Nursing students' perspectives on being work-ready with electronic medical records: Intersections of rurality and health workforce capacity.

AIM: To explore nursing students' views on being prepared for using electronic medical records during clinical placement. BACKGROUND: The need for an undergraduate nursing curriculum to include electronic medical record training has been internationally recognised, however successful implementation has been inconsistent worldwide and limited in Australia. Many nursing students are unprepared to effectively provide care during clinical placement using electronic medical records and are therefore not work-ready as registered nurses. DESIGN: Online survey. METHODS: Third-year nursing students from two multi-campus universities were invited to complete the survey. RESULTS: Most students believed that learning electronic medical records during simulations would be extremely or very useful. Student confidence levels correlate with the amount and type of exposure to electronic medical records prior to clinical placement. Four themes emerged from qualitative analysis: Don't throw out the baby with the bathwater; Prepare us for practice; Mistakes - hardly any; and Universities need to catch up and put out. CONCLUSION: Students receiving hospital-based education on eMR and eObs can improve student confidence in preparation for clinical practice. First-year optional eMR university education had a limited impact on students' perception of preparedness for clinical practice. Shared responsibility between both the universities and health services on eMR education would provide improved student confidence and preparedness for clinical practice. This study supports the international research that eMR education needs to be scaffolded over the three years of study with increasing complexity of real-life scenarios.

Acupressure Intervention Program for Older Adults in Australian Residential Aged Care Facilities: A Qualitative Evaluation.

The current study explored participants' experiences and perceptions of receiving acupressure within an Australian aged care context. Participants were older adults living in three residential aged care facilities who had received an acupressure intervention. Data were collected using semi-structured interviews and analyzed using a thematic approach. Twelve participants (10 females and two males) were interviewed. Four major themes emerged: Having Better Sleep, Feeling Calm and Relaxed, Promoting Well-Being and Functional Status, and Acceptability of Acupressure. Participants' perception of the acupressure was positive, as participants found acupressure to be beneficial for the improvement of sleep, mood, and general well-being. Participants' overall perception supports the acceptability of acupressure and suggests acupressure may be beneficial for improving sleep, relaxation, and well-being in older adults. [Journal of Gerontological Nursing, 50(1), 30-36.].

Factors that Influence Women's Decision on the Mode of Birth After a Previous Caesarean Section: A Meta-ethnography.

Background: Caesarean section (CS) rates are continuing to rise worldwide. Elective repeat CS (ERCS) greatly contribute to the rising rate which increases unnecessary risks of maternal and neonatal morbidity and mortality. Vaginal birth after caesarean (VBAC) is a safe mode of birth for most women; however, uptake remains low. Our objective is to find the factors that influence women's decision-making to support informed choices for the mode of next birth after caesarean section (NBAC). Methods: A literature search was conducted in CINAHL, Maternity and Infant Care, Embase, EmCare, Cochrane Library and Medline databases. Primary, qualitative, peer reviewed, English language research articles were assessed according to inclusion/exclusion criteria. Articles were systematically assessed for inclusion or exclusion. Included studies were assessed using the Critical Appraisal Skills Programme qualitative studies checklist, Noblit and Hare's seven-step meta-ethnography approach synthesised themes. Results: Fourteen primary research articles were included. Six studies on 287 women focused on VBAC, and eight studies examined both VBAC and ERCS with 1861 women and 311 blogs. Thematic analysis yielded four primary themes: Influence of health professionals, impact of previous birth experience, optimal experience, and being in control. Conclusion: This meta-ethnography highlights health professionals' influence on women's decision making. To assist in decision-making, women need supportive health professionals who provide the current evidence-informed information about risks and benefits of each mode of birth. Health professionals need skills to provide supportive shared decision-making, debrief women regarding indications for their primary caesarean, and address issues of safety, fear, and expectations of childbirth.

Promoting patient safety using electronic medical records in nursing/midwifery undergraduate curricula: Discussion paper.

