Influences of healthcare workers' behaviours towards infection prevention and control practices in the clinical setting: A systematic review.

AIM: To systematically evaluate empirical studies investigating the influences of healthcare workers' behaviours towards infection prevention and control practices in the Coronavirus clinical space, and to appraise and synthesise these findings. DESIGN: A systematic review of the literature. METHODS: The review used a five-step framework described by Khan et al. (Journal of the Royal Society of Medicine, 2003, 96 and 118) of Framing questions for a review; Identifying relevant work; Assessing the quality of studies; Summarising the evidence; and Interpreting the findings. Searches were conducted in CINHAL, MEDLINE, PsychINFO, Scopus, and Google Scholar databases to retrieve relevant peer-reviewed literature published in English between 2019 and 2023. Covidence and Joanna Briggs Quality appraisal tools were used for critical assessment. To improve transparent reporting, this review used a Synthesis Without Meta-analysis (SWiM) in systematic review guidelines, as informed by Campbell et al. (BMJ, 2020, 368). RESULTS: Twenty studies were included in this review, identifying nine themes describing factors influencing HCWs' behaviours towards IPC practices in the coronavirus environment. The overarching influences emerged as knowledge-oriented, person-oriented, and environment-oriented. CONCLUSION: Healthcare workers' responsibilities at point-of-care involve providing direct care to patients with highly transmissible infections and working in clinical settings that may be ill-designed for IPC practices, increasing the risk of transmission. Given the lack of a definitive solution to eradicate new mutant viruses and that IPC practices are the mainstay of prevention and control of transmissible, measures to improve are imperative. The identified HCWs' domains on behaviours towards IPC are critical in strategies to mitigate risks and further set an opportunity for developing an IPC model congruent with the rapid response required for HCWs during emerging or re-merging mutant virus outbreaks. This is significant, given that HCWs' preparedness with IPC practices at point-of-care is central to patient care, the workforce and community safety.

A global exploration of palliative community care literature: An integrative review.

AIM: This review sought to discover how community nurses globally provide palliative care, with specific focus on how they manage the personal and professional stressors associated with caring for dying clients in the home. DESIGN: An integrative review methodology was used to gain insight into how community palliative care is delivered worldwide. BACKGROUND: The provision of home palliative care by community nurses gives clients the ability to spend their final days in familiar surroundings. Research has focussed on the provision of palliative care in the inpatient setting, with little known about the community setting. METHODS: Data were collected through a literature search, then a critical analysis approach was used to evaluate the strengths of palliative care literature by analysing recurrent themes to stimulate further research on the topic. DATA SOURCES: The following databases were used to conduct the literature search: CINAHL, Medline, Pubmed, Scopus, Ovid. RESULTS: The results highlighted the importance of building a skilled palliative community nursing workforce and the need to offer specialised palliative care training to nurses, particularly around difficult conversations and service coordination. CONCLUSION: The literature identified the challenges implicit within the community nursing role in delivering palliative care, but it did not identify the factors that enhance the nurses' ability to manage the stressors associated with this role. The input of nurses must be sought to understand the development of resilience. IMPLICATIONS FOR THE PROFESSION: Community palliative care nursing requires time spent with clients and family members who are suffering, therefore predisposing nurses to stress. Effort must be made to provide palliative care nurses with support to enhance professional resilience.

Exploring nurses' perceptions of clinical handover in regional health care facilities: A exploratory qualitative study.

