Erasure of the young trans person: A critical discursive review of contemporary health care literature.

INTRODUCTION: Trans youth experience significantly higher rates of societal violence and ill-health compared to their cisgender peers. Although recent clinical guidelines for trans young people in health have paved the way for revolutionizing care, many trans young people still experience adversity in clinical settings. This discursive literature review provides a novel approach in exploring why trans young people experience violence in health care despite the availability of evidence-based resources and guidelines. DESIGN: Databases (CINAHL and Scopus) were systematically searched to identify qualitative literature on the experiences of trans young people (<18 years) in health care settings. METHOD: Rather than synthesizing and presenting the literature, Fairclough's (2001) CDA methodology was used to critically analyze the literature as texts in a data corpus. The authors engaged with the data from a critical social theory perspective. RESULTS: Fifteen qualitative articles and one report (n = 16) on the experiences of trans young people (3-24 years) in health care settings were included. Two key discourses were identified in the literature. First, discourses that constituted the trans young person were identified in the definitions of 'trans' as a pathological incongruence and as alternate, self-determined ways of being. Further discourses were identified in the constitution of trans young people as victims, extra-pathological, and alternatively problematised as socially dysphoric. Second, discourses in health provider responses were identified in dismissive, gatekeeping, regulatory, and respectful practices. DISCUSSION: The discursive constitution of the trans young person as incongruent, vulnerable, and pathological is constituted and generated by dismissive, gatekeeping, and regulatory practices of health care providers. The analysis reveals how trans young people are considered pathological and deemed treatable (at the site of the body), in the interest of 'protecting' them from a perceived abject future of trans adulthood. The logic and violence of cisgenderism is uncovered as the foundation of these dominant discourses, whereby growing up cisgender is often presented as the only option in health care settings. The dominant discourses that constitute the trans young person in health care as incongruent, pathological, and vulnerable, alongside the reifying health care responses of dismissal, gatekeeping, and regulation contribute to the erasure of the young trans person. CONCLUSION: This paper identified key discourses in the literature in how trans young people are constituted and regulated in health care. This review highlights an urgent need for further critical scholarship in trans health by trans researchers, from critical perspectives. Furthermore, it provides a starting point for critical reflection of health care provider and researcher practices and the re-imagination of trans-futurity for all young people in health care. CLINICAL RELEVANCE: Nurses are situated at the forefront of health care delivery and play a crucial role in the advocacy and provision of culturally safe care. With this ideal proximity to clients, nurses can powerfully affect change through better understanding and reflecting on how regulatory practices constitute and position trans young people in health care. Nursing knowledge, such as cultural safety, can offer novel approaches in working towards safer ways of meeting the needs of trans young people.

Medical students' awareness of overdiagnosis and implications for preventing overdiagnosis.

Overdiagnosis is a growing health issue, yet our understanding of medical students' exposure to this concept within medical education is limited. Our aim was to explore students' experience of diagnostic learning to identify how overdiagnosis may be understood by students. During in-person and online semi-structured interviews throughout 2021, we explored the education experience of twelve Western Sydney University medical students in years 3-5. Through inductive thematic analysis we identified four themes. These themes encompassed student commitment to learning about diagnosis, lack of certainty surrounding diagnosis and emotional factors of medical care, overdiagnosis as seen through the lens of high and low-value care during clinical placements and student-identified missed learning opportunities related to overdiagnosis. This study found that medical students develop inherent knowledge of overdiagnosis through an interplay of personal factors, medical school curriculum and the setting in which their training takes place. Our findings allow insight for future improvement of medical curriculum to produce exceptional medical graduates.

Strategies used by midwives to enhance knowledge and skill development in midwifery students: an appreciative inquiry study.

