The perspectives of internationally qualified nurses regarding their specialty skill transition to Australia: A cross-sectional survey.

AIM: To identify barriers and facilitators of speciality skill transfer for internationally qualified nurses in Australia from the nurses' perspective. DESIGN: A cross-sectional study. METHODS: A cross-sectional online survey was distributed through social media, snowballing and nursing professional organization. Data analysed using Statistical Package for the Social Sciences. DATA SOURCES: Online survey data from participants matching the inclusion criteria were collected from July to September 2022. RESULTS: Survey results reveal facilitators (competence, scope of practice, linguistic sufficiency, understanding of decision-making) and barriers (lack of opportunity, transition pathways, confidence in overseas education, financial instability) for internationally qualified nurses' speciality skill utilization in Australia. CONCLUSION: Identifying and addressing barriers and facilitators, along with developing tailored transition pathways, are crucial for maximizing speciality skill utilization among internationally qualified nurses. These findings have implications for policymakers, healthcare organizations and nurses. They highlight the need to address barriers, facilitate smooth transitions and implement proactive measures for internationally qualified nurses to effectively utilize their specialty skills. IMPACT: The study addresses maximizing skill usage for internationally qualified nurses, identifies barriers and facilitators for specialty skill transfer in Australia and will impact policymakers, healthcare organizations and nurses by guiding strategies for safe nursing service delivery and optimizing patient care. REPORTING METHOD: STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: A total of 71 internationally qualified nurses contributed their experiences and opinions. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Lack of opportunity and the lack of transition pathways inhibit the use of specialty nursing skills by internationally qualified nurses. This study's findings contradict the result of other studies that suggest language is a significant obstacle to the utilization of specialty skills of internationally qualified nurses. TRIAL AND PROTOCOL REGISTRATION: The protocol is registered on OSF. The data for this study are available for sharing with the reviewers upon request. However, it is worth noting that ethical approval has not been obtained specifically for web sharing, and therefore, the data has not been posted in any repositories or public platforms.

Introduction of a Registered Undergraduate Student of Nursing workforce: A qualitative study of student and registered nurses.

AIM: To explore the benefits and challenges of a recently introduced Registered Undergraduate Student of Nursing workforce from the perspective of Nurses and Registered Undergraduate Students of Nursing, in a major metropolitan hospital in Australia in 2020. DESIGN: A qualitative descriptive study was undertaken using individual interviews and focus groups. METHODS: Purposively selected employed Registered Undergraduate Students of Nursing and nurses who worked with them were interviewed, using a semi-structured format. Recordings were transcribed and coded using NVivo software. Reflexive thematic analysis using an inductive approach was undertaken. RESULTS: Four major themes were revealed: (i) Navigating the programme, (ii) Belonging and integration; (iii) Patient care; and (iv) Continuing Development. Initial challenges were common, often related to clarifying the scope of practice for the new role. Ongoing issues were associated with gaps in understanding the role and lack of integration into the team. Mostly, nurses and Registered Undergraduate Students of Nursing built positive, professional relationships. Nurses valued the Registered Undergraduate Student of Nursing knowledge and skill level, reporting improved workload and work experiences when the Registered Undergraduate Student of Nursing was on shift. Nurses believed that the Registered Undergraduate Students of Nursing enhanced patient care. Registered Undergraduate Students of Nursing described positive, therapeutic relationships with patients. Registered Undergraduate Student of Nursing employment provided opportunities for new learning, leading to increased efficiency and confidence on clinical placement. CONCLUSIONS: This employment model benefited the Registered Undergraduate Students of Nursing and nurses who worked with them. In the absence of adequate training and support, challenges remained unresolved and negatively impacted the experience for nurses. In addition to university-level education and clinical placement, the employment model can create a third space for student learning via on-the-job training. The study supports the ongoing employment of student nurses through the Registered Undergraduate Student of Nursing model. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Impact This study contributes to the very small body of literature investigating Registered Undergraduate Student of Nursing workforces in Australian hospitals. It is the first to explore the experiences of both nurses and students working together in a major metropolitan setting and also the first in the context of the COVID-19 pandemic. This study reflected a mostly positive experience for Registered Undergraduate Student of Nursing and the nurses who worked with them and highlighted the importance of adequate oversight and support in the implementation and maintenance of a Registered Undergraduate Student of Nursing workforce. Employed Registered Undergraduate Students of Nursing reported improved confidence, skills, and felt like they started clinical placement at an advantage, ready to step up and learn the Registered Nurse scope of practice. In addition to university-level education and clinical placement, this employment model creates a third space for learning via on-the-job training. REPORTING METHOD: COREQ guidelines were followed in the reporting of this study. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study.