AIM: This study sought to explore nurses' perceptions of clinical handover in a regional health care facility to better understand the local context and identify the most appropriate clinical handover models. BACKGROUND: Clinical handover is an essential aspect of clinical care, and yet using accurate spoken and written communication can be neglected in nursing, potentially resulting in patient harm. Although much information is available on clinical handover in metropolitan settings, few studies have examined the regional context. METHODS: This study was an exploratory qualitative study based at one small regional health care facility located 100 km from a metropolitan Australian centre. The study utilized an Appreciative Inquiry approach to identify how nurses perceive the use of standardized oral and written clinical handover. Focus groups were engaged to explore the perceptions of nurses "handing over" in the smaller regional facility. RESULTS: Through focus group interviews with Registered and Enrolled Nurses, the data revealed that the cultural context of the ward influenced perceptions of clinical handover and that handover served as a light in the dark for all nursing staff; as an evolving communication tool illuminating patient care needs. CONCLUSION: This study facilitated understanding of the handover needs of smaller Australian regional hospitals. This study identified gaps in perception about handover practices between junior and senior nurses. New graduate nurses develop confidence in supportive clinical environments. A transition to practice programme would need to address the challenges new graduates face in the regional setting. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers in regional facilities can champion supportive senior nurses to mentor new graduate nurses and enhance the transition to practice for the new nurse.

Psychometric evaluation of the 11-item English language usage scale in commencing nursing students.

BACKGROUND: Globalisation has increased the number of students from culturally and linguistically diverse backgrounds enrolling in nursing programs where English is the primary medium of instruction. These students may experience challenges with English language usage and need to be identified early to ensure academic success. OBJECTIVE: To develop and test the psychometric properties of a self-report English language usage scale (ELUS-11). METHODS: Prospective, correlational study of commencing nursing students enrolled in a communication unit at a university in the western Sydney region of Australia. English-language usage was measured using the ELUS-11, an 11-item self-report tool with a 5-point Likert scale response format. Factorial validity was examined using exploratory and confirmatory factor analysis and logistic regression was used to compute the predictive validity of the ELUS. RESULTS: Of the 1723 students enrolled, 1100 (64%) returned surveys with all items of the ELUS-11 completed. The mean age of respondents was 25.4 years (SD: 8.0 years), 85% were female and 67% spoke a language other than English at home. Exploratory factor analysis yielded a one-factor structure that explained 65% of the variance, with factor loadings ranging from 0.72 to 0.86; and high internal consistency (α = 0.96). The ELUS-11 was able to discriminate among different groups of students based on age, domestic/international enrolment status and language spoken at home (all p < 0.001). Logistic regression revealed the ELUS-11 had good predictive validity, with those in the high ELUS-11 group over three times more likely to obtain a pass grade in their first written assessment (Adjusted odds ratio: 3.01, 95% CI: 2.05-4.43). CONCLUSION: The ELUS-11 is a valid and reliable measure of English-language usage, and appropriate for use in an undergraduate nursing population to identify students at risk of poor academic performance.

The educational benefits of drama in nursing education: A critical literature review.

BACKGROUND: With the increasing use of technology in nursing, the importance of interpersonal skills can often be forgotten. Patient safety can also be compromised if these skills are not emphasised in nursing education. OBJECTIVES: This review explores how drama in undergraduate and postgraduate nursing education can enhance the development of interpersonal skills such as empathy, emotional intelligence and communication. DESIGN: A critical review of qualitative literature. DATA SOURCES: Seven databases (CINAHL, MEDLINE, Scopus, Eric, Psycinfo, and databases dedicated to the Arts, Modern Language Association (MLA) and JSTOR were searched. REVIEW METHODS: Studies were screened against inclusion and exclusion criteria. Data from studies selected for the review were extracted using a summary table and a thematic analysis was conducted to identify major themes to answer the research question. RESULTS: 1275 studies were identified. Following a rigorous screening process, 29 studies met the inclusion criteria and were critically appraised using the CASP tool. Of the 29 studies, 17 were excluded due to their methodological quality. A final 12 studies were included in this review. Four themes demonstrated the value of drama in nursing education. These were an understanding of the patient experience, the development of professional identity, the enhancement of communication skills and increased self-reflection and critical thinking. CONCLUSIONS: Interpersonal skills are at the core of nursing and educational interventions that use drama can enhance the development of these skills.

'Statistical significance' in research: wider strategies to meaningfully interpret findings.

