventions for pressure injury prevention among critically ill patients: A systematic review.

AIM: To systemically synthesise the evidence on the most effective nursing interventions to prevent pressure injuries among critical care patients. BACKGROUND: Although pressure injury (PI) prevention is a focus of nursing care in critical care units, hospital-acquired pressure injuries continue to occur in these settings. DESIGN: A systematic review of literature guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Synthesis without meta-analysis (SWiM) guidelines. METHODS: Four electronic databases were searched for relevant studies. Included studies were screened and then critically appraised using the appropriate Joanna Briggs Institute appraisal tool. Data were analysed and reported using a narrative synthesis. RESULTS: The review included 14 studies. Randomised controlled trials, quasi-experimental, case series and cross-sectional studies were included. The review identified four broad categories of interventions that are the most effective for preventing pressure injuries: (a) PI prevention bundles, (b) repositioning and the use of surface support, (c) prevention of medical device-related pressure injuries and (d) access to expertise. All the included studies reported a reduction in pressure injuries following the interventions; however, the strength of the evidence was rated from moderate to very low. CONCLUSIONS: Nurses are well qualified to lead in the prevention of pressure injuries in critical care units. Every critically ill patient requires interventions to prevent pressure injuries, and the prevention of PIs should be considered a complex intervention. Nurses must plan and implement evidence-based care to prevent all types of pressure injuries, including medical device-related pressure injuries. Education and training programmes for nurses on PI prevention are important for prevention of pressure injuries. RELEVANCE TO CLINICAL PRACTICE: Nursing interventions should consist of evidence-based 'bundles' and be adapted to patients' needs. To prevent pressure injuries among critically ill patients, nurses must be competent and highly educated and ensure fundamental strategies are routinely implemented to improve mobility and offload pressure.

Understanding perceptions of health, lifestyle risks and chronic disease in middle age.

AIM: The aim of this paper is to explore the perceptions, attitudes and beliefs of middle-aged Australians around their health, lifestyle risks and chronic disease. BACKGROUND: Health promotion and risk reduction are important to stem the rising prevalence of chronic disease. While there has been much emphasis on supporting these strategies in older Australians, there has been less attention on those in middle age. However, as this group age, their health will inevitably be impacted by lifestyle risk. DESIGN: A qualitative descriptive study using semi-structured interviews. Reporting was guided by the COREQ checklist. METHODS: Thirty-four participants aged 40-65 years were recruited across South Eastern New South Wales, Australia, using convenience sampling. Semi-structured interviews were conducted by four registered nurses with qualitative research experience. Verbatim transcripts were analysed using thematic analysis. RESULTS: Sixteen women and 18 men participated in the interviews. Four themes emerged, namely: adopting healthy lifestyles; denial; an impetus for change; and sustaining change. Perceptions about what constituted good health varied, with male participants being more ambivalent about their health. Impetus for change was mostly influenced by family history, awareness of health risks and identification of risks by health professionals. Participants found sustaining change challenging, particularly with regard to smoking cessation and dietary modifications. CONCLUSIONS: Understanding the perceptions of health of middle-aged people is important and enables health professionals to engage in early behavioural change conversations that consider perceived barriers to lifestyle modification. Findings from this study emphasise the importance of discussions about lifestyle risk to reduce the future burden of chronic disease. RELEVANCE TO CLINICAL PRACTICE: These findings illustrate the importance of understanding perceptions of health to guide primary health care nurses to develop person-centred health promotion and chronic disease prevention strategies in this age group.

COVID-19: Knowledge, anxiety, academic concerns and preventative behaviours among Australian and Indian undergraduate nursing students: A cross-sectional study.

AIMS AND OBJECTIVES: To compare knowledge, anxiety, academic concerns and preventative behaviours between undergraduate nursing students in Australia and India during the COVID-19 pandemic. BACKGROUND: Based on the World Health Organization's direction for containment of the novel coronavirus (COVID-19), countries implemented varying levels of restrictions including closure of university campuses and providing on line undergraduate education. METHODS: Students in NSW, Australia and Kerala, India completed an online survey assessing their (a) knowledge and source of information about COVID-19; (b) anxiety; and coping strategies; (c) academic concerns; and (d) preventative behaviours. Descriptive and inferential statistics were used to summarise the data. RESULTS: Data from 99 Australian and 113 Indian undergraduate nurses were analysed. Greater number of Indian students indicated having sufficient knowledge of COVID-19 (OR 0.22; 95% CI 0.08, 0.63), getting information about COVID-19 from social media (OR 0.03; 95% CI 0.01, 0.07) and being concerned about 'attending clinical placement' (MD-1.08; 95% CI -1.94, -0.23). Australian students reported significantly higher levels of anxiety (MD 1.99 95% CI 1.21, 2.78), difficulty sleeping (OR 18.00; 95% CI 6.76, 47.96), concentrating (OR 33.22; 95% CI 13.85, 79.67) and eating (OR 14.05; 95% CI 3.19, 61.84). Greater number of Australian students indicated that they would go to the University if they needed to meet with other students (OR 9.21; 95% CI 3.08, 27.55), had to access the library (OR 7.20; 95% CI 3.26, 15.90) or had a group assignment (OR 2.93; 95% CI 1.26, 6.77). CONCLUSIONS: Wide variations were present in knowledge, anxiety, academic concerns and preventative behaviours among undergraduate nursing students in two countries. RELEVANCE TO CLINICAL PRACTICE: Undergraduate students may benefit from additional support from the University and staff in the clinical setting with online learning and resources in order to adjust to the 'new normal' and enable them to achieve academic success.

