Transition experiences of Middle Eastern midwives into Australian practice: A multiple case narrative study.

AIM: To explore transition experiences of Middle Eastern qualified midwives into practice in Australia. DESIGN: This was a qualitative study using multiple case narrative approach underpinned by structuration theory. METHODS: A total of 19 Middle Eastern qualified midwives from different states of Australia participated in this study. Individual semi-structured interviews were conducted between November 2020 and September 2021, digitally recorded and then transcribed. Transcriptions were analysed in three stages, with three main categories generated in the second stage and a core category that was developed in third. RESULTS: Entering the Australian workforce, Middle Eastern qualified midwives had to reframe their professional identities to fit the new system by adjusting to three aspects of the practice, including preparation for practice, scope of practice and context of practice. While they were prepared by medically oriented curricula, worked in systems that had limitations for midwives to practise in antenatal and postnatal and lacked regulation standards, they learned to practise autonomously in their full scope in a standardized context in Australia. CONCLUSION: Middle Eastern qualified midwives in Australia re-evaluated their practice in their home countries, realized the gaps and adjusted to new ways of practising in Australia. IMPACT: To effectively use the potential of Middle Eastern midwives for workforce sustainability in Australia, support should be available to enable them to develop the necessary competencies for safe practice in Australia including provision of context-specific transition programmes prior to registration and supporting mentorship after their integration into the Australian healthcare workforce. PATIENT OR PUBLIC CONTRIBUTION: Patient or public contribution does not apply to this study as its purpose was to explore the transition experiences of Middle Eastern qualified midwives themselves.

Experiences of nurses and midwives with disabilities: A scoping review.

AIM: To identify the extent and type of evidence exploring the workplace experiences of nurses and midwives with disabilities. DESIGN: Scoping Review. DATA SOURCES: Four electronic databases were systematically searched in February 2022 to identify studies discussing the experiences of nurses and midwives with disabilities, published between 2012 and 2022. Google Scholar and Theses Global were also searched. REVIEW METHODS: All search results, irrespective of their format, were uploaded to Covidence to assist with the selection of evidence. Studies discussing the experiences of nurses and midwives with disabilities were included. Two reviewers conducted screening and data extraction independently, and a third reviewer resolved conflicts. RESULTS: Searches identified 130 studies. After screening for title and abstract, full-text review identified 23 studies for data extraction and analysis. Data were summarized and presented in tabular form under two categories (1) workplace experiences and (2) impact in the workplace. Results were presented in a descriptive, narrative form with accompanying tables. CONCLUSION: The nurse or midwife can be impacted significantly by disability. Currently, little is known about the workplace experiences of nurses and midwives with disabilities. Therefore, a better understanding of the experiences of the nurse and midwives with disabilities is important to increase diversity, equity, accessibility, and inclusion. IMPACT: Shortage of nurses and midwives worldwide highlights the need to understand why nurses and midwives with disabilities decide to leave the profession. Further research exploring the experiences of nurses or midwives with disabilities will help identify support requirements, develop frameworks for reasonable adjustment accommodations, and assist with future workforce planning. The EQUATOR guidelines for PRISMA have been met. No Patient or Public Contribution.

Compassion fatigue and compassion satisfaction among palliative care health providers: a scoping review.