BACKGROUND: The P -value is frequently used in research to determine the probability that the results of a study are chance findings. A value less than 0.05 was once typically considered only to mean that results are 'statistically significant', as it indicates the chance they are false positives is less than one in 20 (5%). However, P<0.05 has transcended into meaning a study has had positive findings and its results are true and meaningful, increasing the likelihood it will be published. This has led to researchers over-emphasising the importance of the P-value, which may lead to a wrong conclusion and unethical research practices. AIM: To explain what the P -value means and explore its role in determining results and conclusions in quantitative research. DISCUSSION: Some researchers are calling for a move away from using statistical significance towards meaningful interpretation of findings. This would require all researchers to consider the magnitude of the effect of their findings, contemplate findings with less certainty, and place a greater emphasis on logic to support or refute findings - as well as to have the courage to consider findings from multiple perspectives. CONCLUSION: The authors argue that researchers should not abandon P -values but should move away from compartmentalising research findings into two mutually exclusive categories: 'statistically significant' and 'statistically insignificant'. They also recommend that researchers consider the magnitudes of their results and report whether findings are meaningful, rather than simply focusing on P -values. IMPLICATIONS FOR PRACTICE: Lessening the importance of statistical significance will improve the accuracy of the reporting of results and see research disseminated based on its clinical importance rather than statistical significance. This will reduce the reporting of false positives and the overstatement of effects.

How to embed a conceptual or theoretical framework into a dissertation study design.

BACKGROUND: Using a theoretical framework is often viewed as laborious or unnecessary for higher degree research projects. However, considering research problems through the lens of a theoretical framework can provide a structure for students to focus their research questions and produce findings that are more likely to address the research problem. AIM: To explain the utility of a theoretical framework and demonstrate the inclusion of a theoretical framework - deterrence theory - in a research project exploring plagiarism in nursing education. DISCUSSION: The experiences of a higher degree research student provided insight into the inclusion of a theoretical framework in a research plan. The benefits of this process are highlighted so other students can appreciate the importance of this process to their research plan and findings. CONCLUSION: A framework can add value to the overall research plan, from developing the research question through to the analysis and presentation of research findings. Fundamentally, frameworks provide a map for a study, providing a rationale for the development of the research questions or research hypothesis. A theoretical framework brings cohesion to the research project by linking the research questions and providing 'intellectual bins' for data analysis and presentation of research findings. IMPLICATIONS FOR PRACTICE: This article may assist higher degree research students in recognising the benefits of using a theoretical framework and provides an example of a 'real-life' application in a research project. The authors argue that theoretical frameworks can strengthen the likelihood that the research has produced meaningful findings that have addressed the research problem.

Relationships between academic literacy support, student retention and academic performance.

Retention and the academic success of nursing students remains a high priority in Australian and global higher education. This study examines an embedded academic support strategy, provided by Professional Communication Academic Literacy (PCAL) support staff, and undergraduate Bachelor of Nursing student uptake of the support. It reports on the profile of those who sought support, and the relationships between student support, retention and academic performance. A total of 11 290 PCAL consultations were recorded during a 17-month period from January 2016, with these consultations initiated by 2827 individual students. Among the undergraduate nursing students (n = 4472), those who sought PCAL support were over 7 times more likely (Adjusted Odds Ratio: 7.81, 95% CI: 6.18 to 9.86) to continue in the nursing program, taking into consideration age and enrolment category of students. Among students who continued or are continuing in the program, those who did not seek PCAL support had a lower grade point average (GPA) (mean: 3.9) compared to those who sought PCAL support between 1 and 3 times (mean: 4.3), and those who sought PCAL support on more than 3 occasions had the highest GPA (mean: 4.4), suggesting that frequency of consultations influenced academic success and retention.

Does the use of annotated exemplars by nursing students predict academic performance? A cohort study.

