Practical advice for refugees aspiring to become registered nurses in Australia.

AIMS: This paper describes practical advice for refugees aspiring to become Registered Nurses (RNs) in Australia. DESIGN: Qualitative description using a naturalistic inquiry framework. METHODS: Between February 2018 and September 2019, the lead author conducted semi-structured interviews with employed RNs that are former refugees that speak English. Interviews were 45-90 min in duration and digitally recorded. Participants provided voluntary informed consent and were sent questions beforehand. All transcription data were thematically analysed for key themes until no further themes were identified. This paper covers practical advice provided by the participants at the conclusion of their interviews. RESULTS: Twelve participants provided practical advice. Six themes were identified: (1) Find your purpose and set goals; (2) Work hard and never give up; (3) Seek support; (4) Capitalize on opportunities; (5) Be optimistic; (6) Give back. The last theme, give back, was salient across all interviews and was an inherent motivator for some participants once their RN status was achieved. CONCLUSION: Each participant set the goal of becoming a fully registered nurse and made it a life goal that provided meaning for them. Despite their experiences, the participants provided practical advice that could guide younger people aspiring to become successfully qualified RNs. IMPACT: The findings in this study are unique as they are derived from people with experiences as refugees who, despite their adversity, became RNs. The practical advice provides a framework not only for younger people from refugee backgrounds seeking to achieve their professional goals, but others looking to succeed in other workforce sectors. The practical advice for success will be useful in informing nursing authorities, tertiary institutions and private and public health organizations to develop effective approaches to guide the next generation of would-be RNs set to contribute to nursing practice in Australia. There were no patient or public contributions as the focus was the personal and professional lives of nurses with refugee backgrounds.

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

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

"I am still passionate despite the challenges": Nurses navigating the care for refugees.

AIMS AND OBJECTIVES: To report the challenges faced by the nursing workforce in refugee health. BACKGROUND: Nurses are in the forefront of care provision for refugees who are recognised as one of the most vulnerable population groups in the world. The number of refugees in Australia is increasing, and more nurses are needed as care providers. Research on the challenges faced by refugee health nurses is sparse. DESIGN: Qualitative research methodology was used to study the experience of refugee health nurses. Using a descriptive qualitative research approach, a better understanding of the ongoing challenges of caring for refugees is presented. METHOD: Semi-structured interview with a convenience sample of registered nurses who worked in New South Wales refugee health services was conducted and digitally recorded in 2013. Responses were transcribed verbatim and analysed for themes. RESULTS: Six refugee health nurses who have been working in New South Wales refugee health services between 1-8 years participated in this study. A thematic analysis of the data led to three main themes: caring for clients with challenging needs; challenges in the course of caring for refugees; and passion in caring for refugees. Participants reported what it means to be refugee health nurses, they explored their roles and emphasised the need to understand refugee health issues. CONCLUSIONS: This study provides more insight into the unique experiences nurses have when caring for refugees. More debriefing opportunities and resources may reduce the challenges of caring. RELEVANCE TO CLINICAL PRACTICE: The refugee health nurses' stories support the need for further role refinement for nurses caring for refugees in the community, rural areas and health clinics. This is essential in promoting their well-being and that of the vulnerable population they are caring for.

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

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

Developing a tool to measure the factors influencing nurses' enjoyment of nursing.