AIMS: To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses. DESIGN: Mixed method explanatory sequential design. METHODS: A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena. RESULTS: Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not. CONCLUSIONS: Delegation is a two-way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety. IMPACT: Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses. Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants. Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff. REPORTING METHOD: Complied with the APA Style JARS-MIXED reporting criteria for mixed method research. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Roles of nurse-surgeons in global surgical care: A scoping review.

AIM: To identify the roles of nurse-surgeons in the provision of surgical care. DESIGN: Scoping review. METHODS: This scoping review adhered to the JBI guideline for scoping reviews and EQUATOR Network's PRISMA-ScR checklist. Searches were performed from May 2022 to July 2022 using a combination of MeSH headings, keywords and filters via database and hand searching based on the eligibility criteria. Keywords included nurse-surgeon, nurse endoscopist, nurse hysteroscopist and nurse cystoscopist. Data sources were CINAHL, Cochrane, Google Scholar, PubMed and Scopus. Descriptive analysis was used to report the findings. RESULTS: Ninety-six included records indicated nurse-surgeon practice in 26 countries. Forty-one nurse-surgeon titles were found, the majority of which were types of nurse practitioner. A total of 5,684,198 surgeries were performed by nurse-surgeons varying from laparotomies to biopsies. Nine records reported that nurse-surgeons perform surgeries safely and on par with physicians with zero to minimal complications. Nineteen records reported improved surgical care efficiency by nurse-surgeons in terms of patient access to surgery, waiting times, surgery times, patient show rates, patient education, physician workload and junior physicians' training. Seven records reported high patient satisfaction. Nurse-surgeons were cost-effective according to five records. Thirteen records recommended the standardization of nurse-surgeon practice. CONCLUSION: Nurse-surgeons performed millions of surgeries worldwide assisting in easing the global surgical burden. This review identified the roles and benefits nurse-surgeons play in global surgical care. Research gaps on nurse-surgeon roles were discovered including the ambiguity in nurse-surgeon titles and the need to regulate nurse-surgeon practice. IMPACT: This research addressed the clinical safety, quality, contribution to timely surgical access and cost efficiency of nurse-surgeon performed surgeries, as well as the need to standardize nurse-surgeon practice and use a more consistent nurse-surgeon title to ensure role identification and monitoring.

Integrative review: Factors impacting effective delegation practices by registered nurses to assistants in nursing.

AIM: To identify the evidence on factors that impact delegation practices by Registered Nurses to Assistants in Nursing in acute care hospitals. DESIGN: An integrative review. DATA SOURCES: Database searches were conducted between July 2011 and July 2021. REVIEW METHODS: We used the 12-step approach by Kable and colleagues to document the search strategy. The (Whittemore & Knafl. 2005. Journal of Advanced Nursing, 52(5), 546-553) integrative review framework method was adopted and the methodological quality of the studies was assessed using Joanna Briggs critical appraisal instruments. RESULTS: Nine studies were included. Delegation between the Registered Nurse and the Assistant in Nursing is a complex but critical leadership skill which is impacted by the Registered Nurse's understanding of the Assistant in Nursing's role, scope of practice and job description. Newly qualified nurses lacked the necessary leadership skills to delegate. Further education on delegation is required in pre-registration studies and during nurses' careers to ensure Registered Nurses are equipped with the skills and knowledge to delegate effectively. CONCLUSION: With increasing numbers of Assistants in Nursing working in the acute care environment, it is essential that Registered Nurses are equipped with the appropriate leadership skills to ensure safe delegation practice.