AIMS: To examine the usefulness of the annotated exemplar as an academic support strategy, and explore the characteristics of students who were more likely to engage with this academic support tool. Additionally, to identify if there was any influence on the academic performance in the assessment activity among those who engaged with the annotated exemplar. BACKGROUND: Annotated exemplars have the potential to target students en masse and provide meaningful, task specific comments that guide students prior to assessment submission. Effective strategies to support student learning are needed as nursing students are increasingly entering tertiary studies from non-traditional backgrounds. DESIGN: A cohort study was used to collect administrative data, academic grades and annotated exemplar usage statistics. SETTING: A large multi-campus university in NSW, Australia during Spring semester 2016. PARTICIPANTS: Second year undergraduate students enrolled in a single unit in the Bachelor of Nursing Program. METHODS: Quantitative data related to marks, grades and usage information; and demographic data and contact details were extracted from the online learning management system and student electronic records. RESULTS: Of the 1120 students enrolled in the unit, 49.5% of students engaged with the annotated exemplar. Students more likely to engage with the tool were older, female, born outside of Australia and had higher hit rates on the online learning management site. Of those who engaged with the annotated exemplar, there was no demonstrated increase in assessment mark. CONCLUSION: To improve student performance it is essential that feedback is engaging and effective. While, in this study, use of the annotated exemplar was not reflected in student marks, it is unclear how students may have performed without access to the exemplar. Further research is required to explore the reasons why students did not engage with the annotated exemplar and, for those who did, why the intervention did not impact on assessment mark.

Language support improves oral communication skills of undergraduate nursing students: A 6-month follow-up survey.

BACKGROUND: With the widening of participation in higher education, it is essential in the discipline of nursing that students are able to communicate proficiently to deliver quality patient care. However, undergraduate students can experience significant difficulties with spoken communication critical to professional nursing, which places them 'at risk' of failure during the nursing course. OBJECTIVES: To examine the relationship between students' use of academic literacy support and oral communication skills. DESIGN: Prospective, correlational survey design. SETTING: A large multi-campus university in Western Sydney, Australia. PARTICIPANTS: A total of 1699 assessment ratings of first and second year nursing students were completed at both baseline and at the 6-month follow-up in 2015. METHODS: The CLIP index was embedded as an assessment requirement in four clinical skills-based units and assessed at the end of each semester in the first two years of the Bachelor of Nursing program. In this study, first and second year students were assessed in Semester 1 at baseline and also six months later in Semester 2. RESULTS: From Semester 1 to Semester 2, the mean CLIP scores improved from 15.8 (SD: 3.7) to 17.2 (SD: 3.3) and all four components of the mean CLIP index improved. The smallest improvement was in the area of pronunciation while the lexical component had the greatest improvement. In addition, students who attended an academic literacy consultation or workshop for oral language support were over 1.5 times more likely to achieve an improvement in CLIP score (AOR: 1.58, 95% CI: 1.26 to 1.98). CONCLUSION: The CLIP tool can be used to track and monitor students' oral language skills over the course of their study, and identify 'at risk' students requiring additional support through on-campus language support programs.

Exploring nursing students' experiences of a drop-in support-centre: A mixed-methods study.

BACKGROUND: The increased use of blended learning approaches in undergraduate nursing programs has resulted in reduced on-campus contact with academic staff and other students. OBJECTIVES: To explore student's experiences of a Drop-In-Support-Centre and assess the impact of attendance on academic performance. DESIGN: Concurrent mixed-methods. SETTING: A large metropolitan, multi-campus university in Sydney, Australia. PARTICIPANTS: Undergraduate nursing students enrolled in a 3-year Bachelor of Nursing program. METHODS: In March 2016, to support students' learning, a weekly Drop-In-Support-Centre (DISC) initiative was piloted. The DISC provided an informal, learning space one day a week for students to access academic support. Baseline quantitative data was extracted from the University administrative dataset with a 12-month follow-up Grade Point Average (GPA) in January 2017. Attendance at the DISC was collected progressively throughout 2016. Qualitative data were collected using semi-structured interviews. RESULTS: Of 1016 undergraduate nursing students enrolled on the campus, 163 (16%) attended DISC at least once. Attendees were older, more likely to be Overseas-born (74% versus 45% native-born, p < 0.001). Sub-group analysis of first year students revealed attendees had a higher grade point average than non-attendees (4.20 versus 3.85, p = 0.005). Controlling for demographic factors, they were over three times more likely (Adjusted Odds Ratio: 3.75, 95% CI: 1.44-9.78) to achieve a higher GPA (>4.0) compared to non-attendees. Thirteen students were interviewed. Two main themes emerged; 1) 'Home away from home' and 2) 'A sense of community: Everyone supports each other' with three accompanying sub-themes. CONCLUSIONS: This study supports the usefulness of a Drop-In-Support-Centre in enhancing students' learning experiences and outcomes. The success of the program is highlighted by an improvement in academic performance of students who attended the DISC.