This discussion paper highlights the importance of Australian nursing and midwifery students' lack of exposure to electronic medical records during their undergraduate programs. There is pressure on universities offering nursing and midwifery programs to provide students with opportunities to learn to use patient electronic medical records. This will provide authentic rehearsal with the digital technology prior to clinical placements and increase graduate work readiness. Informed by contemporary literature, we describe the benefits of implementing electronic medical records (eMR) in health organisations and identify the challenges and barriers to implementing and integrating the education of electronic records into undergraduate nursing and midwifery programs. Undergraduate students who had not experienced eMR as part of on-campus learning felt unprepared and lacked confidence when commencing clinical practice. Some international nursing and midwifery programs have found that student's skills improve in decision-making and documenting patient observations when eMR is integrated into their university education program. Successful integration of an eMR program should consider academic/teaching staff skills and confidence in technology use, initial and ongoing costs and technical support required to deliver the program. In conclusion, Australian universities need to embed eMR learning experiences into the nursing and midwifery undergraduate curricula to increase students work-readiness with a focus on patient safety.

The Effect of Acupressure on Sleep Quality of Older People in Australian Residential Aged Care Facilities: A Pilot Randomized Controlled Trial.

This study investigated the effects of acupressure on sleep quality, anxiety, depression, and quality of life among older people in Australia. Acupressure improved overall subjective sleep quality and anxiety but no differences in depression and quality of life. Future studies with larger sample sizes are required to generate good evidence.

Midwifery continuity of care and vaginal birth after caesarean section: A randomised controlled trial.

PROBLEM AND BACKGROUND: Caesarean section (CS) rates in Australia and many countries worldwide are high and increasing, with elective repeat caesarean section a significant contributor. AIM: To determine whether midwifery continuity of care for women with a previous CS increases the proportion of women who plan to attempt a vaginal birth in their current pregnancy. METHODS: A randomised controlled design was undertaken. Women who met the inclusion criteria were randomised to one of two groups; the Community Midwifery Program (CMP) (continuity across the full spectrum - antenatal, intrapartum and postpartum) (n=110) and the Midwifery Antenatal Care (MAC) Program (antenatal continuity of care) (n=111) using a remote randomisation service. Analysis was undertaken on an intention to treat basis. The primary outcome measure was the rate of attempted vaginal birth after caesarean section and secondary outcomes included composite measures of maternal and neonatal wellbeing. FINDINGS: The model of care did not significantly impact planned vaginal birth at 36 weeks (CMP 66.7% vs MAC 57.3%) or success rate (CMP 27.8% vs MAC 32.7%). The rate of maternal and neonatal complications was similar between the groups. CONCLUSION: Model of care did not significantly impact the proportion of women attempting VBAC in this study. The similarity in the number of midwives seen antenatally and during labour and birth suggests that these models of care had more similarities than differences and that the model of continuity could be described as informational continuity. Future research should focus on the impact of relationship based continuity of care.

Midwives knowledge and education/training in complementary and alternative medicine (CAM): A national survey.

Despite the proliferation of research exploring complementary and alternative medicine (CAM) use in maternity care and midwifery practice, there is a gap on midwives' level of CAM knowledge and education/training. This national survey investigated Australian midwives' knowledge and education/training in CAM. A total of 571 midwives completed the survey (16%). Over half (54.3%) had some level of CAM education/training (self-learning to diploma) and with multiple CAM modalities. The top four modalities that midwives had received education/training were acupressure (66.5%), aromatherapy (60.3%), massage (45.5%), and reflexology (37.7%). There was a significant correlation between midwives attending a CAM workshop with competency-assessment (p < 0.000) and confidence to discuss CAM options with pregnant women compared with participants who have not. There are no other health-related therapies used by women consumers with such frequency where clinicians are not expected to have baseline knowledge and understanding. Midwifery education programs need to include evidence-based information on CAM modalities.

Introduction of patient electronic medical records (EMR) into undergraduate nursing education: An integrated literature review.