A translational research framework for nurse practitioners.

AIMS: This study aims to explore a proposed translational research continuum for nurse practitioners. BACKGROUND: Nurse practitioners are acknowledged as clinical leaders responsible for transforming health care delivery. It is important that nurse practitioners contribute to health care knowledge using scientific processes for the implementation of evidence-based practice and evaluation of outcomes of interventions for their patient groups. EVALUATION: This paper provides a review of translational research literature including implementation science to align nurse practitioner activities to a modified translational research framework. KEY ISSUES: A translational research framework has the potential to strengthen nursing research in the nurse practitioner role. Adapting an accepted translational research continuum for nurse practitioners places the clinical nursing leaders in an equitable research position with all health care professionals. IMPLICATIONS FOR NURSING MANAGEMENT: The translational research continuum provides nursing management with a structure to benchmark nursing research. The continuum applies a modern research framework to support research engagement for the nurse practitioner role.

Does participation in extended immersive ward-based simulation improve the preparedness of undergraduate bachelor's degree nursing students to be ready for clinical practice as a registered nurse? An integrative literature review.

AIMS AND OBJECTIVES: To determine if extended immersive ward-based simulation programmes improve the preparedness of undergraduate bachelor's degree nursing students to be ward ready for professional practice as a registered nurse. BACKGROUND: The practice readiness of new graduate nurses to enter the workforce continues to raise concern among educators and industry. Often the transition period is a vulnerable time when the reality of clinical practice bears little resemblance of their experiences as a student. Simulation of a busy ward offers the opportunity for pre-registered nurses to practise a variety of situations they are likely to encounter once qualified in a safe and supportive learning environment. METHODS: The review considered studies that investigated the experiences and learning outcomes of nursing students following participation in extended immersive ward-based simulation. Databases searched included CINAHL, EMBASE, Medline and Scopus. Two reviewers independently assessed retrieved studies that matched inclusion criteria using standardised critical appraisal instruments. Reporting of review followed PRISMA checklist. RESULTS: Fourteen studies met the inclusion criteria. The majority of studies used a quasi-experimental mixed methods approach (10). Programme evaluations focused on self-reporting in learning satisfaction and student perceptions of performance. Six studies used a pre- and post-test design to compare the after effect on preparedness for professional practice. Two studies investigated student learning between simulated experiences and experiences gained during clinical placements. CONCLUSION: Learning satisfaction was high among students who participated in programmes that incorporated extended immersive ward-based simulation experiences. Students are able to practise what they need to know and on what will be expected of them in professional practice. Evidence on whether these programmes make a difference in workplace performance, and retention of graduate nurses is yet to be established. RELEVANCE TO CLINICAL PRACTICE: Extended immersive ward-based simulation allows educators the opportunity to meet the perceived needs of students in preparation for professional practice.

Experiences of Western Australian rural nursing graduates: A mixed method analysis.