A reflection on the challenges in interviewing Arab participants.

BACKGROUND: Cultural beliefs and ways of thinking need to be considered when interviewing Arab participants with chronic diseases. AIM: To provide insights into the challenges of interviewing Arab participants. DISCUSSION: This paper taps into the first author's experiences of interviewing ten Arab participants with type 2 diabetes and coexisting depression. Issues relating to gatekeeping, gender, participants' privacy and superstitious thinking need to be taken into consideration, particularly when discussing sensitive topics that may challenge social norms. These issues can influence the building of rapport, which may affect the depth of information collected. CONCLUSION: This paper offers insight and recommendations for other researchers conducting qualitative research with Arab participants. IMPLICATIONS FOR PRACTICE: Paramount in conducting qualitative studies with Arab participants are: an early, open discussion about personal space with participants and their families; matching the genders of participants and interviewers; and involving participants in the selection of pseudonyms.

The importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice: A systematic review.

OBJECTIVES: This systematic review was designed to assess the importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice. It aimed to explore the link between academic literacy and writing in an undergraduate nursing degree and the development of critical thinking skills for their future professional clinical practice. DESIGN: A systematic review of qualitative studies and expert opinion publications. DATA SOURCES: A systematic literature search was undertaken of the following databases: ERIC, PubMed, CINAHL, MEDLINE and Scopus. All papers reviewed were from 2000 to 2016 and were written in English. REVIEW METHODS: We identified 981 studies and expert opinion papers from the selected databases. After reviewing key words and abstracts for the inclusion and exclusion criteria, 48 papers were selected for review. These were read and reread, with 22 papers, including one thesis, selected for quality appraisal. One paper was discarded due to the exclusion criteria. RESULTS: Three major themes were evident from this study. First, students need assistance to develop tertiary level academic literacy skills when they commence their undergraduate nursing degree. Second, that teaching practices need to be consistent in both designing assessments and in giving feedback to students, in order to assist improvement of academic literacy skills. And finally, academic literacy can facilitate critical thinking when students are assessed using discipline specific genres that relate to their future professional nursing practice. CONCLUSIONS: This review highlights the importance of critical thinking in clinical nursing practice and its strong relationship with academic writing skills. It has shown critical thinking is discipline specific and nursing students need to be taught discipline specific literacy genres in undergraduate nursing degrees. Nursing has a diverse educational and cultural mix of students, and educators should not assume academic literacy skills upon commencement of an undergraduate nursing programme.

Students' experiences of embedded academic literacy support in a graduate entry nursing program: A qualitative study.

Graduate entry nursing (GEN) programs were designed to address the predicted nursing shortfall. In Australia, although these programs attract students from culturally and linguistically diverse (CALD) backgrounds, the workload is compounded by cultural differences and a new academic learning environment which presents additional challenges. This qualitative descriptive study explored the experiences of GEN students enrolled in the introductory unit of their nursing program with embedded academic literacy support in Sydney, Australia. Twenty-four commencing GEN students were interviewed in January 2016. Interviews were transcribed verbatim and thematically analysed. Three main themes emerged which illustrated that GEN students were 'diamonds in the rough'. They possessed a raw natural beauty that required some shaping and polishing to ensure academic needs were met. To ensure retention is high, institutions need to evaluate how best to support and harness the potential of these unique students.