BACKGROUND: Midwifery practice experience for midwifery students is an important component of education to enhance knowledge and skill development. Practicing midwives provide student support in the clinical setting, there is minimal literature relating to strategies midwives use to support students. OBJECTIVE: To explore midwifery student experiences of the strategies used by midwives to facilitate knowledge and skill development in the clinical practice setting. METHODS: Qualitative approach based on Appreciative Inquiry. The setting is one University in Australia. Participants, thirteen Graduate Diploma in Midwifery students. Individual interviews followed by thematic analysis. RESULTS: Data analysis identified six themes, Willingness to share knowledge and develop skills; The positive use of questioning; Moderating support; Teaching through the woman; Learning through problematisation and Providing constructive affirmation. CONCLUSIONS: Midwives incorporated varied strategies to support student development in the clinical setting. For an equitable clinical experience, all midwives need support to develop skills and confidence in facilitating student learning.

Exploration of barriers to screening for domestic violence in the perinatal period using an ecological framework.

AIMS: To explore Australian healthcare providers' perspectives on factors that influence disclosure and domestic violence screening through the lens of Heise's (1998) integrated ecological framework. DESIGN: This paper reports the findings that were part of a sequential mixed methods study with survey data informing interview questions. Participants for interviews were recruited after expressing an interest after completing surveys, as well as via snowball sampling. METHODS: Semi-structured interviews were undertaken in 2017 with 12 practicing healthcare providers delivering care to women in the perinatal period in Greater Western Sydney, NSW, Australia. Data were analysed using Braun and Clarke's (2006) six-step thematic approach. FINDINGS: The findings were framed within Heise's integrated ecological framework under four main themes. The main themes were 'Ontogenic: Factors preventing women from disclosing'; 'Microsystem: Factors preventing healthcare providers from asking'; 'Exosystem: Organizational structures not conducive to screening'; and 'Macrosystem: Cultural attitudes and socioeconomic influences affecting screening'. CONCLUSION: Organizational policies are needed for better systems of reminding healthcare providers to enquire for domestic and family violence and mandating this within their practices. Mandatory domestic and family violence education and training that is suitable for the time constraints and learning needs of the healthcare provider is recommended for all healthcare providers caring for perinatal women. Further research is needed in addressing culturally specific barriers for healthcare providers to enquire about domestic and family violence in a culturally appropriate way. PUBLIC AND PATIENT ENGAGEMENT AND INVOLVEMENT IN RESEARCH (PPEI): No Patient or Public Contribution was embedded into the research reported in this paper as this research was specifically exploring healthcare providers' perspectives on domestic violence screening within their own practice experience.

Understanding relationships between general self-efficacy and the healthy ageing of older people: An integrative review.

AIMS AND OBJECTIVES: The aim of this integrative review was to investigate current literature exploring relationships between general self-efficacy and the healthy ageing of older people. BACKGROUND: Enhancing the health and well-being of older adults, while mitigating consequences of illness and frailty are important priorities in healthy ageing. General self-efficacy is closely associated with human behaviour and has been linked with improved health and well-being. DESIGN: An integrative review using the five-stage method described by Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546). METHODS: Academic databases CINAHL, MEDLINE and APA PsycInfo were searched between 2010 and 2020 for original, peer-reviewed papers, published in English that investigated general self-efficacy and factors associated with the healthy ageing of older people. Included papers were critically appraised using the Appraisal tool for Cross-Sectional Studies (AXIS tool) and Critical Appraisal Skills Programme, and underwent data abstraction and synthesis via a constant comparative method. This review was also evaluated using the PRISMA checklist. RESULTS: Twenty-one papers were included in this review. Two main themes emerged. The first highlights positive relationships between general self-efficacy and health and ageing perceptions, with subsequent influence on health behaviours. The second includes two sub-themes, which explores general self-efficacy's role in maintaining well-being through its effects on psychological health and overcoming physical decline through adaption to changing physical and health conditions. CONCLUSIONS: Promoting general self-efficacy has potential benefits for the healthy ageing of older people through positive effects on ageing and health perceptions, health behaviours, psychological health and overcoming physical decline. RELEVANCE TO CLINICAL PRACTICE: Understanding how general self-efficacy facilitates healthy ageing can guide nursing practices that reduce or mitigate consequences of illness and physical decline on the health and well-being of older people. Strategies aimed at increasing older people's general self-efficacy can help to facilitate subsequent positive effects on factors that promote healthy ageing.