AIMS AND OBJECTIVES: To determine whether the current rural graduate programmes in Western Australia adequately support new graduate nurses transitioning into practice. BACKGROUND: Graduate nurse's transition to employment is a time of significant change and challenge, often resulting in periods of transition shock. These challenges are magnified in rural areas where graduates have to relocate to commence their career with limited rural nursing experience. Graduate programmes were developed to smooth the transition for university trained bachelor's degree registered nurses into the workforce. Supportive graduate nursing programmes are essential for enabling transition to practice and reduce attrition rates. DESIGN: Longitudinal convergent mixed method parallel design was informed by Duchscher's transition stage model. METHOD: Thematic analysis was applied to all interviews. COREQ checklist was completed. Descriptive statistics and content analysis were used to analyse the survey responses. RESULTS: New graduates cycled through both transition shock and honeymoon periods on commencement of employment, reporting high levels of satisfaction in simultaneity with signs of transition shock. Satisfaction dropped within 7 months indicating a transition crisis before an adjustment period occurred at the end of their graduate year. Limited resources were highlighted as obstacles to providing adequate support to rural graduate nurses. CONCLUSION: The honeymoon stage of transition co-existed with transition shock at the commencement of graduate programmes, which may obscure the need for continuing adequate support. Inadequate and/or a lack of preceptorship was evident throughout the Western Australian rural graduate programmes. Graduate programmes need to be structured but flexible to allow for individual differences in graduates' and clinical contexts. RELEVANCE TO CLINICAL PRACTICE: Structured but flexible graduate programmes allow for individual differences in graduates and clinical situations. New graduate nurses would benefit from a break midway through their graduate year to assist and overcome the transition crisis stage. Education of nurses undertaking the preceptor role is required to deliver adequate support to graduate nurses and decrease transition shock.

The impact of blood sampling technique, including the use of peripheral intravenous cannula, on haemolysis rates: A cohort study.

AIMS: To explore the relationship between blood sampling techniques and haemolysis. BACKGROUND: Haemolysis rates of blood samples have been thought to be influenced by the method of collection. There is a lack of research evidence available to clearly show the comparative risk of haemolysis across different blood sampling methods, including venepuncture and use of peripheral intravenous cannulas. DESIGN: A prospective cohort study. Reporting followed the STROBE checklist. METHODS: A trained observer was used to record blood sampling techniques over a 10-week period between April and June 2019. These records were then linked to pathology haemolysis results. Multivariable logistic regression was used to model patient and blood draw characteristics affecting haemolysis. RESULTS: Most of the blood samples were not haemolysed (n = 324, 87.1%). Multivariable analysis showed haemolysis was associated with increased tourniquet duration and if the level of tube was less than half full. Univariable analysis showed haemolysis was associated with increased age of the patient, the difficulty of cannulation/ venepuncture and increased number of attempts. No difference was found in the haemolysis rate related to the qualification of the blood collector. CONCLUSION: There was no significant difference in haemolysis rates associated with sampling blood from a PIVC compared with venepuncture. Research should be undertaken to determine whether education on the factors influencing haemolysis is useful in decreasing haemolysis rates. RELEVANCE TO CLINICAL PRACTICE: There was no association with increased haemolysis rates when drawing blood via venepuncture compared with a peripheral intravenous cannula. Haemolysis of blood samples was associated with increased tourniquet duration, if level of the tube was less than half-filled, increased age of the patient and difficulty of blood draw. Awareness of the risk of haemolysis associated with specific blood sampling methods may assist clinicians to improve care.

Contemporary nursing graduates' transition to practice: A critical review of transition models.

AIM AND OBJECTIVE: To critically review contemporary transition theories to determine how they apply to the newly qualified graduate registered nurse programmes. BACKGROUND: Graduate nurse transition to employment is the time of significant change which has resulted in high attrition rates. Graduates are often challenged by their expectation of nursing practice and the reality of the role. The transition from hospital-based training to university-based training has resulted in the need for primary employment to commence with graduate/orientation/internship programmes to help support new graduates transition into clinical practice. One transition model, Duchscher's stages of transition theory, utilised three former theories to develop a final model. DESIGN: A narrative critical literature review. METHOD: The theories selected for the review were Kramer's reality shock theory, Benner's novice to expert theory, Bridges transition theory and Duchscher's stages of transition theory. CONCLUSION: Duchscher's stages of transition theory reflects the experiences of registered nursing transition into the workforce directly from university. The application of the theory is effective to guide understanding of the current challenges that new graduate nurse's experience today. There is a need for new graduates to complete their university degree as advanced beginners in order to decrease the experience of transition shock and keep pace with rapidly changing demands of the clinical environment. This may be achieved by increasing ward-based simulation in university education. A theoretical framework can provide a deep understanding of the various stages and processes of transition and enable development of successful programmes. RELEVANCE TO CLINICAL PRACTICE: Both universities and hospitals need to adapt their current practice to align with the needs of new graduates due to large student numbers and ongoing systematic advancements to decrease the attrition rate.