BACKGROUND: To prepare student nurses for clinical practice where patient electronic medical records (EMR) competence is required, nursing undergraduate curricula must provide simulation access to developing this skill set. At this stage, however, the integration of electronic documentation into the Australian undergraduate nursing curriculum has been piecemeal. Aim The aim of this integrated literature review was to identify benefits and challenges for faculty nursing staff and nursing students in relation to the integration, use and evaluation of EMR in an undergraduate nursing program. METHODS: A systematic search of relevant peer-reviewed research and project report articles was conducted in the electronic databases. Generic qualitative thematic analysis was then undertaken with themes generated from the data itself. RESULTS: Fifty eight articles were identified, of these 23 were found to meet the inclusion criteria. Three major themes were identified: 1) Advantages of using EMR in academic settings, 2) Identified Challenges and Limitations of EMR programs; and 3) Developing an academic EMR program and implementing EMR education program in stages. All papers acknowledged that EMR will be standard in healthcare and should be viewed as an 'essential tool' for inclusion in undergraduate nursing programs. CONCLUSION AND IMPLICATIONS FOR PRACTICE: There is a significant increase of electronic technology in healthcare settings, especially relating to patient documentation. Therefore, teaching the use of EMR in the simulated clinical learning environment for new healthcare providers such as nursing students is essential. The papers reviewed identified an urgent need for higher education nursing programs to support undergraduate nursing students and faculty staff to ensure EMR can be implemented effectively into the undergraduate nursing curriculum.

Older people's perspectives on use of complementary and alternative medicine and acupressure: A qualitative study.

OBJECTIVE: This study explored older people's knowledge, experience and perception of complementary and alternative medicine (CAM) and acupressure, and their willingness to accept acupressure. METHOD: This qualitative descriptive study, using semi-structured interviews, was conducted at two residential aged care facilities. Thematic analysis was used to analyse the data. RESULTS: Fifteen older people participated. Participants had limited knowledge about CAM and acupressure. Many of them had positive views on CAM, and were willing to accept acupressure. There were five major themes: knowledge and understanding about CAM, experience of using CAM, general views on use of CAM, reasons for not using CAM, and willingness to accept acupressure. CONCLUSION: The findings show the diverse views on CAM and acupressure from the perspectives of the older people in this study. There is a need for further research investigating the usefulness of CAM and acupressure in aged care settings.

Acupressure to improve sleep quality of older people in residential aged care: a randomised controlled trial protocol.

BACKGROUND: Sleep disturbance in older people is an important health issue that is associated with many other health problems. Effective interventions are required to address sleep problems in this group. Acupressure has been suggested as a potential therapeutic technique to improve sleep. The aim of this study is to evaluate the effects of an acupressure intervention on sleep quality, anxiety, depression, and quality of life among older persons in residential aged care facilities within an Australian context. METHODS/DESIGN: This is a randomised controlled trial with two parallel groups in a pre- and post-test study. Study participants will be older people living in residential aged care facilities. They will be assigned to intervention and control groups using computer-generated random numbers. The intervention group will receive 12-min acupressure three times per week for four consecutive weeks, applied on three acupoints: HT7, PC6, and SP6. The control group will receive only routine care. The primary outcome measure is sleep quality, and secondary outcomes include anxiety, depression, and quality of life. Data will be collected before the intervention, immediately after the end of the intervention, and 2 weeks after the intervention. DISCUSSION: This study targets a poorly met healthcare need of older people who are experiencing sleep disturbance and its negative consequences. To the researchers' knowledge, this is the first study evaluating acupressure in an Australian aged care context, using specific acupoints and a standardised acupressure protocol. If the results show positive outcomes, acupressure could be used to manage sleep disturbances for older people in the Australian context as well as in the global ageing population. This will contribute to reducing negative consequences of sleep disturbance and use of sleep medications. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12619000262101. Registered on 20 February 2019.

Nurses and midwives teaching in the academic environment: An appreciative inquiry.