An exploration of women's sexual and reproductive health following traumatic brain injury.

AIMS AND OBJECTIVES: To develop a gendered understanding of sexual and reproductive health for Australian women following traumatic brain injury. BACKGROUND: The intersection of socialised normative expectations of sexuality and sexual health, and being a woman with a disability, can lead to inequity and a misconception that a woman with a disability is asexual. DESIGN: An equal weighting concurrent mixed methods design. METHODS: Twenty women participated in conversational interviews and 49 women completed an online survey. Equal priority was given to both qualitative and quantitative data which were collected concurrently. A separate analysis of data was performed and was later merged. This paper follows the Good Reporting of a Mixed Methods Study guidelines for reporting mixed methods research. RESULTS: Women reported changes in menstruation, reproduction, and sexual activity. Results identified that following traumatic brain injury, routine reproductive, and sexual health screening were neglected. Women revealed a personal reticence to discuss sexual health in a holistic sense and appeared more comfortable discussing reproductive health rather than sex for pleasure. Additionally, they perceived there was a reticence by clinicians to discuss sexual health as part of their rehabilitation. CONCLUSIONS: Shifting the focus to be on women's health through periodic comprehensive health assessments is essential to the delivery of holistic health care. These results can inform the provision of sexual health, sexual safety, and sexual assertiveness education and training for women and girls within a rehabilitation framework and would be a way of addressing what women in this study identified as an unmet need. RELEVANCE TO CLINICAL PRACTICE: Reproductive and sexual health are important elements of routine comprehensive health screening for women. Nurses are well positioned to begin discussions regarding sexual agency, sexual, and reproductive health to ensure person-centred care.

An exploration of women's knowledge and experience of perimenopause and menopause: An integrative literature review.

AIM: To explore the international literature related to women's knowledge and experience of perimenopause and menopause and to inform future directions for research and individualised healthcare delivery. BACKGROUND: Menopause is a normal physiological process experienced by most women. Despite this, care and support is fragmented and the implication on women's long-term health is not sufficiently understood. DESIGN: An integrative review of primary research on women's knowledge and experience of perimenopause and menopause. METHOD: CINAHL, Medline, Wiley Online Library, SCOPUS, PubMed and Google Scholar were searched from 2011 to 2021.Quantitative and qualitative studies written in English exploring women's knowledge and experience of menopause were included. The search strategy for the review complied with PRISMA guidelines. The mixed methods appraisal tool was used to assess quality. Thematic analysis was employed to present a narrative synthesis of the data. RESULTS: A total of 17 studies, comprising 10 quantitative, and seven qualitative studies met the inclusion criteria. The four themes regarding women's knowledge and experience of perimenopause and menopause identified in the literature were as follows: (1) Symptoms associated with perimenopause and menopause; (2) Strategies to manage symptoms; (3) Support and information (4) Attitudes, education and health literacy. CONCLUSION: This integrative review of the international literature highlights that women's knowledge of perimenopause and menopause varies significantly globally and within countries. The experience of perimenopause and menopause for women is heterogenous and influenced by deeply embedded sociocultural patterns. RELEVANCE FOR CLINICAL PRACTICE: This integrative review has shown that individualised support for women during perimenopause and menopause is critical to ensure the diverse needs of women are suitably addressed. NO PATIENT OR PUBLIC CONTRIBUTION: As this was a review of the literature, no patients, service users, caregivers or members of the public were involved in this review.

Workplace gender discrimination in the nursing workforce-An integrative review.