An integrative review to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes.

AIMS: This study aimed to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes. BACKGROUND: Changing health-care delivery is synonymous with the nurse practitioner role. The literature is critical of the lack of research by nurse practitioners, reporting the effects of a change to health-care delivery. DESIGN: This study used a systematic integrative review by using Torraco's approach. DATA SOURCES: Databases Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Web of Science and SCOPUS were searched for peer-reviewed publications from 2000 to 2019. REVIEW METHODS: A systematic approach was used to screen and analyse the literature. Inclusion/exclusion criteria were applied, and quality appraisal was undertaken by two reviewers. RESULTS: Eighteen articles were selected. The research projects were across the community and acute care settings. Research methodologies varied including preintervention and postintervention studies, evaluation of quality improvement projects, randomized controlled trial and descriptive studies. Multiple data collection tools were used. Two major themes were identified including evidence-based practice champions and improved patient outcomes. CONCLUSION: The nurse practitioner role is pertinent toward improving evidence-based practice in clinical settings. Positive patient outcomes and praise for clinical leadership are evident in the literature. Research by nurse practitioners to date has focused on individual services.

A quantitative systematic review of the association between nurse skill mix and nursing-sensitive patient outcomes in the acute care setting.

AIMS: To examine the association between nurse skill mix (the proportion of total hours provided by Registered Nurses) and patient outcomes in acute care hospitals. DESIGN: A quantitative systematic review included studies published in English between January 2000 - September 2018. DATA SOURCES: Cochrane Library, CINAHL Plus with Full Text, MEDLINE, Scopus, Web of Science and Joanna Briggs Institute were searched. Observational and experimental study designs were included. Mix-methods designs were included if the quantitative component met the criteria. REVIEW METHODS: The Systematic Review guidelines of the Joanna Briggs Institute and its critical appraisal instrument were used. An inverse association was determined when seventy-five percent or more of studies with significant results found this association. RESULTS: Sixty-three articles were included. Twelve patient outcomes were inversely associated with nursing skill mix (i.e., higher nursing skill mix was significantly associated with improved patient outcomes). These were length of stay; ulcer, gastritis and upper gastrointestinal bleeds; acute myocardial infarction; restraint use; failure-to-rescue; pneumonia; sepsis; urinary tract infection; mortality/30-day mortality; pressure injury; infections and shock/cardiac arrest/heart failure. CONCLUSION: Nursing skill mix affected 12 patient outcomes. However, further investigation using experimental or longitudinal study designs are required to establish causal relationships. Consensus on the definition of skill mix is required to enable more robust evaluation of the impact of changes in skill mix on patient outcomes. IMPACT: Skill mix is perhaps more important than the number of nurses in reducing adverse patient outcomes such as mortality and failure to rescue, albeit the optimal staffing profile remains elusive in workforce planning.

Drawing blood from peripheral intravenous cannula compared with venepuncture: A systematic review and meta-analysis.

AIMS: To synthesize the evidence evaluating if blood samples are similar when obtained from peripheral intravenous cannula compared with venepuncture. DESIGN: A systematic review and meta-analysis was undertaken. DATA SOURCES: Searches were conducted in databases for English language studies between January 2000-December 2018. REVIEW METHODS: The search adhered to the Meta-analysis of Observational Studies in Epidemiology guidelines. The methodological quality of studies was assessed using Joanna Briggs critical appraisal instruments. The overall quality of the evidence was assessed using the GRADE. RESULTS: Sixteen studies were identified. Findings suggest haemolysis rates are higher in blood sampled from peripheral intravenous cannula. However, haemolysis rates may be lower if a peripheral intravenous cannula blood sampling protocol is followed. For equivalence of blood test results, even though some results were outside the laboratory, allowable error and were outside the Bland-Altman Level of Agreement, none of these values would have required clinical intervention. With regard to the contamination rates of blood cultures, the results were equivocal. CONCLUSION: Further research is required to inform the evidence for best practice recommendations, including, if a protocol for drawing blood from a peripheral cannula is of benefit for specific patient populations and in other settings. IMPACT: Venepuncture can provoke pain, anxiety and cause trauma to patients. Guidelines recommend blood samples from peripheral intravenous cannula be taken only on insertion. Anecdotal evidence suggests drawing blood from existing cannulas may be a common practice. Further research is required to resolve this issue.