BACKGROUND: Palliative care can be demanding and stressful for providers. There is increasing recognition in the literature of the impact of caregiving in palliative care settings, including compassion fatigue and compassion satisfaction. However, to date this literature has not been systematically reviewed. The purpose of this scoping review was to map the literature on compassion fatigue and compassion satisfaction among palliative care health providers caring for adult patients. METHODS: Scoping review method guided by Joanna Briggs Institute guidelines was conducted using four electronic databases to identify the relevant studies published with no time limit. Following the title and abstract review, two reviewers independently screened full-text articles, and extracted study data. A narrative approach to synthesizing the literature was used. RESULTS: Twenty studies were included in the review. Five themes emerged from synthesis: conceptualisation of compassion fatigue and compassion satisfaction; measurement of compassion fatigue and compassion satisfaction; consequences of compassion fatigue or compassion satisfaction and providing care for patients with life-threatening conditions; predictors or associated factors of compassion fatigue and compassion satisfaction among palliative care health providers; and strategies or interventions to support palliative care health providers and reduce compassion fatigue. CONCLUSIONS: Limited studies examined the effectiveness of specific interventions to improve compassion satisfaction and reduce compassion fatigue among palliative care health providers. Further investigation of the impacts of compassion fatigue and compassion satisfaction on palliative care health providers and their work is also needed.

How is clinical credibility defined in nursing? A concept mapping study.

AIM: To develop a working definition of 'clinical credibility' in nursing science. METHODS: This is stage 2 of a registered report. Concept mapping methodology, 1. Preparation, 2. Generation of statements (brainstorming), 3. Structuring of statements (prioritising/clustering), 4. Representation of statements, 5. Interpretation of maps and 6. Utilisation of maps were used. Part 1 of our registered report followed the required items on the SPIRIT 2013 checklist. Part 2 was reporting the results of our study adhered to the STROBE reporting guidelines. RESULTS: Participants (n = 67) from three stakeholder groups participated in this study. Nursing students (n = 23), nurses and other healthcare professionals (n = 23), and patients (within the last 12 months) (n = 21). Participants (n = 62) generated statements (n = 429) in response to the question: 'What does clinical credibility mean to you?'. Following statement reduction, participants (n = 61) prioritised and clustered (n = 80) statements. The data were analysed using the concept mapping software, Ariadne. A visual 'concept map' was produced showing the importance and relationship of each statement as viewed by all participants. The final concept map had nine clusters. In order of importance these are as follows: 1. Safe practice, 2. Communication, 3. Patient-centred care, 4. Accountable, 5. Professional practice, 6. Clinical competence, 7. Teaching attributes, 8. Contemporary expert and 9. Leadership. This study was undertaken over an eight-month period. CONCLUSION: Clinical credibility is not necessarily about contemporary clinical practice. It is a multidimensional construct of which current clinical practice is one element.

How is clinical credibility defined in nursing? Protocol for a concept mapping study.

AIM: To develop a working definition of the concept of "clinical credibility" in nursing science. BACKGROUND: In both academic and clinical settings, the phrase "clinical credibility" is used when discussing the education of health professionals. No clear definition for the concept is evident in the academic literature. To date, there has not been a study undertaken to develop a working definition of clinical credibility in nursing science. METHODS: This protocol is stage 1 of a registered report. We will use concept mapping to compare and organise views of three stakeholder groups: nursing students (n = 20) from years 2 or 3 of a three-year Bachelor of Nursing Programme, nurses and other health professionals (n = 20) still practising within a clinical setting, and people who have recently been inpatients in hospital (n = 20). First, participants will take part in separate stakeholder focus groups to generate statements about "What is clinical credibility?". Second, the same participants will complete two tasks: (1) rank the importance of each statement (prioritising) and (2) put the statements that appear to go together into groups (clustering). The data will then be analysed using a specialised software program called Ariadne. A visual "concept map" will be produced showing the importance and relationship of each statement as viewed by the participants. The projected timeline for the study is one year. The paper complies with the SPIRIT 2013 guidelines for study protocols adapted for mixed methods research. CONCLUSION: The findings of this study will provide a working definition of the concept of "clinical credibility" in nursing science. RELEVANCE TO CLINICAL PRACTICE: The findings can be used to develop a measure of clinical credibility to predict student satisfaction and patient safety outcomes.

Child feeding practices and concerns: Thematic content analysis of Thai virtual communities.