BACKGROUND: The past two decades has seen significant change in nursing and midwifery education in Australia. Although, regulatory documents explicate expectations of teaching, and supervising in the context of being a nurse or midwife, the move from hospital-based to higher education learning nessitated a change in how students receive their education and who provides it. The quality of teaching by nurse or midwife academics is subject to the academic's ability to transition from a clinical educator to academic. OBJECTIVE: To explore the experiences of nurse and midwife academics teaching in the academic environment. DESIGN: Appreciative Inquiry (AI) was used to explore the experiences of academics teaching final year nursing and midwifery students. SETTING: Two regional universities in Australia. PARTICIPANTS: Seven nursing and midwifery academics teaching a unit of study focusing on mentorship, leadership and teaching. METHODS: Narrative data from interviews conducted using AI were collected, transcribed and analysed to produce themes. RESULTS: Three key themes were identified; 'Feeling valued', 'Feeling safe' and 'Having connections'. These themes and related subthemes impacted teaching experiences and role transition from experienced clinician to academic. CONCLUSION: Nursing and midwifery academics would benefit from organisational support in their role transition from clinician to academic. Further research is crucial regarding initiatives that can support academics to feel safe, valued and connected when teaching the next generation of nurses and midwives.

Midwives' personal views and beliefs about complementary and alternative medicine (CAM): A national survey.

Complementary and Alternative Medicine/Therapies (CAM) options have increasingly been used by pregnant women, however literature describing midwives' views and beliefs towards CAM is sparse. This study aimed to investigate Australian midwives' views and beliefs about CAM. METHODS: A national survey of Australian College of Midwives midwife members (n = 3552) (UTSHREC 2015000614) included questions on midwives' views and support of CAM, and beliefs using a validated CAM Health Belief Questionnaire (CHBQ). RESULTS: The response rate was 16%. Most respondents believed women should have the right to choose CAM (93.3%); and didn't view CAM a threat to public health (91.7%). Nearly half (49.5%) believed that their hospital/service did not have guidelines/procedures on CAM. The CHBQ mean score was 45.43 (SD9.98). CONCLUSION: Most respondents agreed with the fundamental beliefs of CAM. This study confirms the need for a national CAM policy for midwives; and research on midwives' CAM training.

An integrative review of acupressure interventions for older people: A focus on sleep quality, depression, anxiety, and agitation.

OBJECTIVES: This integrative review aimed to synthesize studies that investigated the effects of acupressure on sleep quality, depression, anxiety, and agitation in older people, and to describe the acupressure procedures and techniques applied in the included studies. METHODS: A literature search was conducted using electronic databases including CINAHL, Cochrane Library, EMBASE, and MEDLINE. The inclusion criteria for the review were studies examining the effect of acupressure in older people aged 60 years and above, measured the outcomes for sleep quality, depression, anxiety or agitation, applied body acupressure, and published in English language. The exclusion criteria were studies using auricular acupoints only, and articles published in any language other than English. Methodological quality of studies was assessed using the critical appraised tools developed by the Joanna Briggs Institute. The information about study design, findings, and description of acupressure intervention were extracted, summarized, and synthesized. RESULTS: A total of 255 articles were identified from the search and as well one article from cross-references. From there, a total of 19 studies were included in this review. Nine studies consistently showed positive effects of acupressure on sleep quality, and four studies consistently showed that acupressure reduced depression. The outcomes of acupressure on anxiety and agitation showed inconsistent findings, in which three studies measured anxiety and five studies measured agitation. There was also variation of acupressure techniques applied in the reviewed studies. CONCLUSION: This review found some emerging evidences that acupressure can be beneficial for older people who suffer from sleep problems and depression. Use of specific acupressure points, with standardized acupressure treatment protocols, may improve sleep quality and possibly psychological wellbeing of older people. Future research with well-designed mixed method studies are required to produce stronger evidence, as well as in-depth understanding of acupressure intervention in aged care context.

Midwives' personal use of complementary and alternative medicine (CAM) influences their recommendations to women experiencing a post-date pregnancy.