An inductive qualitative approach to explore Nurse Practitioners views on leadership and research: An international perspective.

AIMS AND OBJECTIVES: To explore the ways in which Irish and Australian Nurse Practitioners (NPs) implement leadership and research in their roles and whether there is a difference in how leadership and research are demonstrated between NPs in Ireland and Australia. BACKGROUND: The original concept of the NP role was to expand nursing practice in order to provide high-quality, accessible health care to patients. This placed NPs at the crux of changes to healthcare delivery. Implementing these changes requires leadership. Research demonstrates the effects of these changes to healthcare delivery and contributes to healthcare knowledge from the nursing profession. DESIGN: In the qualitative phase of a mixed methods study, an interpretative descriptive approach was used to draw on participant experiences. METHODS: Thirty-eight respondents agreed to be interviewed following an online survey. Ten interviews were recorded and transcribed verbatim. Data were analysed using Braun and Clarke thematic analysis method. The research complied with the consolidated criteria for reporting qualitative research, COREQ. RESULTS: Ten participants, five NPs from Ireland and five from Australia were interviewed. Four themes emerged from the analysis: (a) Innovative leadership, which included the categories of leadership activities, the work of NPs and trailblazers; (b) Optimism, incorporating pride in achievements, the future outlook for the role and continued innovation of NPs over time; (c) Research, which included the NP research role, research challenges, support and research leadership; and (d) Resilience, which included overcoming resistance, isolation and seeking positive support systems. CONCLUSION: Nurse Practitioners are clinical leaders focused on improving healthcare delivery for patient populations. There is a lack of understanding of the NP role. Nurse Practitioners lack confidence to be independently research active. Research by NPs requires support from nurses in academia. There is no difference in the role in Ireland and Australia. RELEVANCE TO CLINICAL PRACTICE: Nurse Practitioners are engaged in healthcare transformation. Nurse Practitioners require support from research experts in academia to make a significant contribution to nursing knowledge in healthcare delivery.

Estimation of Body Fluid Status by Fluid Balance and Body Weight in Critically Ill Adult Patients: A Systematic Review.

BACKGROUND: The charting of daily fluid balances and measurement of body weight changes are two noninvasive methods commonly used in the intensive care unit for estimating body fluid status. The determination of body fluid status plays an important role in the management of critically ill patients where aggressive fluid resuscitation is often required. This can adversely affect patient outcomes if changes in fluid distribution are not detected early in patients who are susceptible to fluid overload. AIM: To synthesize the best available evidence on the accuracy of daily fluid balance charting compared with the measurement of body weight for the estimation of body fluid status in critically ill adult patients. METHODS: The review considered studies that investigated the accuracy of charting daily fluid balances or changes in body weight measurements or used both noninvasive methods in the estimation of body fluid status. The search sought to identify published, English language studies from 1980 until February 2018. Databases searched included MEDLINE, CINAHL, EMBASE, TRIP, Scopus, TROVE, ProQuest Dissertations, Australian and New Zealand Trials Registry, and Cochrane Central Register of Clinical Trials. Three reviewers independently assessed retrieved studies that matched inclusion criteria using standardized critical appraisal instruments. RESULTS: The review included 13 cohort studies. Effectiveness of daily fluid balance charting was affected by inaccuracies observed in seven studies. Inability to obtain consecutive daily body weight measurements reduced the accuracy of monitoring changes in five studies. Seven studies found measurement of daily fluid balance inconsistent with changes in body weight. LINKING EVIDENCE TO ACTION: The accuracy of charting fluid balance is suspect. Measurement of body weight is hard to accomplish. A combination of the two commonly used methods is more likely to be effective in estimating body fluid status than reliance on one single approach.

