Achieving consensus on the essential knowledge and skills needed by nursing students to promote planetary health and sustainable healthcare: A Delphi study.

AIM: To achieve consensus on the knowledge and skills that undergraduate/pre-licensure nursing students require to steward healthcare towards a more sustainable future. DESIGN: A two-phase real-time Delphi study. METHODS: Phase 1 included the generation of Planetary Health, climate change and sustainability knowledge and skill statements based on a review of relevant literature. Phase 2 consisted of a real-time Delphi survey designed to seek consensus on the proposed statements from a panel of 42 international experts. RESULTS: Of the 49 survey statements, 44 (90%) achieved ≥75% consensus and 26 (53%) achieved ≥80% consensus. Three were removed and 32 were modified to improve clarity of language. CONCLUSION: The knowledge and skills statements that emerged through this Delphi study can serve as a guide for incorporating Planetary Health, climate change and sustainability into nursing education programs. IMPLICATIONS FOR THE PROFESSION: Incorporating Planetary Health and climate change education into nursing programs has the potential to produce more environmentally conscious and socially responsible nurses. IMPACT: The absence of consensus on the essential knowledge and skills expected of nursing students has hindered the advancement of curricula and impacted educators' confidence in teaching Planetary Health and climate change. This study has resulted in a meticulously crafted framework of knowledge and skill statements that will be beneficial to educators, the future nursing workforce, and, ultimately, the individuals and communities whom nurses serve. REPORTING METHOD: This paper adheres to the Conducting and REporting DElphi Studies (CREDES) reporting guideline. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Nursing/midwifery students' perceptions of caring pedagogy and online learning during the COVID-19 pandemic.

AIM: This study aimed to gain a better understanding of nursing/midwifery students' perspectives on a pedagogy of caring and online learning during the COVID-19 pandemic. In addition, it aimed to determine if the COVID-19 pandemic impacted students' perceptions and experience of online learning and students' desire to enter the nursing/midwifery workforce. DESIGN: Mixed methods. METHODS: A multi-centre cross-sectional survey of Australian nursing and midwifery students was undertaken to explore students' experience of learning during the COVID-19 pandemic. RESULTS: There are several key findings from this study that may be relevant for the future delivery of undergraduate health education, students transitioning to practice and healthcare workforce retention. The study found that although students were somewhat satisfied with online learning during COVID-19, students reported significant issues with knowledge/skill acquisition and barriers to the learning process. The students reported feeling less prepared for practice and identified how clinical staff were unable to provide additional guidance and support due to increased workloads and stress. The textual responses of participants highlighted that connection/disconnection, empathy and engagement/disengagement had an impact on learning during COVID-19. CONCLUSION: Connection, engagement and isolation were key factors that impacted nursing students' online learning experiences. In addition, graduates entering the workforce felt less prepared for entry into practice due to changes in education delivery during COVID-19 that they perceived impacted their level of clinical skills, confidence and ability to practice as new graduate nurses/midwives. PATIENT OR PUBLIC CONTRIBUTION: Not applicable. IMPACT: Attention must be given to the transition of new graduate nurses and midwives whose education was impacted by pandemic restrictions, to support their professional career development and to ensure retention of future healthcare workforce. Connection, engagement and isolation were key factors that impacted nursing students' online learning experiences. Educators should consider how connection and engagement can be actively embedded in the online learning environment.

Australian nurses' and midwives' perceptions of their workplace environment during the COVID-19 pandemic.

Background: Working as a front-line worker during a pandemic is a unique situation that requires a supportive work environment. An informed understanding of nurses' and midwives' workplace experiences during a pandemic, such as COVID-19, may enable better preparation and targeted support for future pandemics at an individual, organisational, and policy level. Aim: The aim of this study was to explore nurses' and midwives' workplace experiences during the COVID-19 pandemic response. Methods: A cross-sectional online survey consisting of open-ended questions was conducted with a convenience sample of nurses and midwives (n = 1003) working in New South Wales Health hospital settings, in Australia. Open-ended questions were analysed using content analysis. Results: Five themes were identified; 'organisational communication', 'workplace support', 'availability of personal protective equipment', 'flexible working', and 'new ways of working'. Nurses' and midwives' workplace experiences during COVID-19 were influenced by leaders who were perceived to be adaptive, authentic, responsive, transparent, and visible. While many expressed a number of workplace challenges, including access to personal protective equipment, there was opportunity to explore, develop, and evaluate new and alternate models of care and working arrangements. Conclusion: It is important that nurses and midwives are supported and well prepared to cope during pandemics in the workplace. Organisational leadership and timely dissemination of transparent pandemic plans may support nurses' adaptive workplace experiences.