AIMS AND OBJECTIVES: To develop a tool to measure the influencing nurses' enjoyment of nursing. BACKGROUND: Enjoyment in the workplace is an influential aspect found to boost work morale, job satisfaction leading to higher work retention which is important in nursing given the availability of nurses in the workforce. This study looks to refine the determinants of enjoyment from nurses in a large metropolitan hospital in western Sydney. DESIGN: Quantitative. METHODS: A 23-item survey questionnaire was used to ask nurses to rate the determinants that affect their enjoyment of nursing on a five-point Likert scale. The survey was distributed in a hard copy and online through a hospital-wide broadcast. Demographic items were also collected. RESULTS: A total of 124 responses were received, of which 54 were from online and 70 from hard copy surveys. The data analysis found 16 determinants of enjoyment. Of these, four were perceived by over 80% of the nurses to negatively impact their enjoyment. In contrast, nine items showed a positive effect on enjoyment with educating others, connecting with others, variety of work, doing and sharing with others, supporting others being the most positive (≥89% of responses). Three items were considered neutral: criticism, busy workload and changing policies. CONCLUSIONS: This study has added to the growing evidence on nurse enjoyment and its effects on job satisfaction. Nurses enjoy caring for patients and also find enjoyment and satisfaction in teaching others to care as well as socially connecting. RELEVANCE TO CLINICAL PRACTICE: Enjoyment seems to be one of the main reasons nurses continue to stay in nursing even though the system and people are not always supportive, encouraging or conducive to career development.

Treatment in the home setting with intermittent pneumatic compression for a woman with chronic leg ulcers: a case report.

BACKGROUND: Intermittent Pneumatic Compression (IPC) is shown to improve the healing rate of Venous Leg Ulcers (VLU) in the hospital setting. The current Australian "Gold Standard" treatment according to the Australian and New Zealand Wound Management Associations' (AWMA) Prevention & Management of Venous Leg Ulcer guidelines is compression, generally in the form of bandaging then progressing to hosiery once wounds are healed to prevent recurrence. This is recommended in conjunction with other standards of wound management including; nutrition, exercise, client education and addressing underlying pathophysiology and psychosocial factors. Compression bandaging is predominantly attended by community nurses in the clients' home. Barriers to delivery of this treatment include; client concordance and or suitability for bandaging including client habitus, (shape of legs), client lifestyle, clinician knowledge and clinicians physical ability to attend bandaging, in particular for obese clients with limited mobility who pose a manual handling risk to the clinician themselves. The use of IPC may assist in mitigating some of these concerns, therefore it would seem wise to explore the use of IPC within the home setting. CASE PRESENTATION: This paper will present an original case report on the successful treatment of a woman living with chronic bilateral lower leg ulcers using IPC as an adjunct treatment in her home. This paper supports recommendations to explore the use of IPC therapy in the home setting, for treatment of chronic leg ulcers requiring compression. CONCLUSION: Use of IPC in the home is anticipated to improve client involvement, concordance, client outcomes and reduce risk to staff applying conventional compression bandaging systems, particularly for obese clients with limited mobility.

Enjoyment in nursing--experiences from the clinical milieu.

AIMS AND OBJECTIVES: To present findings from a qualitative study which aimed to explore and describe experiences of enjoyment in nursing. BACKGROUND: The topic of 'enjoying nursing' is often part of job satisfaction surveys conducted in the workplace and in some studies it has been found to be the prime reason that nurses stay in the workforce. However, there is little research which explores the concept fully. DESIGN: Qualitative in-depth interviews. METHOD: Semi-structured individual interviews were conducted with 17 nurses in a local health district in Sydney, Australia. Data from digitally recorded individual interviews were transcribed and the content was analysed for themes relating to aspects of nursing that were enjoyable and others that were not. RESULTS: The major themes to emerge from the data describing enjoyment of nursing were: doing for others, supporting others and educating others. Themes that identified not enjoying nursing were related to the aggression of others, i.e. patients/clients, families or other staff in the workplace, as well as system issues. System issues referred mainly to the need for support from other nurses and management. CONCLUSION: Nurses still enjoy caring for patients and teaching others to care. This is the reason they remain in nursing even though the system and people are not always supportive or encouraging. RELEVANCE TO CLINICAL PRACTICE: Managers and educators can use these results to assist them to understand the importance of giving support to nursing staff to optimise their enjoyment of caring for their patients/clients.

What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand.