AIM: To critically synthesise the literature that explores the experiences of workplace gender discrimination from the perspective of registered nurses. DESIGN: Integrative review. REVIEW METHODS: Primary research articles reporting on the experience of workplace gender discrimination towards registered nurses in any setting were eligible for inclusion. Studies were critically appraised for methodological quality using a modified Critical Appraisal Skills Program list. The six phases of thematic analysis proposed by Braun and Clarke (2006) were used to guide the analysis. Data were extracted and coded, and themes were identified according to the review aims and significant findings of each study. DATA SOURCES: CINAHL, MEDLINE, SCOPUS, Cochrane Library, published between January 2012 and June 2022. RESULTS: Twenty studies met the inclusion criteria. Major themes identified were (1) career progression, (2) career interruption, (3) positioning of men in nursing and (4) positioning of women in nursing. CONCLUSION: This review shows that both men and women in nursing experience workplace gender discrimination; however, the forms and consequences of this discrimination differ substantially by gender. IMPLICATIONS FOR THE PROFESSION: It is important that the pursuit of greater numerical representation of men in nursing does not result in further reinforcing patriarchal advantage. Professional development for nurse leaders in managing gender issues is recommended. IMPACT: This integrative review presents current issues on workplace gender discrimination for men and women in nursing. The findings suggest gender roles and norms have an effect on the careers of both men and women in nursing. The time has come to alter restrictive gender norms and to challenge notions of hegemonic masculinity and femininity. REPORTING METHOD: We have adhered to relevant EQUATOR guidelines-PRISMA. NO PATIENT OR PUBLIC CONTRIBUTION: For this literature review on workplace gender discrimination for registered nurses, we did not engage members of the patient population, nor the general public.

Mediating effect of job performance between emotional intelligence and turnover intentions among hospital nurses during the COVID-19 pandemic: A path analysis.

Background: Nursing shortages are a persistent and concerning problem for the nursing workforce worldwide. However, the COVID-19 pandemic has brought additional stressors and workloads and has worsened nursing shortages. Aim: To investigate interrelationships among emotional intelligence, job performance, and turnover intentions of nurses during the coronavirus disease 2019 (COVID-19) pandemic, and explore the mediating effect of job performance between emotional intelligence and turnover intentions. Methods: A cross-sectional survey was conducted. In total, 673 nurses working in a medical centre hospital in northern Taiwan were recruited from November 2020 to April 2021. An anonymous questionnaire was used in this survey. Data were collected using a seven-item turnover intention scale, a 16-item emotional intelligence scale, a 24-item job performance scale, and demographic questions. A path analysis was performed. This study was based on STROBE guidelines. Findings: Statistically significant correlations between turnover intentions and emotional intelligence (r = -0.10, p = 0.012), between turnover intentions and job performance (r = -0.13, p = 0.002), and between emotional intelligence and job performance (r = 0.54, p < 0.001) were detected. Model fit indices were adequate. Job performance had a significant indirect effect between emotional intelligence and turnover intentions (ß = -0.16, p = 0.011). Discussion: It was found that job performance was a mediator between emotional intelligence and turnover intentions during the pandemic. The study results support the need to continue to create healthy work environments. Conclusion: These results can assist hospitals in developing specific evidence-based interventions such as showing appreciation and providing acknowledgments to reduce turnover of their nurses during the COVID-19 pandemic.

Being tied down-The experience of being physically restrained while mechanically ventilated in ICU.

AIMS: To explore the experience of physical restraints during mechanical ventilation in intensive care from the perspectives of patients and family members. DESIGN: This research was a qualitative study with a naturalistic inquiry framework adhering to the Consolidated Criteria for Reporting Qualitative Research guidelines. METHOD: In-depth, semi-structured conversations were conducted with five patients and six family members who had either personally experienced or witnessed their loved ones being physically restrained during mechanical ventilation in intensive care. Data collection occurred between March 2018 and June 2019. These conversations were audio-recorded and transcribed. Reflexive thematic analysis was used to analyse the data. RESULTS: Three major themes emerged from the data. These themes were: Being tied down; Feeling helpless; and Finding light in the darkness. CONCLUSION: The experience of physical restraints during mechanical ventilation in intensive care leads to traumatic experiences which can impact patients and families long after their ICU stay. Holistic care, which considers the physical, emotional and psychological needs of patients and families, should be more thoroughly explored when managing treatment interference to minimize harm. IMPACT: This study gained insight into the physical, emotional and psychological consequences of applying physical restraints to patients who are mechanically ventilated as an intervention for preventing treatment interference. The findings of this study have the potential to improve ICU patient and family outcomes by influencing current physical restraint practices. Recommendations from this research can contribute to practice change by informing policy, shifting workplace culture and norms about restraints, and encouraging education and training.