The practice of rural and remote nurses in Australia: A case study.

AIM AND OBJECTIVE: To delineate contemporary practice of registered nurses working in rural and remote areas of Australia. BACKGROUND: Despite the implementation of strategies to address challenges reported by rural and remote nurses, concern remains over safety and quality of care, the well-being of nurses and retention of the nursing workforce. Twenty years on, geographically dispersed nurses still experience scarce human and material resources. DESIGN: A multiple case study design was implemented. METHODS: Nurses were recruited from 240 sites. The study comprised three phases of data collection. First, a content analysis of 42 documents relating to the context of nursing, specifically rural and remote nursing; second, a content analysis of an online questionnaire (n = 75); and third, a thematic analysis of semi-structured interviews (n = 20). COREQ reporting guidelines were used. RESULTS: Each phase of data collection informed subsequent data collection and analysis within the study. Following triangulation of data from each phase of the study, the major themes reported are "a medley of preparation for rural and remote work"; "being held accountable"; "alone, with or without someone"; and "spiralling well-being." CONCLUSIONS: Regardless of strategies, challenges of nursing in rural and remote areas persist. Issues of isolation, stress, burnout and a lack of organisational commitment to employees affect the retention of rural and remote nurses. While useful, professional development courses and graduate certificates are yet to make an impact on reducing these issues. RELEVANCE TO CLINICAL PRACTICE: Registered nurses argue for more experience rather than more education to facilitate transition into this nursing area. The finding that experience is perceived as more valuable than education suggests the need for innovative ways to gain experience to practice in rural and remote nursing. Lack of organisational commitment requires attention to promote the well-being of nurses and patient safety.

Exploring clinical facilitation and student learning on undergraduate nursing placements through a community of practice lens: A qualitative study.

Background: High-quality clinical placement experiences are important for preparing undergraduate student nurses for practice. Clinical facilitation and support significantly impact student placement experiences and their development of skills, knowledge, and attitudes in the healthcare setting.Aim: This research aimed to explore university-employed clinical facilitators' perspectives on providing quality clinical facilitation and student learning on placement.Design: An exploratory, descriptive research design was used to examine the perspectives of n = 10 university-employed clinical facilitators working in regional New South Wales, Australia (March 2020-December 2021).Methods: Semi-structured interviews were used to explore the experiences of a purposeful sample of university-employed clinical facilitators. Data was thematically analysed using Miles et al.'s (2014) qualitative data analysis framework.Results: Five key themes were identified 1) relationships at the core of quality, 2) a culture of commitment to student learning, 3) connection to the curriculum, 4) examining the model, and 5) empowering growth and development. Clinical facilitators perceive their role as misunderstood, undervalued, and isolating and that they require further preparation and ongoing professional development to provide quality facilitation. Building rapport and relationships with staff and students was at the core of quality clinical facilitation.Conclusions: The clinical facilitator role has an important function in preparing student nurses for practice and needs further recognition and continued professional development. Education providers and healthcare organisations need to examine strategies to provide inclusive and supportive work environments, building communities of practice for clinical facilitators and stakeholders to share their experiences and knowledge, promoting individual and group learning, thus improving the student placement experience and fostering the professional identity of clinical facilitators.

Final year nursing students' preparedness for medication administration during COVID-19: A multi-site survey study.