Development of an Australian nursing critical thinking tool using a Delphi process.

AIM: To develop a critical thinking assessment tool for Australian undergraduate nurses. BACKGROUND: Critical thinking is an important skill but difficult to assess in nursing practice. There are often many responses a nurse can make to a clinical problem or situation. Some responses are more correct than others and these decisions have an impact on a patient's care and safety. Differences in a response can relate to the depth of knowledge, experience and critical thinking ability of the individual nurse. DESIGN: This study used a Delphi process to develop five clinical case studies together with the most appropriate clinical responses to 25 clinical questions. METHOD: The Delphi technique was undertaken using the Qualtrics survey tool between October 2016-January 2017. A panel of 13 nursing experts from various geographical locations in Australia participated in the study to review the case scenarios and answers to questions posed. Four rounds of participation were required to achieve a minimum of 80% agreement between participants. Participants were asked to rank answers for 25 multi-choice questions based on the correct nursing management of case scenarios provided and provide feedback as to the accuracy and relevance of the scenarios and answers. RESULTS: Four rounds of Delphi questions were required to reach consensus on the correct wording and answers for the scenarios. Five case studies have been developed with nursing responses to patient management in rank order from most correct to least correct. CONCLUSION: Use of the tool should provide confidence that a nurse has met a certain level of critical thinking ability.

An integrative review of rural and remote nursing graduate programmes and experiences of nursing graduates.

AIMS AND OBJECTIVES: To examine international studies that specifically focus on transition to practice for graduate registered nurses in rural and remote areas. BACKGROUND: Supportive graduate nursing programmes are essential for enabling nursing graduates' transition to practice and reducing attrition rates. Literature examining support measures for nursing graduates within metropolitan areas is abundant. However, there is a paucity of evidence on effective graduate programmes for rural and remote-based nursing graduates. DESIGN: A systematic approach was used to identify robust research within appropriate electronic databases. METHOD: Eligible articles were critically reviewed using the Mixed Method Appraisal Tool critical appraisal tool. Eligible articles were thematically analysed using the Braun and Clark approach. RESULTS: Eight articles met the selection criteria for inclusion. Findings revealed that while most graduate nurses survived the transition process, they often felt overwhelmed and abandoned with intense feelings of frustration. Many suffered transition shock and did not feel ready for the role. Socialisation of graduates to the clinical environment was lacking. Support offered in many graduate programmes was ad hoc and unstructured. Senior staff were inadequately supported in their roles as preceptors to assist with the transition. Critical support measures recommended included both debrief sessions and regular one-on-one support. CONCLUSIONS: Graduate programmes need to be structured yet flexible to accommodate the needs of rural and remote nurse graduates. Graduates need to be transitioned into practice with decremental support processes for both workloads and education. Preceptors require education on how to mentor before they can provide the appropriate support for graduates. Without these measures in place, a decrease in transition shock may not be possible. RELEVANCE TO CLINICAL PRACTICE: Graduate programmes need to be structured yet flexible, including assistance with both clinical skills and socialisation. Senior staff require education before they can adequately support new graduates.

The role of the family in supporting the self-management of chronic conditions: A qualitative systematic review.