The experience of workplace gender discrimination for women registered nurses: A qualitative study.

AIM: To explore the experiences of female registered nurses (RNs), who encounter workplace gender discrimination in nursing. DESIGN: This study used a qualitative exploratory design informed by feminist perspectives and was underpinned by social constructionism. METHODS: Women who were RNs (N = 10) and employed in New South Wales (NSW) were purposively selected to convey their experiences of workplace gender discrimination. Data were collected through semi-structured interviews, between April and July 2020. Analysis was guided by the work of Anderson and Jack (Women's words; 1991) who recommend three ways of listening. Interviews were transcribed verbatim and Braun and Clarke's (Qualitative Research in Psychology, 3, 77-101; 2006) six-step guide was used to develop themes. RESULTS: Thematic analysis revealed five overarching themes: It's a man's world; Gender stereotypes; Being a woman and nurse; Reluctance to call out gender discrimination and The status quo. Findings from this study highlighted that participants believed men's career progression in nursing were favoured over women. CONCLUSION: Findings from this research highlight that socially constructed gendered norms continue to form the basis of inequality for women in the workplace. Fostering and sustaining workplace cultures that support family and work life balance, and that do not discriminate against women, is fundamental to ensuring equality for women. IMPACT: There is limited qualitative research into women's experiences of workplace gender discrimination in nursing. This research highlights the need for workplace strategies to be implemented to ensure women are better supported and equally represented in leadership positions and advanced practice roles in nursing. All nurses should be given equal consideration based on experience and qualifications. Career development and progression opportunities should be fair, equitable and transparent with clearly documented criteria.

A scoping review: Treatment attitudes and adherence for adults with schizophrenia.

AIM AND OBJECTIVES: This scoping review presents an exploration of literature on the relationship between treatment attitudes and adherence in adults experiencing schizophrenia. BACKGROUND: Strategies to address adherence and improve treatment outcomes are described in literature. However, adherence remains a challenge for people experiencing mental illness in practice. Transformational frameworks, evidence-based practice and patient-centred approaches have been established and implemented but non-adherence incidence rates continue to rise among people with schizophrenia. Moreover, the relationship between treatment attitudes and adherence in adults diagnosed with schizophrenia remains unclear. DESIGN: A scoping review using the framework offered by Implementation Science, 5, 2010, 1. The PRISMA-ScR checklist was used to ensure integrity of the review. METHODS: Four databases PsychINFO, Medline, Cochrane and CINAHL databases were searched for literature along with the reference lists of eligible sources. Original research, peer-reviewed articles published between 2010 and 2020 in English language were included. Articles were included if study participants were adults with a diagnosis of schizophrenia or related psychosis. Methodological quality was evaluated using a quality assessment checklist, the Critical Appraisal Skills Programme tool. RESULTS: Ten articles were included in the study. Five main themes about treatment adherence emerged from the literature: (i) severity of symptoms, (ii) side effects, (iii) beliefs and attitudes, (iv) insight and (v) support and relationships. CONCLUSIONS: This scoping review concluded that attitude influenced adherence to medication in people with schizophrenia. The five main themes reported directly influenced attitude, impacting on treatment adherence in people experiencing schizophrenia. This review makes recommendations for a person-centred and recovery framework that aims to improve adherence. RELEVANCE TO CLINICAL PRACTICE: Nurses in all healthcare settings could use evidence-based strategies to enhance treatment adherence in people with a range of physical and mental health conditions.

Effectiveness of a musical fitness programme for older adults with cognitive impairment in long-term care facilities: A quasi-experimental study.

