The impact of pregnancy on women with adolescent idiopathic scoliosis: a scoping review.

INTRODUCTION: Adolescent idiopathic scoliosis is the most common spinal deformity encountered in adolescents and larger curves are more prevalent in girls. For females with scoliosis, women's health issues are of particular concern, especially pregnancy. The aim of this review was to summarise the best available evidence to determine the influence of pregnancy on scoliosis-related outcomes in women with scoliosis and whether scoliosis affects maternal-health outcomes, differentiating between patients who have been managed conservatively and/or surgically. EVIDENCE ACQUISITION: A search was conducted using CINAHL, Scopus, Cochrane Database, MEDLINE, and EMBASE from inception to May 2023 to identify relevant articles in any language. The scoping review followed the PRISMA-ScR guidelines. Studies were eligible if they included pregnant women (primiparous or multiparous) with a diagnosis of scoliosis of unknown aetiology. The results were summarized by outcomes, including pregnancy and scoliosis-related outcomes and type of management. EVIDENCE SYNTHESIS: Our comprehensive search strategy identified 6872 articles, of which 50 articles were eligible for this review. Back pain appears to be more prevalent in this population during pregnancy and associated with the major curve and the decrease of lumbar lordosis. There have been reports of failed attempted spinal anaesthesia among patients with instrumented scoliosis correction and minor complications related to epidural anaesthesia at a higher rate compared to non-instrumented patients and healthy controls, however successful spinal analgesia can be achieved in patients with instrumented scoliosis correction. Overall, the caesarean section rate was similar in scoliosis patients compared to controls without scoliosis and to national averages. Curve progression occurs in some but not all patients during pregnancy, and this phenomenon occurs irrespective of the treatment received. CONCLUSIONS: Higher-quality prospective longitudinal research is needed to understand the relationship between pregnancy and adolescent idiopathic scoliosis. Further, the patient's perspective, concerns and fears surrounding pregnancy with scoliosis are yet to be explored. Exploring the impact of pregnancy on women with adolescent idiopathic scoliosis would have clinically relevant outcomes and could help provide pertinent answers to patients and healthcare workers and help guide future research.

Left behind: Exploring the concerns of emergency department staff when personnel are utilised for inter-hospital transfer.

BACKGROUND: Inter-Hospital Transfer (IHT) may require an escort from the referring hospital, either a Registered Nurse (RN), physician or both, leading to a sudden drop in staffing levels within the referring department potentially increasing risk to patients and staff. AIMS: To explore the perspectives of RNs and physicians of differing experience levels when left behind due to an escorted IHT, and the decision-making protocols for IHT. METHOD: A qualitative exploratory approach of 5 RNs and 4 physicians selected using purposeful sampling. Data were collected through semi-structured interviews and thematically analysed. FINDINGS: Five themes were identified: the impact of being left behind; the burden of transfer; missed care; a triangulation of competing needs upon the decision-making process; and the effect of inter-hospital transfers on staff with different experience levels. CONCLUSION: IHT is described differently by less experienced RNs compared to their more experienced counterparts especially concerning safety and risk. Physicians described the department as vulnerable with ad-hoc decision-making protocols surrounding IHT the norm.

Exploring Nursing Staff's Experiences and Perspectives of COVID-19 Lockdown in a Residential Aged Care Setting in Australia.

An exploratory qualitative study was performed to evaluate the experiences of nursing staff (N = 10) working in a residential aged care facility (RACF) during the coronavirus disease 2019 (COVID-19) pandemic lockdown. Semi-structured, in-person interviews were performed, and thematic analysis was used to analyze the data. Care staff had little or no knowledge of how to cope with a lockdown necessitated by a pandemic. However, management developed proactive plans as they aligned with the changing care circumstances and ongoing government directives. Five major themes were identified: Prolonged Use and Shortage of Personal Protective Equipment; "Blind Leading the Blind"; Communication and Teamwork; Lack of Education; and Resident Response. RACF staff described working under stressful conditions during the initial COVID-19 pandemic lockdown; yet with experience, care staff and the management team adapted to pandemic requirements to meet the needs of residents in their care. RACFs should be prepared for the impact of pandemics on staff and ensure care resources and support are available for the continuity of safe and quality care of residents. [Journal of Gerontological Nursing, 49(3), 34-39.].