AIM: To examine final-year undergraduate nursing students' characteristics and their perceived preparedness for medication administration across three universities during COVID-19. BACKGROUND: Medication administration is a complex process and medication errors can cause harm to the patient. Nurses are at the frontline of medication administration; therefore, nursing students must be well-prepared to administer medicines safely before graduation. Little is known about final-year undergraduate nursing students' perceived medication administration preparedness during COVID-19. DESIGN: A multi-site study using a cross-sectional survey of student demographics, the 'Preparedness for Medication Administration' (Revised) tool and an open-ended question. METHODS: The questionnaire was distributed to nursing students in their final semester of the program in 2022 across two universities in Australia and one in New Zealand. Completed surveys n=214. Descriptive statistics were used to analyse the demographic data. Differences in demographic data and preparedness scores between the three universities were analysed using ranked means, correlation coefficient, Chi-Square, Mann- Whitney U and Kruskal- Wallace H. Directed content analysis was used to analyse the data from the open-ended question. RESULTS: Overall, students reported high preparedness scores for medication. International students reported significantly higher preparedness scores (Md =119, n=29) compared with domestic students (Md=112.00, n=164), U=1759.50, z=-2.231, p=02, r=.16. Mean ranked scores for each item were above average across the three universities. The impact of COVID-19 on curriculum and students' opportunity to practice may be one explanation for the difference in preparedness scores between universities. International participants reported significantly higher scores on the Preparedness for Medication Administration (Revised) tool than domestic participants. Older students were more confident in applying principles of pharmacology to practice. Students' comments generated three major categories and five subcategories indicating preparedness gaps. CONCLUSION: This study provides insights into students' medication management preparedness during restrictions and before transitioning to the role of Registered Nurse. It highlights the need to provide integrated and comprehensive medication education and assessments throughout the curriculum and the need for additional support for newly graduated nurses in medication management due to the restrictions.

The impact of COVID-19 pandemic-related stress experienced by Australian nurses.

Globally, the impact of COVID-19 on healthcare workers' mental health has been a major focus of recent research. However, Australian research involving nurses, particularly across the acute care sector, is limited. This cross-sectional research aimed to explore the impact of pandemic-related stress on psychological adjustment outcomes and potential protective factors for nurses (n = 767) working in the Australian acute care sector during the COVID-19 pandemic. Nurses completed an online questionnaire with psychometrically validated measures of pandemic-related stress, psychological adjustment outcomes (depression, anxiety, and subjective well-being), and protective factors (posttraumatic growth and self-compassion). Descriptive analyses revealed that pandemic-related stress was reported by 17.7% of the participants. Psychological adjustment outcome scores above normal for depression (27.5%) and anxiety (22.0%) were found, and 36.4% of the participants reported poor subjective well-being. Regression analyses suggest that pandemic-related stress predicted greater depression (B = 0.32, SE = 0.02, 95% confidence interval [0.28, 0.35]) and anxiety (B = 0.26, SE = 0.01, 95% confidence interval [0.24, 0.29]) and less subjective well-being (B = -0.14, SE = 0.01, 95% confidence interval [-0.16, -0.12]). Self-compassion weakened the relationship between pandemic-related stress and greater depression, however, exacerbated the relationship between pandemic-related stress and less subjective well-being. Posttraumatic growth reduced the negative relationship between pandemic-related stress and psychological adjustment outcomes. These findings will inform strategies to facilitate psychological resources that support nurses' psychological adjustment, enabling better pandemic preparedness at both an individual and organizational level.

Skin assessment of patients at risk of pressure ulcers.

The incidence of pressure ulcers in the community and in acute settings is a concern for patients and healthcare professionals. The high cost to healthcare services of treating individuals with pressure ulcers means prevention is much cheaper than cure. Nurses have a responsibility to implement and participate in prevention programmes to decrease the incidence of pressure ulcers. Assessment is the first stage in prevention. This article focuses on the assessment of pressure areas, providing the reader with the knowledge of where and when skin assessment should take place and what needs to be assessed.

Fractures: pathophysiology, treatment and nursing care.

Many nurses working in the primary and secondary sectors will care for patients who have sustained fractures. The ability to assess these patients systemically in addition to the injury is important in detecting complications and enhancing bone healing at the various stages of injury or treatment. This article describes different types of fracture and principles for their management. The nursing care of patients who has sustained a fracture is discussed from admission to discharge.

Nursing management of patients who are nil by mouth.

This article examines how to manage patients who are nil by mouth (NBM) and maintain optimal nutritional status. Pre-operative fasting and other reasons why patients might be NBM, methods of administering nutritional support and nursing considerations, such as mouth care, urine output, intravenous therapy and skin assessment are also discussed. The article provides an insight into the psychological effects on patients who are NBM and emphasises the importance of patient education.