Parents' child feeding practices are influenced not only by family but also by a broader circle of networks, including online groups. Peer-to-peer platforms such as Facebook groups facilitate a learning environment and may influence the transmission of user-generated content into practice. These digital data not only benefit participants but also offer new opportunities for researchers to study related phenomena. Therefore, this study employs thematic content analysis to investigate peer-exchanging discourse conveyed in Facebook peer-support groups in children's diets in Thailand. To identify the area of interest, we classified and quantified the initial posts and investigated the relationship between initial posts' contents and community engagement. Thematic analysis was used to qualitatively describe the peer-exchanging content that responded to the initial posts. Of the five approved Facebook groups, 200 initial posts with their 1964 comments were extracted anonymously. Results revealed that Facebook groups devoted to diets for children have become a platform for Thai parents to seek informational and emotional support. The top-ranked initial posts were related to requesting knowledge and skills about age-appropriate food and meal preparation. Parents have also expressed anxiety about feeding and tension related to food fussiness which created the need for emotional support. Age-appropriate feeding, homemade baby foods, concerns about food seasonings and food allergy awareness were observable within online groups. However, a shift from traditional child feeding practices to new ideas created cultural gaps which lead to arguments in some families. Understanding these views would help guide to address parental concerns better.

Enablers and Barriers to Registered Nurses Expanding Their Scope of Practice in Australia: A Cross-Sectional Study.

A number of resources exist to assist registered nurses in Australia to determine their scope of practice; however, the ability of a professional nurse to expand his or her practice is highly context dependent. This article reports on barriers and enablers to expanding scope of practice, as identified by registered nurses across Australia. A cross-sectional survey administered online in 2016 returned 1,205 useable submissions. Results indicated that nurses wishing to expand their practice felt supported to do so by nursing colleagues and were aware of professional and regulatory documents relating to expanding scope of practice. Less support for this process was evident from other health professionals or employers. Respondents also indicated that they were motivated to expand their scope by professional satisfaction, potential for career advancement, and the desire to meet health service user's needs. The majority of respondents identified barriers to expanding scope of practice, including lack of remuneration and the absence of supportive guidelines. Respondents in the early stage of their careers were more likely to perceive organizational support for expanding their scope of practice. When required to expand their role, the majority of respondents indicated that they had undertaken additional training or accessed various resources to guide them in this process. Barriers to expanding nursing scope of practice can result in underutilization of the one of the greatest resources in the health care system. This article identifies a number of strategies that can facilitate role expansion to ensure that nursing continues to make a significant contribution to positive health service outcomes in Australia.

Salinized rivers: degraded systems or new habitats for salt-tolerant faunas?

Anthropogenic salinization of rivers is an emerging issue of global concern, with significant adverse effects on biodiversity and ecosystem functioning. Impacts of freshwater salinization on biota are strongly mediated by evolutionary history, as this is a major factor determining species physiological salinity tolerance. Freshwater insects dominate most flowing waters, and the common lotic insect orders Ephemeroptera (mayflies), Plecoptera (stoneflies) and Trichoptera (caddisflies) are particularly salt-sensitive. Tolerances of existing taxa, rapid adaption, colonization by novel taxa (from naturally saline environments) and interactions between species will be key drivers of assemblages in saline lotic systems. Here we outline a conceptual framework predicting how communities may change in salinizing rivers. We envision that a relatively small number of taxa will be saline-tolerant and able to colonize salinized rivers (e.g. most naturally saline habitats are lentic; thus potential colonizers would need to adapt to lotic environments), leading to depauperate communities in these environments.

Supporting a good life and death in residential aged care: an exploration of service use towards end of life.

BACKGROUND: The concept of a 'good death' involves end-of-life care in an appropriate setting and in keeping with the person's preferences. Limited research has examined the circumstances and place of death for older people living in residential aged care. OBJECTIVE: This exploratory study investigated the nature of health service use and place of death of older people living in aged care to identify factors that lead to transfer of end-of-life care to other settings and poorer outcomes. METHODS: Retrospective review of residential aged care client records between July 2014 and June 2015. CONCLUSION: The majority of people in this study died in their home setting of residential care and a number were in receipt of palliative care prior to their deaths. The study proposes a national approach to the use of terminology and documents related to palliative and end-of-life care and education in assessment and recognition of nearing the end of life.