OBJECTIVE: To investigate the effectiveness of a musical fitness programme (MFP) intervention in improving neuropsychiatric symptoms, depression, upper-limb muscle strength and cognition of older adults with cognitive impairment in long-term care (LTC) facilities. BACKGROUND: Because of population ageing, the number of older adults with cognitive impairment has been increasing. The effectiveness of medications in treating cognitive impairment is limited; therefore, the global trend has been for non-pharmacological treatments. However, intervention studies of MFPs on older LTC residents with cognitive impairment are scant. DESIGN: This study adopted a quasi-experimental design in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist. In total, 84 older adults with cognitive impairment were recruited from seven LTC facilities. The MFP was implemented from July-November 2019. METHODS: The intervention group received the MFP, which was 50 min per session, twice a week for 12 weeks, whereas the comparison group received usual care. Neuropsychiatric inventory nursing home version, the Cornell scale for depression in dementia Chinese version, 30-s arm curl test and Mini-Mental State Examination were the outcome measures. Data were analysed using Chi-square test, t test and repeated measure analysis of variance. RESULTS: After the intervention, the scores of neuropsychiatric inventory and the Cornell depression exhibited significant differences over time between two groups (F = 3.6, p = .029; F = 5.96, p = .003, respectively). Nevertheless, 30-s arm curl test and Mini-Mental State Examination demonstrated non-significant between-group differences. CONCLUSION: The MFP can effectively reduce neuropsychiatric symptoms and depression in older adults with cognitive impairment in LTC facilities. To ensure a more robust evidence base, more research is warranted. RELEVANCE TO CLINICAL PRACTICE: The MFP is a non-pharmacological treatment that can be implemented to promote psychological well-being among older adults with cognitive impairment in LTC facilities, and to indirectly reduce nursing staff burden. To assist nursing staff in providing this intervention, on-the-job training is needed.

The experiences of 'significant others' supporting people with severe burn injury: An integrative literature review.

BACKGROUND: Severe burn injury is a traumatic experience for both patients and their significant others. Although research has focused on the experience of people with burn injury, there is a paucity of research focusing on the experiences of the significant other. Significant others are frequently expected to advocate and make decisions on behalf of the patient, which may have an impact on their psychological wellbeing. An understanding of the experiences of significant others will inform strategies to better support their needs. OBJECTIVES: The aim of this integrative literature review was to critically examine research related to the experiences of significant others supporting a patient with a severe burn injury in the hospital. METHODS: CINAHL Plus with Full Text (EBSCO), MEDLINE ALL (Ovid), Scopus, and APA PsycINFO were searched up to December 2019 for English language studies using search terms burns, significant other, ICU, and psychological impact. Records were independently screened and assessed for methodological quality, and the data were synthesised. RESULTS: Nine articles were included in the review. Three used a quantitative approach, and six were qualitative studies. Three major themes were identified, namely, (i) psychological consequences and emotional trauma, (ii) redefining relationships, and (iii) coping strategies. CONCLUSION: The review identified that significant others experience adverse psychological consequences including post-traumatic stress, anxiety, and depression. The burn injury resulted in a redefining of relationships with others and particularly with the patient through this shared experience. Significant others found ways to adapt to stressors, including taking control of the situation and seeking greater involvement in the patient's care.

Women's tenacity following traumatic brain injury: Qualitative insights.

AIM: To explore perspectives of Australian women who had sustained a traumatic brain injury to develop a gendered understanding of their experiences. DESIGN: Qualitative findings from a concurrent mixed methods study. METHODS: Australian women who had sustained a traumatic brain injury participated in conversational interviews. Data were collected from June 2017 - May 2018. Women's narratives were listened to in various ways (Anderson & Jack, Learning to listen: Interview techniques and analyses, 1991) and analysed using thematic analysis (Braun & Clark, Thematic analysis, 2016). RESULTS: Two overarching themes Loss-A life once lived and Realigning Self-A new way of being were identified. Women discussed many losses due to injury, loss of income and potential earnings, loss in relationships and loss of identity. These all took time to reconfigure in their lives, as they adjusted to a range of ongoing impairments from the traumatic brain injury. CONCLUSION: Socially constructed gendered norms continue to at times negatively inform delivery of health care for women following traumatic brain injury. Loss associated with the injury is felt for decades and regardless of time since injury realigning of self, requires remarkable tenacity. Readjustment often continues without end; therefore, individualized health and rehabilitation services must be offered across women's lifespans. IMPACT: There is limited research into women's experiences of traumatic brain injury which suggests experiences will be the same for men and women. This research highlights biological sex differences and socialized gendered roles are important factors to consider for women following traumatic brain injury. Differences are influenced by sociocultural factors and they relate to sexual and reproductive health and gendered roles such as caring for children, caring for ageing parents, employment and projected earnings. These findings should be used to inform the development of individualized health and rehabilitation services which women in this study have identified and must be offered across their lifespans.