Coping with COVID-19. Work life experiences of nursing, midwifery and paramedic academics: An international interview study.

BACKGROUND: The COVID-19 global pandemic was declared in March 2020. By June 2022, the total deaths worldwide attributed to COVID-19 numbered over 6.3 million. Health professionals have been significantly impacted worldwide primarily those working on the frontline but also those working in other areas including nursing, midwifery, and paramedic higher education. Studies of occupational stress have focused on the clinical health professional roles but scant attention has been drawn to the pressures on university-based academic staff supporting and preparing professionals for frontline health work. DESIGN AND OBJECTIVES: This qualitative study sought to explore the challenges experienced by health academics (nurses, midwives and paramedics), during COVID-19 and identify strategies enlisted. SETTING AND PARTICIPANTS: Six Australian and two United Kingdom universities collaborated, from which 34 health academics were individually interviewed via video or teleconference, using six broad questions. Ethical approval was obtained from the lead site and each participating University. DATA ANALYSIS: Thematic analysis of the data was employed collaboratively across institutions, using Braun and Clarke's method. RESULTS: Data analysis generated four major themes describing academics': Experiences of change; perceptions of organisational responses; professional and personal impacts; and strategies to support wellbeing. Stress, anxiety and uncertainty of working from home and teaching in a different way were reported. Strategies included setting workday routine, establishing physical boundaries for home-working and regular online contact with colleagues. CONCLUSIONS: The ability of nursing, midwifery and, paramedic academic staff to adapt to a sudden increase in workload, change in teaching practices and technology, while being removed from their work environment, and collegial, academic and technological supports is highlighted. It was recognised that these changes will continue post-COVID and that the way academics deliver education is forever altered.

Nursing in a different world: Remote area nursing as a specialist-generalist practice area.

OBJECTIVE: Remote area nurses provide primary health care services to isolated communities across Australia. They manage acute health issues, chronic illness, health promotion and emergency responses. This article discusses why their generalist scope of practice should be formally recognised as a specialist nursing practice area. DESIGN: Constructivist grounded theory, using telephone interviews (n = 24) with registered nurses and nurse practitioners. SETTING: Primary health care clinics, in communities of 150-1500 residents across Australia. PARTICIPANTS: A total of 24 nurses participated in this study. RESULTS: Nurses' perceived their clinical knowledge and skill as insufficient for the advanced, generalist, scope of practice in the remote context, especially when working alone. Experience in other settings was inadequate preparation for working in remote areas. Knowledge and skill developed on the job, with formal learning, such as nurse practitioner studies, extending the individual nurse's scope of practice to meet the expectations of the role, including health promotion. CONCLUSION: Remote area nursing requires different knowledge and skills from those found in any other nursing practice setting. This study supports the claim that remote area nursing is a specialist-generalist role and presents a compelling case for further examination of the generalist education and support needs of these nurses. Combined with multidisciplinary collaboration, developing clinical knowledge and skill across the primary health care spectrum increased the availability of health resources and subsequently improved access to care for remote communities. Further research is required to articulate the contemporary scope of practice of remote area nurses to differentiate their role from that of nurse practitioners.

Transition experiences of newly qualified registered graduate nurses employed in a Neonatal Intensive Care Unit.

OBJECTIVE: To explore the experiences of newly qualified registered graduate nurses' clinical and professional learning experiences, during their first six-months of post registration employment within a graduate nurse transition program in a Neonatal Intensive Care Unit (NICU). METHOD: Narrative inquiry with thematic analysis was used to explore the newly qualified registered graduate nurses' accounts via semi-structured interviews, conducted between January 2018 - January 2019, of their clinical and professional learning during their employment in the Neonatal Intensive Care Unit. SETTING: In total, eight newly qualified registered graduate nurses employed at two Western Australian Hospitals sites were recruited. FINDINGS: Themes identified included: feeling unprepared; experiences of horizontal violence; the need for a supportive structural environment and seeking feedback. Participants reported overwhelming feelings of stress, emotional exhaustion, concerns for patient safety and for some, fear of early career burnout. CONCLUSION: In this study, newly qualified registered graduate nurses were clinically underprepared for entering a Neonatal Intensive Care Unit with all participants reporting high levels of psychosocial distress. This was further compounded by a lack of structured support, horizontal violence, and inadequate or no regular feedback from preceptors, resulting from a negative workplace culture and poor educator behaviours. Recommendations for improving the experiences of newly qualified registered graduate nurses employed in the Neonatal Intensive Care are discussed.