AIMS AND OBJECTIVES: To explore the contribution of family members in promoting and supporting the self-management of chronic conditions amongst adult family members. BACKGROUND: The prevalence of chronic disease continues to grow globally. The role of the family in chronic condition management and support for self-management has received little attention. DESIGN: A systematic review of qualitative literature using the Joanna Briggs Institute approach for qualitative systematic reviews. METHODS: Ovid (MEDLINE, CINAHL and PsycINFO) were searched for the period of database inception-2016. The QARI (Qualitative Assessment and Review Instrument) critical appraisal instrument was used to assess the quality of each study. Using the Joanna Briggs Institute-QARI data extraction tool, findings related to the family role in the self-management of chronic conditions were extracted and each finding rated according to Joanna Briggs Institute-QARI levels of credibility. Findings were categorised and synthesised to produce a final set of aggregated findings. RESULTS: Families were key in constructing an environment that was conducive to family engagement and support. Adaptation within the family included maintaining cohesion between family members, normalisation and contextualisation of the chronic condition. CONCLUSIONS: Whilst evidence on the value of the family in promoting positive health outcomes is clear, research on how families can specifically support the self-management of chronic conditions is emerging. RELEVANCE TO CLINICAL PRACTICE: Family adaptability has been found to be the most powerful predictor of carer depression. Families may need support to change their home and family organisation to adapt to the challenges they face overtime. Change in roles and subsequent adaptation can be stressful, even for those family members at a distance. Nurses working in hospital and community settings can play an important role in assessing how families are adapting to living with chronic illness and to explore strategies to cope with challenges in the home setting.

Intentional rounding in acute adult healthcare settings: A systematic mixed-method review.

AIMS AND OBJECTIVES: To determine the impact of intentional rounding on patient and nursing outcomes and identify the barriers and facilitators surrounding implementation. BACKGROUND: Intentional rounding is an organised approach whereby health professionals' regularly check on patients to ensure their fundamental care needs are met. Despite wide scale adoption of intentional rounding, there is limited evidence to inform practice. METHODS: This systematic mixed-method review was conducted using the Joanna Briggs Institute methodology. Databases CINAHL, MEDLINE, EMBASE, COCHRANE, SCOPUS and WEB of SCIENCE were searched to identify research studies published in English between January 2006-January 2017 that reported on intentional rounding and patient and nursing staff outcomes. Studies were assessed for methodological quality. The findings were synthesised into themes using a narrative approach. RESULTS: Twenty-one studies were included in the review. Six studies reported a reduction in the number of falls, and a further five studies reported a reduction in call bell use following the introduction of intentional rounding. Nurses' satisfaction and attitudes towards intentional rounding were reported in seven studies with equivocal results. The quality of the studies was weak making comparisons difficult. CONCLUSIONS: While results suggest positive outcomes for falls and call bell use, conclusions on the available data are overshadowed by the quality of the studies. Well-designed studies are required to advance evidence in this field. RELEVANCE TO CLINICAL PRACTICE: The evidence on intentional rounding is mixed and suggests that the introduction of intentional rounding should be accompanied by a protocol for robust evaluation to measure the impact of this process change. This should be accompanied by standardised reporting measures to enable comparisons and contribute to the quality of available evidence on intentional rounding.

A protocol for the development of a critical thinking assessment tool for nurses using a Delphi technique.

AIM: The aim of this study was to develop an assessment tool to measure the critical thinking ability of nurses. BACKGROUND: As an increasing number of complex patients are admitted to hospitals, the importance of nurses recognizing changes in health status and picking up on deterioration is more important. To detect early signs of complication requires critical thinking skills. Registered Nurses are expected to commence their clinical careers with the necessary critical thinking skills to ensure safe nursing practice. Currently, there is no published tool to assess critical thinking skills which is context specific to Australian nurses. DESIGN: A modified Delphi study will be used for the project. METHODS: This study will develop a series of unfolding case scenarios using national health data with multiple-choice questions to assess critical thinking. Face validity of the scenarios will be determined by an expert reference group of clinical and academic nurses. A Delphi study will determine the answers to scenario questions. Panel members will be expert clinicians and educators from two states in Australia. Rasch analysis of the questionnaire will assess validity and reliability of the tool. Funding for the study and Research Ethics Committee approval were obtained in March and November 2016, respectively. DISCUSSION: Patient outcomes and safety are directly linked to nurses' critical thinking skills. This study will develop an assessment tool to provide a standardized method of measuring nurses' critical thinking skills across Australia. This will provide healthcare providers with greater confidence in the critical thinking level of graduate Registered Nurses.