The influence of engaging authentically on nurse-patient relationships: A scoping review.

The current international healthcare focus on ensuring the perspectives and needs of individual persons, families or communities are met has led to the core tenet of person-centred care for all. The nurse-patient relationship is central to the provision of care, and enhancing this relationship to ensure trust and respect supports optimal care outcomes for those accessing healthcare services. Engaging authentically is one of the recognised key approaches in person-centred practice, and this scoping review of the literature aims to gain an understanding of the role this process plays in developing effective relationships between nurses and the people they care for. A systematic search of databases and grey literature was undertaken, and twenty-one research papers met the inclusion criteria. A thematic analysis revealed four themes: 'getting to know the patient as a person', 'the complexity of relationship building-it takes time', 'the nurse: characteristics and behaviours that support the nurse-patient relationship' and 'the patient voice'. Nurses and patients both benefit from effective relationships, feeling valued and experiencing greater satisfaction with care. Key elements of engaging authentically were revealed as a nurse-patient relational process through this literature review; however, further research is needed to gain a greater understanding of this concept.

Safety attitudes build safety culture: Nurse/midwife leaders improving health care using quantitative data.

AIM: We aim to determine safety attitudes of nurses and midwives across a Local Health District in Australia and compare results 1 year later following facilitated feedback of results. BACKGROUND: Positive safety cultures are imperative for positive patient and staff outcomes. Staff member's attitude contribute to an organisations safety culture but can differ between health professional groups and across different subcultures. METHOD: The Safety Attitudes Questionnaire (SAQ-Short version) was administered to all nurses and midwives within a Local Health District in NSW, Australia in 2019 and 2020. Results were facilitated back to nursing/midwifery leadership teams with an expectation of developing and enacting an action plan, based on results. RESULTS: Of the six domains in the SAQ-Short version, five domains scores increased significantly (p < .001) over the time period. CONCLUSIONS: Measures over time are important to establish differences in perceptions and feedback on impact of actions. Facilitated feedback of results shows meaning when nursing/midwifery leadership staff have data explained and an opportunity to discuss and plan. IMPLICATIONS FOR NURSING MANAGEMENT: This study shows that facilitated feedback of quantitative survey results brings improved results when a survey is replicated. Nurse managers should enact a contextualized action plan with teams based on survey results to influence improvement in safety attitudes of staff.

The COVID-19 pandemic - A focus on nurse managers' mental health, coping behaviours and organisational commitment.

BACKGROUND: The emergence of COVID-19 has substantially impacted frontline health care workers, including nurse managers. To date, no studies have been conducted to examine the impact COVID-19 has had on Nurse Managers' mental health, coping strategies and organisational commitment. AIM: To investigate the mental health, coping behaviours, and organisational commitment among Nurse Managers during the COVID-19 pandemic. METHODS: Cross-sectional study involving 59 Nursing Managers from one Local Health District in Sydney Australia during the first wave of the COVID-19 pandemic. Data were collected relating to demographics, anxiety, coping strategies and organisational commitment. RESULTS: Overall, approximately three quarters of the Nurse Managers had high anxiety scores. Managers who had worked longer as a nurse had higher scores for adaptive coping strategies and 41% of Nurse Managers considered leaving their jobs. CONCLUSIONS: Strategies to minimise anxiety and enable coping as part of organisational disaster, emergency or crisis planning for Nurse Managers may result in decreased anxiety and stress levels, increased use of adaptive coping strategies and lower intent to leave the organisation and the nursing profession.

The Use of Data Collected From mHealth Apps to Inform Evidence-Based Quality Improvement: An Integrative Review.

BACKGROUND: The global acceptance and use of technology in health care has resulted in an abundance of mobile health (mHealth) applications (apps) available for use in the delivery and improvement of care. With so many apps available to patients and clinicians, it is important to understand how data from apps are being used to inform quality improvement in practice. AIM: The aim of this integrative review is to establish current knowledge of how mHealth apps are used to produce data to inform quality improvement in health care. METHODS: Scopus, Web of Science, CINAHL, and Medline Plus Full Text databases were searched for peer-reviewed papers written in English. The inclusion criteria comprised of full-text, empirical research studies relating to mobile health application use (not development) in clinical care. RESULTS: Nineteen studies met inclusion criteria. The functions of the apps outlined in the studies can be summarized into four different categories: communication, illness management, clinical management, and education/information. The types of data collected by the apps included numerical, textual, photographic, and graphical with several apps able to collect a variety of data types. Analysis of the studies showed that although data collection is rarely outlined as the explicit purpose of mHealth apps, data collected through such technology are and can be used to inform practice change both in real time and retrospectively. LINKING EVIDENCE TO ACTION: This review highlights while this is an emerging area, data obtained from mHealth apps can and are being used to inform quality improvement in health care. Further research is required in this area to adequately understand how data from mHealth apps can be used to produce quality improvement, specifically in relation to nursing. This review also highlights a need for the development of apps that aim to capture data to inform quality improvement, particularly from the patient perspective.