Developing an Australian health and aged care research agenda: a systematic review of evidence at the subacute interface.

Objective The aim of the present study was to systematically review articles describing recent interventions that aimed to improve access and outcomes for older people at the interface between health and aged care, with a focus on subacute care programs of palliative care, rehabilitation, geriatric evaluation and management (GEM) and psychogeriatrics. Methods Australian studies published between 2008 and 2013were evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and National Health and Medical Research Council of Australia (NHMRC) guidelines. Included studies were summarised according to focus areas and results discussed in the current Australian subacute health care context. Results Eleven Australian research articles were identified. Three did not achieve any NHMRC rating level because of methodological approach. Focus areas included: discharge planning; information management or communication; rehabilitation; hospital treatment in residential care; screening and intervention; and Telehealth. Interventions were primarily system centred; only three studies featured patient-level outcome measures. Conclusions There is limited high-quality research investigating the effectiveness of interventions at the health and aged care interface of subacute care. Further research is needed. What is known about the topic? Subacute care offers important healthcare programs for older people, operating at the interface between health and aged care. However, for the most part this has not been subject to research scrutiny. What does this paper add? Identified studies were predominantly hospital oriented and designed to avoid hospital admission and associated costs. Locally integrated, collaborative and multidiscipline based interventions improve system-level outcomes. Alternative and individualised models of care, particularly when provided in their home setting, yields positive outcomes for older people. What are the implications for practitioners? Health and aged care reforms and related research agenda must include the perspectives and experiences of patients and/or carers accessing subacute care programs, yet these are under-reported. The present review highlights opportunities to improve the quality of existing evidence and create a research agenda for the future.

The teaching of physical assessment skills in pre-registration nursing programmes in Australia: issues for nursing education.

Health assessment is a fundamental aspect of the professional nursing role. The teaching of skills in physical assessment is therefore a large component of pre-registration nursing programmes. As the nursing curriculum becomes more crowded with what is deemed to be essential content, there is a need to rationalise what is taught in preparatory nursing programmes to ensure readiness for practice. The study outlined in this paper, as part of a larger project, explored the teaching of physical assessment skills in pre-registration nursing programmes across Australia. Fifty-three academics completed the 121 item online survey, indicating whether each skill was taught with practice, taught with no practice or not taught at all. The results suggest that only half the skills were being taught by more than 80% of the academics and 23 skills (19%) were taught by more than 90%. Of the 121 skills commonly taught--69 skills (57%) were taught with student practice and 29 (24%) were taught with no student practice. The results of this study raise questions about the teaching of physical assessment in pre-registration nursing programmes. The suggestion is not that skills that are used regularly or infrequently should be removed from the curriculum, rather, the authors propose that consideration be given to whether the teaching of skills that are never likely to be used is occurring at the expense of comprehensive mastery of core skills.

Saline mine water influences eukaryote life in shallow groundwater of a tropical sandy stream.

Eukaryotic communities in groundwater may be particularly sensitive to disturbance because they are adapted to stable environmental conditions and often have narrow spatial distributions. Traditional methods for characterising these communities, focussing on groundwater-inhabiting macro- and meiofauna (stygofauna), are challenging because of limited taxonomic knowledge and expertise (particularly in less-explored regions), and the time and expense of morphological identification. The primary objective of this study was to evaluate the vulnerability of eukaryote communities in shallow groundwater to mine water discharge containing elevated concentrations of magnesium (Mg) and sulfate (SO4). The study was undertaken in a shallow sand bed aquifer within a wet-dry tropical setting. The aquifer, featuring a saline mine water gradient primarily composed of elevated Mg and SO4, was sampled from piezometers in the creek channel upstream and downstream of the mine water influence during the dry season when only subsurface water flow was present. Groundwater communities were characterised using both morphological assessments of stygofauna from net samples and environmental DNA (eDNA) targeting the 18S rDNA and COI mtDNA genes. eDNA data revealed significant shifts in community composition in response to mine waters, contrasting with findings from traditional morphological composition data. Changes in communities determined using eDNA data were notably associated with concentrations of SO42-, Mg2+ and Na+, and water levels in the piezometers. This underscores the importance of incorporating molecular approaches in impact assessments, as relying solely on traditional stygofauna sampling methods in similar environments may lead to inaccurate conclusions about the responses of the assemblage to studied impacts.