Complementary and Alternative Medicine (CAM) have increasingly been used by pregnant women with a steady rise in interest by midwives. Literature describing CAM and self-help options midwives recommend to women experiencing a post-date pregnancy is sparse. This study aimed to investigate if Australian midwives' personal CAM use impacts on discussions and recommendations of CAM/Self-help strategies. METHODOLOGY/DESIGN: A survey of a national midwifery association midwifery members (n=3,552) was undertaken at a midwifery conference (October 2015) and via e-bulletins (November 2015-March 2016). The self-administered survey included questions on what self-help and CAM strategies midwives discuss and recommend to women with a post-date pregnancy, midwives' confidence levels on discussing or recommending CAM, midwives' own personal use of CAM. FINDINGS: A total of 571 registered midwives completed the survey (16%). Demographics (age, years as a midwife, state of residence) reflected Australian midwives and the midwifery association membership. Most respondents discuss (91.2%) and recommend (88.6%) self-help/CAM strategies to women with a post-date pregnancy. The top five CAM recommended were Acupuncture (65.7%), Acupressure (58.1%), Raspberry Leaf (52.5%), Massage (38.9%) and Hypnosis/Calmbirthing/Hypnobirthing (35.7%). Midwives were more likely to discuss strategies if they personally used CAM (p<.001), were younger (p<.001) or had worked less years as midwives (p=.004). Midwives were more likely to recommend strategies if they used CAM in their own pregnancies (p=.001). CONCLUSION: Midwives' personal use of CAM influenced their discussions and recommendations of CAM/self-help strategies to women experiencing a post-date pregnancy. This study has implications for inclusion of CAM in midwifery education curricula.

Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians.

PROBLEM: One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section. BACKGROUND: Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section (CS) if their health care providers lack skills and confidence in supporting vaginal birth after caesarean section (VBAC). AIM: To explore the views and experiences of providers in caring for women considering VBAC, in particular the decision-making processes and the communication of risk and safety to women. METHODS: A descriptive interpretive method was utilised. Four focus groups with doctors and midwives were conducted. FINDINGS: The central themes were: 'developing trust', 'navigating the system' and 'optimising support'. The impact of past professional experiences; the critical importance of continuity of carer and positive relationships; the ability to weigh up risks versus benefits; and the language used were all important elements. The role of policy and guidelines on providing standardised care for women who had a previous CS was also highlighted. CONCLUSION: Midwives and doctors in this study were positively oriented towards assisting and supporting women to attempt a VBAC. Care providers considered that women who have experienced a prior CS need access to midwifery continuity of care with a focus on support, information-sharing and effective communication.

Pregnant women and health professional's perceptions of complementary alternative medicine, and participation in a randomised controlled trial of acupressure for labour onset.

UNLABELLED: Feasibility randomised controlled trials of complementary medicine are important to evaluate acceptability and practicality. This study examined participants' and health professionals' perceptions of CAM and participation in a feasibility RCT of acupressure for labour onset. METHODS: A qualitative study incorporated within an RCT. Data were collected from postnatal women via questionnaires and health professionals via focus groups. RESULTS: Four themes emerged from the women's views: "Using CAM to start labour", "Feeling empowered through action", "Desiring randomisation to acupressure group", and "Welcoming the opportunity to assist in research". Five themes emerged from the health professionals' views: "Personal awareness and attitudes towards CAM"; "Supporting and empowering women"; "Complements the wellness model of pregnancy and childbirth"; "Need for evidenced based practice"; and "Randomisation 'doing it on the sly'". CONCLUSIONS: Themes from the groups were similar. The study protocol will be refined with a placebo group to improve equipoise with a powered RCT planned.

A feasibility randomised controlled trial of acupressure to assist spontaneous labour for primigravid women experiencing a post-date pregnancy.