Understanding nurses' perspectives of physical restraints during mechanical ventilation in intensive care: A qualitative study.

AIMS AND OBJECTIVES: This study explored the experiences of nurses using physical restraints on mechanically ventilated patients in intensive care. BACKGROUND: Physical restraints are frequently used to prevent treatment interference and maintain patient safety in intensive care units worldwide. However, physical restraints are found to be ineffective in preventing treatment interference and cause negative outcomes for patients. The practices surrounding physical restraints are inconsistent due to a lack of education, training and protocols. DESIGN: This research was conducted as a qualitative study with a naturalistic inquiry framework adhering to the Consolidated Criteria for Reporting Qualitative Research guidelines. METHODS: Twelve in-depth, semi-structured conversations were conducted with registered nurses who have experience working in intensive care and have cared for patients who were physically restrained and mechanically ventilated. These conversations were audio-recorded and transcribed. Thematic analysis was used to analyse the data. RESULTS: Three major themes emerged from the data. The themes were as follows: the ICU culture and its impacts on physical restraint practices; the consequences of physical restraints through a nursing lens; and understanding the ways of learning. CONCLUSION: The insights into the ICU culture, the nurses' understanding of the consequences of physical restraints and the ways in which nurses learn physical restraint practices have provided a greater depth of knowledge and understanding of the realities of current practice in ICU. This new information demonstrates nurses' understanding of the potential harm caused by physical restraints and the way in which current practices are guided more-so by workplace norms and expectations rather than on critical thinking and decision-making. RELEVANCE TO CLINICAL PRACTICE: These insights provide valuable information to intensive care clinicians, educators and policymakers to guide future practice and improve patient outcomes by highlighting the importance of education on physical restraint practices and informing the development of policies and guidelines.

Factors contributing to high turnover rates of emergency nurses: A review of the literature.

OBJECTIVES: The objective of this study was to identify factors that contribute to high turnover rates of nurses working in emergency departments. REVIEW METHODS/DATA SOURCES: The search strategy for the review complied with Preferred Reporting Items for Systematics Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cummulative Index of Nursing and Allied Health Literature (CINAHL), and Google Scholar were systematically searched for literature studies published between 2006 and 2018. A predefined set of exclusion and inclusion criteria was used by two of the authors. Inclusion criteria included full-text articles available in English, original research that meets National Health and Medical Research Council (NHMRC) guidelines, peer-reviewed articles, and articles related to emergency departments (EDs) only. Data were analysed thematically using Braun and Clarke's six key phases of thematic analysis. RESULTS: A total of 20 articles, comprising 16 quantitative and four qualitative studies, met the inclusion criteria and identified factors that contribute to high turnover rates in EDs. This review identified three major themes: aggression and violence, critical incidents, and work environment. CONCLUSIONS: This review has identified that there are multiple challenges faced by nurses working in EDs. These challenges may result in high levels of occupational stress, burnout, compassion fatigue, and posttraumatic stress disorder or secondary traumatic stress, which further contributes to attrition rates.

The differing perspectives of doctors and nurses in end-of-life decisions in the intensive care unit: A qualitative study.