Audiometry screening and interpretation.

The prevalence of hearing loss varies with age, affecting at least 25 percent of patients older than 50 years and more than 50 percent of those older than 80 years. Adolescents and young adults represent groups in which the prevalence of hearing loss is increasing and may therefore benefit from screening. If offered, screening can be performed periodically by asking the patient or family if there are perceived hearing problems, or by using clinical office tests such as whispered voice, finger rub, or audiometry. Audiometry in the family medicine clinic setting is a relatively simple procedure that can be interpreted by a trained health care professional. Pure-tone testing presents tones across the speech spectrum (500 to 4,000 Hz) to determine if the patient's hearing levels fall within normal limits. A quiet testing environment, calibrated audiometric equipment, and appropriately trained personnel are required for in-office testing. Pure-tone audiometry may help physicians appropriately refer patients to an audiologist or otolaryngologist. Unilateral or asymmetrical hearing loss can be symptomatic of a central nervous system lesion and requires additional evaluation.

The use of physical assessment skills by registered nurses in Australia: issues for nursing education.

The purpose of pre-service nursing education programs is to prepare competent graduates who are able to function as safe, professional registered nurses. An extensive element of these programs is the teaching of physical assessment skills, with most programs educating students to perform over 120 such skills. Previous research from North America suggests that the majority of skills taught to nurses in their pre-service programs are not used in practice. As part of a larger study, an online survey was used to explore use of 121 physical assessment skills by Australian nurses. Recruitment occurred via mailed invitation to members of the Australian Nursing Federation. Data were extracted from 1220 completed questionnaires returned by nurses who were mostly employed in New South Wales, were female and experienced nurses. Respondents indicated that they used only 34% of skills routinely. Results reinforce evidence found in the literature that many of the skills taught to nurses are either not used at all (35.5%) or are used rarely (31%). These findings have implications for the teaching of physical assessment skills in pre-service nursing programs, and raise questions about the value of extensive skills teaching in the context of contemporary health care. Further research into barriers to the use of physical assessment skills in nursing and the need for comprehensive skills preparation for the generalist nurse is likely to offer some solutions to these questions.

The evolution of registration standards for internationally qualified midwives in Australia.

BACKGROUND: Registration as an internationally qualified midwife in Australia can be challenging, as the individual must meet rigorous education and professional competency assessment standards. AIM: The purpose of this discussion is to present an overview of the evolution of registration standards for internationally qualified midwives in Australia from 2000 to 2020 and evaluate their effectiveness in promoting internationally qualified midwives' professional integration. RESULTS: Australian registration policies for internationally qualified midwives have undergone significant change over the last 20 years. In 2010, registration policy and governance moved from state or territory to national jurisdiction, then these standards were upgraded in 2014, and finally transitioned to an outcome-based assessment (OBA) program in 2020. Inconsistency and lack of transparency in established registration policies and their implementation were revealed, most notably when bridging programs for internationally qualified midwives from non-English speaking backgrounds were discontinued in Australia in 2015, despite reference in the NMBA policy as an available transition program from 2000 to 2020. The implementation of OBA in 2020, which occurred after a significant delay, complicated registration processes further with inclusion of two levels of assessment (MCQ examination and OSCE) and associated expenses. CONCLUSION: Evidence-based strategies and regulatory adjustments are necessary to effectively register internationally qualified midwives in Australia, particularly those from non-English speaking backgrounds.