Plagiarism in nursing education: an integrative review.

AIMS AND OBJECTIVES: To identify the prevalence and antecedents of plagiarism within nursing education and approaches to prevention and management. BACKGROUND: There has been growing media attention highlighting the prevalence of plagiarism in universities, including the academic integrity of undergraduate nursing students. A breach of academic integrity among nursing students also raises further concern with the potential transfer of this dishonest behaviour to the clinical setting. DESIGN: Integrative review. METHODS: A systematic search of five electronic databases including CINAHL, MEDLINE, SCOPUS, ProQuest Nursing & Allied Health Source, and ERIC was undertaken. Only primary studies related to plagiarism and nursing students (undergraduate or postgraduate) studying at a tertiary education institution or nursing faculty were included. Both qualitative and quantitative study designs were included. RESULTS: Twenty studies were included in this review with six key themes identified: (1) prevalence; (2) knowledge, understanding and attitudes; (3) types of plagiarism; (4) antecedents to plagiarism; (5) interventions to reduce or prevent plagiarism; and (6) the relationship between academic honesty and professional integrity. Plagiarism is common among university nursing students, with a difference in perception of this behaviour between students and academics. The review also highlighted the importance of distinguishing between inadvertent and deliberate plagiarism, with differing strategies suggested to address this behaviour. Nevertheless, interventions to reduce plagiarism have not been shown to be effective. CONCLUSIONS: The current punitive approach to plagiarism within nursing faculties has not reduced its occurrence. There is a need to promote awareness, knowledge and provide students with the appropriate referencing skills, to reduce the significant amount of inadvertent plagiarism. RELEVANCE TO CLINICAL PRACTICE: The importance of promoting honesty and academic integrity in nursing education is highlighted. Cheating within the academic setting has been associated with dishonesty in the clinical setting, which highlights the importance of nurturing a culture of honesty and integrity at university.

Self-Efficacy, Depression, and Self-Care Activities in Adult Jordanians with Type 2 Diabetes: The Role of Illness Perception.

Diabetes mellitus is reaching epidemic levels worldwide. In a developing country like Jordan, type 2 diabetes mellitus (T2DM) has reached a prevalence rate of 17.1%. This cross-sectional study examined the relationship between self-care activities and: illness perception, depression, social support, religiosity and spiritual coping, and self-efficacy among patients with T2DM. A random sample of 220 patients with T2DM, who attended Jordan University Hospital in Jordan were enrolled. The data were collected through a structured interview and the medical files. The instruments consisted of a sociodemographic and clinical standardised questionnaires: Brief Illness Perception Questionnaire, Patients' Health Questionnaire-9; ENRICH Social Support Instrument; Religious and Spiritual Coping Subscale; Diabetes Management Self-Efficacy Scale; and Summary of Diabetes Self-Care Activities. Bivariate analysis investigated the relationship between variables. Structure Equation Modelling (SEM) was performed to test the proposed conceptual model. The study found that approximately 70% of the respondents suffered some form of depressive symptoms. The SEM showed a direct relationship between self-efficacy and self-care activities (ß = 0.40; p < 0.001). Depression was indirectly related to self-care activities through self-efficacy (ß = -0.20; p = 0.003); nevertheless, it was directly related to perception of: treatment control, consequences, and emotional representations. Overall, the sequence between illness perception and self-efficacy was mediated by depression. Strategies to promote self-efficacy and illness perception are vital in customising a diabetes health plan to meet Arabic cultural expectations.

Language translation challenges with Arabic speakers participating in qualitative research studies.