OBJECTIVE: this Australian feasibility study aimed to determine; the willingness of women experiencing a post-date pregnancy to participate in a randomised controlled trial (RCT) of acupressure and compliance with the study protocol. The study also aimed to determine the effect size of the primary outcome in order to calculate a sample size for a future appropriately powered RCT. DESIGN: a two-arm randomised controlled trial. Staff providing clinical care were blinded to group allocation unless the participant disclosed study participation. SETTING: maternity services at two outer metropolitan public hospitals in New South Wales, Australia PARTICIPANTS: sixty seven healthy primigravid women experiencing a singleton cephalic pregnancy at 40 weeks±2 days gestation were assessed as eligible to participate and were provided with study information. INTERVENTION: both groups received standard clinical care, with the intervention group also receiving verbal and written instructions on the self-administration of three acupoints (Spleen 6, Large Intestine 4, and Gall Bladder 21) to be used until spontaneous or induced labour began. MEASUREMENTS: assessment of feasibility included determining recruitment rate and acceptability of an RCT for a CAM modality, and acupressure treatment compliance, via participant surveys. The primary clinical outcome was spontaneous onset of labour. FINDINGS: from the 67 women eligible during the timeframe for the study, 44 women (65.6%) agreed to participate and were randomised. There was no statistically significant difference in rate of spontaneous onset of labour (50% acupressure vs 41% control). Twenty nine participant surveys were returned (65.9%). In the intervention group there was a high compliance with the acupressure protocol (83%) and the use of the three acupoints (94%). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this feasibility study revealed that pregnant women are interested in the use of CAM, and acupressure in particular, for the initiation of labour. Most women found it acceptable to be randomised to receive the intervention. While the 9% difference in the primary outcome was not statistically significant it is the best estimate of the treatment effect for calculating a sample size of 994 for a future RCT with 80% power, alpha 0.05. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ANZCTR:12613000145707.

Impact of acupressure on onset of labour and labour duration: A systematic review.

BACKGROUND: There is worldwide concern with increasing rates of pharmacologically induced labour and operative birth. Many women would like to avoid medical or surgical interventions in childbirth; a desire that may contribute towards the popularity of complementary and alternative medicine/therapies. METHOD: This systematic review examines the effects of acupressure on labour onset and duration of labour. We searched MEDLINE, CINAHL, AMED, Cochrane Collaboration, and Science Direct from 1999 to 2013 for published randomised controlled trials and controlled trials comparing acupressure with placebo and no treatment. Studies recruited primiparous and/or multiparous women with either spontaneous or induced onset of labour. The outcome measures were labour onset and duration of all stages of labour. FINDINGS: Seven trials with data reporting on 748 women using different acupressure points and methods of administration were included in the review. One study examined the initiation of labour and six studies examined labour duration and/or pain levels. The two most studied acupoints were Sanyinjiao/Spleen 6 and Hegu/Large Intestine 4. Results suggest acupressure may reduce the length of labour particularly in the first stage. CONCLUSION: Further research is required on whether acupressure can shorten labour duration, augment prolonged labour or initiate onset of labour by stimulating uterine contractions. Clinical trials should report the basis for acupressure treatment described in the STRICTA (minus needling) and CONSORT non-pharmaceutical guidelines.

Factors that may influence midwives work-related stress and burnout.

RESEARCH QUESTION: To determine the incidence and level of work-related stress and burnout in midwives and contributing and protective demographic factors that may influence those levels. PARTICIPANTS AND METHOD: All registered midwives (152) working in two public hospital maternity units within the same health service district in NSW completed the Maslach Burnout Inventory Human Services Survey and a demographic survey including care model, shift work, lifestyle data and exercise level. FINDINGS: There was a response rate of 36.8% with 56 (56/152) midwives completing the surveys. Almost two thirds (60.7%) of midwives in this sample experienced moderate to high levels of emotional exhaustion, a third (30.3%) scoring low personal accomplishment and a third (30.3%) experiencing depersonalization related to burnout. Significant differences were found among groups of midwives according to years in the profession, shifts worked, how many women with multiple psychosocial issues were included in the midwife's workload and the midwife's uptake of physical exercise. Those midwives who had spent longer in the profession and exercised scored low burnout levels. CONCLUSION: The impact of years in the profession, shifts worked, how many women with multiple psychosocial issues were included in their workload and the midwife's level of exercise significantly affected how these midwives dealt with burnout and provided care for women. As the response rate was low, and the study cannot be generalised to the entire midwifery workforce but provides important insights for further research. Understanding factors related to burnout can benefit health care institutions financially and in terms of human costs, especially in view of consistent international shortages of midwives.