Promoting generalisation in qualitative nursing research using the multiple case narrative approach: a methodological overview.

Background: The ability to generalise research generated findings to different contexts is a significant, yet overlooked, feature in qualitative studies conducted in nursing, where evidence-based clinical practice is highly regarded. The multiple case narrative is a constructivist-narrative approach, claimed to not only have the potential for analytical and case-to-case generalisation but also sample-to-population generalisation. Methods: This paper provides an overview of multiple case narrative by comparing it with similar methodologies, reviewing studies that have used this approach and critically evaluating its capacity for producing generalisable results. Results: The multiple case narrative approach addresses limitations of collective case study, case survey and meta-ethnography by employing greater sample sizes and more generalisable results. Most studies previously using this approach have been performed in the education field and with the purpose of overcoming sample size limitations in qualitative research. The approach offers a uniquely systematic approach to analysis by finding associations between categories generated from collective analysis of large number of cases and providing the potential for sample to population generalisation. Conclusion: Multiple case narrative, which to date has been underutilised, is a systematic approach with characteristics that make it an efficient research technique to provide valid qualitative evidence.

Investigating avian competition for surface water in an arid zone bioregion.

Interference competition has the potential to alter avian assemblages at long-lasting arid zone waterholes, particularly in a warming world, as more potentially aggressive species frequent these sites to drink. We used camera traps and observational surveys to investigate interference competition between terrestrial avian species at six long-lasting waterholes across three sampling seasons (two summers and one winter) within the MacDonnell Ranges Bioregion in central Australia. The proportion of individuals drinking for each of four dietary classes (granivores, nectarivores, omnivores, and insectivores) was modelled in relation to their abundance in the immediate waterhole habitat, which informed the potential for competition in each season. We then used the temporal overlap estimators to quantify the degree of competition between species at waterholes with species grouped into families (Meliphagidae, Ptilonorhynchidae, Estrildidae, and Rhipiduridae). We found the proportion of individuals drinking at waterholes was greatest during hot and dry periods, suggesting the potential for interference competition is greatest during these times. This was particularly the case for nectarivores where, in hot and dry conditions, the proportion of drinking individuals increased significantly as their abundance also increased in the waterhole habitat. We predicted that subordinate species would alter their activity periods to avoid competitive interactions with meliphagids (honeyeaters), however, we found there was a high degree of temporal overlap between all families sampled across all seasons. These results suggest subordinate species are unlikely to be excluded from long-lasting waterholes by potentially aggressive species, such as honeyeaters. However, some species may face trade-offs between foraging and accessing waterholes to stay hydrated as they shift their activity to avoid the hottest parts of the day during the summer months. Under global warming, extended hot and dry periods will likely create conditions where balancing energy and hydration requirements becomes increasingly difficult and results in the loss of body condition.

Biological samples taken from Native American Ancestors are human remains under NAGPRA.

In the United States, the Native American Graves Protection and Repatriation Act (NAGPRA) provides a specific framework for the disposition of Native American Ancestral remains within its purview. However, samples such as a bone fragment, tooth, or other biological tissue taken from the remains of these Ancestors have been treated by institutions and researchers as independent of the individual from whom they were removed and used in destructive research such as paleogenomic and other archaeometric analyses without consultation, consent, and collaboration from Native American communities; are not cared for in keeping with the current best practices for Indigenous Ancestors; and are not likely to be repatriated to their communities. Here, we demonstrate that any biological samples removed from Ancestors who are covered under NAGPRA must also be handled according to the stipulations defined for "human remains" within the legislation. As such, we are not proposing a change to existing legislation, but rather best practices, specific to the context of the United States and NAGPRA, relating to the use of and care for biological samples taken from Native American Ancestors.