BACKGROUND: End-of-life (EOL) decision-making in the intensive care unit (ICU) can be emotionally challenging for both doctors and nurses, who are sometimes placed in difficult positions where they are required to make decisions on behalf of patients. With an ageing population and advances in medical technology, there is an increase in such decisions being made in ICUs. OBJECTIVES: The objective of this study was to explore the perspectives of doctors and nurses involved in the EOL decision-making process in an ICU. METHODS: This study used a qualitative methodology based on naturalistic inquiry. Intensive care nurses and doctors from a large Sydney metropolitan public hospital were purposively selected, and data saturation was reached after a total of eight nurses and four doctors were interviewed. Data were collected through semistructured interviews, either face-to-face or over the telephone. Interviews were then transcribed verbatim, and themes were identified and coded through a line-by-line analysis of each transcript (manual thematic analysis). FINDINGS: The findings revealed two main themes: 'Doctors' and nurses' roles in decision-making' and 'Managing family expectations'. These themes highlighted key differences in decision-making processes, in that doctors tended to aim to meet the family's needs, while the nurses tended to advocate on behalf of the patient and what they interpreted as the patient's best interests. Furthermore, nurses tended to feel undervalued in decision-making during family conferences, when in reality, the doctors were making decisions based on all information obtained, primarily from nursing staff. CONCLUSIONS: EOL decision-making is complex and affects doctors and nurses involved in different ways. More emphasis on interprofessional education and collaboration between the two disciplines may enhance future decision-making processes.

Physical restraints in intensive care-An integrative review.

BACKGROUND: Physical restraints (PRs) are commonly used in intensive care units (ICUs) worldwide for the prevention of treatment interference. While PRs are fundamentally used to maintain patient safety, they can negatively impact the experiences of patients and their families and cause moral and ethical dilemmas for ICU nurses. OBJECTIVES: The aim of this integrative review was to explore the current literature on the use of PR in intensive care. METHODS: This article used an integrative review framework to explore the current literature available on the experiences of PR in ICU. Research published between January 2007 and July 2016 was considered. Databases searched included CINAHL, Proquest, Medline, PubMed, and Cochrane. Inclusion/exclusion criteria were used to screen for eligibility. Methodological quality was evaluated using a quality assessment checklist, adapted from Walsh and Downe, and based on the Critical Appraisal Skills Programme tool. The findings were analysed and synthesised into major themes. RESULTS: Seventeen articles from Europe, Asia, and the United States of America were included. Five major themes emerged: (i) prevention of treatment interference; (ii) nurses' role as primary decision-makers PR application and removal; (iii) adherence to PR protocols; (iv) moral and ethical dilemmas faced by nurses; and (v) experiences of patients and families. The literature identified the prevalence of PR in today's ICUs, the drawbacks of current practice, and the paucity of knowledge of the lived experiences of PR. CONCLUSION: PR is the first choice in preventing of treatment interference, and most clinicians believe there is a valid place for them in ICU. However, its effectiveness in preventing self-extubation is questionable, and there are obvious flaws within this practice including inconsistencies surrounding PR protocols and the shortage of education and training provided to nurses. Further research into lived experiences of PR to gain deeper insights may lead to possible solutions and improve current practice.

Opportunistic domestic violence screening for pregnant and post-partum women by community based health care providers.

BACKGROUND: Domestic violence against women is a global endemic that can commence or escalate during pregnancy and continue postpartum. Pregnant and postpartum women generally access health care providers more at this time than at any other time in their lives. Despite this, little is known about primary health care providers' screening practices for domestic violence. The purpose of this paper is to present survey findings that identified domestic violence screening practices of community based health care providers in pregnant and postpartum women. METHODS: This paper reports on the survey results of a larger sequential mixed methods study that involved a survey and semi-structured interviews, and used a pragmatic approach to the data collection and analysis. The survey sought information via both fixed choice and open responses. Quantitative data from the surveys were entered into the Statistical Package for Social Science (SPSS™ Version 22) and analysed using descriptive statistics. Open responses were collated and then integrated and presented with the quantitative data. RESULTS: Results revealed that some health care providers did not screen for domestic violence. Factors contributing to this lack of screening included: a lack of recognition that this was part of their role; and a lack of domestic violence screening policies and/or reminder systems. Further barriers to domestic violence screening were identified as a lack of time, resources and confidence in undertaking the screening and referral of women when domestic violence was detected. CONCLUSIONS: The findings reported in this paper confirm that further insights into the domestic violence screening practices of community based health care providers is required. Findings also have the potential to inform interventions that can be implemented to increase domestic violence screening and promote appropriate referral practices.