This paper discusses how a research team negotiated the challenges of language differences in a qualitative study that involved two languages. The lead researcher shared the participants' language and culture, and the interviews were conducted using the Arabic language as a source language, which was then translated and disseminated in the English language (target language). The challenges in relation to translation in cross-cultural research were highlighted from a perspective of establishing meaning as a vital issue in qualitative research. The paper draws on insights gained from a study undertaken among Arabic-speaking participants involving the use of in-depth semi-structured interviews. The study was undertaken using a purposive sample of 15 participants with Type 2 Diabetes Mellitus and co-existing depression and explored their perception of self-care management behaviours. Data analysis was performed in two phases. The first phase entailed translation and transcription of the data, and the second phase entailed thematic analysis of the data to develop categories and themes. In this paper there is discussion on the translation process and its inherent challenges. As translation is an interpretive process and not merely a direct message transfer from a source language to a target language, translators need to systematically and accurately capture the full meaning of the spoken language. This discussion paper highlights difficulties in the translation process, specifically in managing data in relation to metaphors, medical terminology and connotation of the text, and importantly, preserving the meaning between the original and translated data. Recommendations for future qualitative studies involving interviews with non-English speaking participants are outlined, which may assist researchers maintain the integrity of the data throughout the translation process.

Predictive validity of the post-enrolment English language assessment tool for commencing undergraduate nursing students.

BACKGROUND: Nursing students with English as an additional language (EAL) may underperform academically. The post-enrolment English language assessment (PELA) is used in literacy support, but its predictive validity in identifying those at risk of underperformance remains unknown. OBJECTIVES: To validate a PELA, as a predictor of academic performance. DESIGN: Prospective survey design. SETTING: The study was conducted at a university located in culturally and linguistically diverse areas of western Sydney, Australia. PARTICIPANTS: Commencing undergraduate nursing students who were Australian-born (n=1323, 49.6%) and born outside of Australia (n=1346, 50.4%) were recruited for this study. The 2669 (67% of 3957) participants provided consent and completed a first year nursing unit that focussed on developing literacy skills. METHOD: Between 2010 and 2013, commencing students completed the PELA and English language acculturation scale (ELAS), a previously validated instrument. The grading levels of the PELA tool were: Level 1 (proficient), Level 2 (borderline), and Level 3 (poor, and requiring additional support). RESULTS: Participants with a PELA Level 2 or 3 were more likely to be: a) non-Australian-born (χ(2): 520.6, df: 2, p<0.001); b) spoke a language other than English at home (χ(2): 490.2, df: 2, p<0.001); and c) an international student (χ(2): 225.6, df: 2, p<0.001). There was an inverse relationship between participants' ELAS scores and PELA levels (r=-0.52, p<0.001), and those graded as 'proficient' with a PELA Level 1 were more likely to obtain higher scores in their: i) unit essay assessment (χ(2): 40.2, df: 2, p<0.001); ii) final unit mark (χ(2): 218.6, df: 2, p<0.001), and attain a higher GPA (χ(2): 100.8, df: 2, p<0.001). CONCLUSION: The PELA is a useful screening tool in identifying commencing nursing students who are at risk of academic underachievement.

Diagnosis of Type 2 Diabetes: The Experience of Jordanian Patients with Co-existing Depression.

In Jordan, Type 2 diabetes mellitus (T2DM) is becoming a significant health problem, and a high concomitant rate of depression among this population complicates the situation. This qualitative study explored and described the emotional reactions of Jordanian patients with co-existing depression, on diagnosis of T2DM. Data were collected using semi-structured qualitative interviews from 15 patients with T2DM and depression in 2013. Interviews were audiotaped, translated and then analysed using thematic analysis. A major theme-'Initial reactions to the diagnosis'-emerged with four accompanying sub-themes (Devastation, Mixed Emotions, Denial and Acceptance). Although the majority of participants expressed negative emotional reactions on first diagnosis, a strong religious conviction allowed for acceptance of the diagnosis. Overall, the study findings support that in Arabic countries, spirituality and faith played a key role in promoting acceptance of concomitant comorbidities, and will often be useful in enhancing positive coping strategies among patients with T2DM and depression.