BACKGROUND: While many guidelines explain how to conduct Health Impact Assessments (HIAs), less is known about the factors that determine the extent to which HIAs affect health considerations in the decision making process. We investigated which factors are associated with increased or reduced effectiveness of HIAs in changing decisions and in the implementation of policies, programs or projects. This study builds on and tests the Harris and Harris-Roxas' conceptual framework for evaluating HIA effectiveness, which emphasises context, process and output as key domains. METHODS: We reviewed 55 HIA reports in Australia and New Zealand from 2005 to 2009 and conducted surveys and interviews for 48 of these HIAs. Eleven detailed case studies were undertaken using document review and stakeholder interviews. Case study participants were selected through purposeful and snowball sampling. The data were analysed by thematic content analysis. Findings were synthesised and mapped against the conceptual framework. A stakeholder forum was utilised to test face validity and practical adequacy of the findings. RESULTS: We found that some features of HIA are essential, such as the stepwise but flexible process, and evidence based approach. Non-essential features that can enhance the impact of HIAs include capacity and experience; 'right person right level'; involvement of decision-makers and communities; and relationships and partnerships. There are contextual factors outside of HIA such as fit with planning and decision making context, broader global context and unanticipated events, and shared values and goals that may influence a HIA. Crosscutting factors include proactive positioning, and time and timeliness. These all operate within complex open systems, involving multiple decision-makers, levels of decision-making, and points of influence. The Harris and Harris-Roxas framework was generally supported. CONCLUSION: We have confirmed previously identified factors influencing effectiveness of HIA and identified new factors such as proactive positioning. Our findings challenge some presumptions about 'right' timing for HIA and the rationality and linearity of decision-making processes. The influence of right timing on decision making needs to be seen within the context of other factors such as proactive positioning. This research can help HIA practitioners and researchers understand and identify what can be enhanced within the HIA process. Practitioners can adapt the flexible HIA process to accommodate the external contextual factors identified in this report.

COVID-19-Related Health Inequalities Induced by the Use of Social Media: Systematic Review.

Background: COVID-19-related health inequalities were reported in some studies, showing the failure in public health and communication. Studies investigating the contexts and causes of these inequalities pointed to the contribution of communication inequality or poor health literacy and information access to engagement with health care services. However, no study exclusively dealt with health inequalities induced by the use of social media during COVID-19. Objective: This review aimed to identify and summarize COVID-19-related health inequalities induced by the use of social media and the associated contributing factors and to characterize the relationship between the use of social media and health disparities during the COVID-19 pandemic. Methods: A systematic review was conducted on this topic in light of the protocol of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. Keyword searches were performed to collect papers relevant to this topic in multiple databases: PubMed (which includes MEDLINE [Ovid] and other subdatabases), ProQuest (which includes APA PsycINFO, Biological Science Collection, and others), ACM Digital Library, and Web of Science, without any year restriction. Of the 670 retrieved publications, 10 were initially selected based on the predefined selection criteria. These 10 articles were then subjected to quality analysis before being analyzed in the final synthesis and discussion. Results: Of the 10 articles, 1 was further removed for not meeting the quality assessment criteria. Finally, 9 articles were found to be eligible and selected for this review. We derived the characteristics of these studies in terms of publication years, journals, study locations, locations of study participants, study design, sample size, participant characteristics, and potential risk of bias, and the main results of these studies in terms of the types of social media, social media use-induced health inequalities, associated factors, and proposed resolutions. On the basis of the thematic synthesis of these extracted data, we derived 4 analytic themes, namely health information inaccessibility-induced health inequalities and proposed resolutions, misinformation-induced health inequalities and proposed resolutions, disproportionate attention to COVID-19 information and proposed resolutions, and higher odds of social media-induced psychological distress and proposed resolutions. Conclusions: This paper was the first systematic review on this topic. Our findings highlighted the great value of studying the COVID-19-related health knowledge gap, the digital technology-induced unequal distribution of health information, and the resulting health inequalities, thereby providing empirical evidence for understanding the relationship between social media use and health inequalities in the context of COVID-19 and suggesting practical solutions to such disparities. Researchers, social media, health practitioners, and policy makers can draw on these findings to promote health equality while minimizing social media use-induced health inequalities.