The Intensive Care Unit Liaison Nurse and their value in averting clinical deterioration: A qualitative descriptive study.

OBJECTIVES: Intensive Care Unit Liaison Nurse roles are associated with improved clinical outcomes for patients and financial benefits for healthcare providers. However, there is little academic exploration of the ward nurses' perspectives of the role and whether it can affect ward nurses' confidence in identifying and managing the deteriorating patient. This study addresses this gap by examining both those perspectives. RESEARCH DESIGN: A qualitative descriptive approach was used, utilising semi-structured interviews to garner the perspectives of ward nurses.Interviewswere conducted with ward nurses who had been involved in a MedicalEmergencyTeam/Code Blue call;sought technical or clinical support;or had been at the bedside during a post intensive care unit discharge review. Data were analysed using thematic analysis. SETTING: A private, not-for-profit, metropolitan acute care hospital. FINDINGS: The participants identified four areas that contributed to improved patient care: reduced Medical Emergency Team/Code calls; improved ward based critical care knowledge through education; improved ward nurses' confidence in dealing with the deteriorating patient and provision of technical support. CONCLUSION: The Intensive Care Unit Liaison Nurse role not only contributes to improved clinical patient outcomes; it also influences confidence levels of the ward nurses in managing deteriorating patients.

Common components of nurse manager development programmes: A literature review.

AIMS: To critically appraise contemporary literature and synthesize common components of nurse manager development programmes. BACKGROUND: Although the need for nurse manager development programmes has been well documented, minimal recent research exists which identifies and evaluates the common components in these programmes. Furthermore, nurse managers continue to be poorly prepared and supported in role transition, contributing to poor organisational and role performance and decreased retention. METHOD: A structured literature review saw 14 original research publications appraised for quality, analysed and included in the review. RESULTS: The common components identified in nurse manager development programmes include curriculum, method of delivery, support, and funding components. Various subthemes were also identified. CONCLUSION: The components identified within existing nurse manager development programmes are varied. Although there are common components within nurse manager development programmes, these individual components have not been evaluated for effectiveness. There is a clear need for further development of nurse manager development programmes and evaluation of the specific components within. IMPLICATIONS FOR NURSING MANAGEMENT: An understanding of the common components in NM development programmes is useful for designing and implementing robust evidence-based programmes. Inclusion of these components may facilitate a smoother role transition, enhance performance and improve recruitment and retention of nurse managers.

Qualitative perspectives of nurse managers on mixed-gender accommodation in a regional hospital in Australia.

AIMS: To explore and analyse the current bed management processes and understand the perspectives of nurse managers on mixed-gender accommodation in a regional hospital in Australia. BACKGROUND: Mixed-gender accommodation was introduced to help manage the increasing demand for hospital beds. Yet, some health services identify same-gender accommodation better aligns with patient-centredness. METHOD: This qualitative research was conducted at a public hospital in regional Australia and focused on the experience in the general wards. Eight nurse managers were selected using purposeful sampling. Data were collected through face-to-face semi-structured interviews and thematically analysed. RESULTS: Three main themes were identified: current admission processes-managing admissions, bed allocation considerations, patient involvement and managing mixed-gender rooms; impacts on patients-participant views, patient experience and bathrooms; and barriers and facilitators-capacity, infrastructure, safety and risk, bed swapping and organisational factors. CONCLUSIONS: The study demonstrates a lack of structure and patient-centredness with mixed-gender allocation processes. Local organisational guidelines are suggested to support improvement in patient-centred inpatient hospital accommodation. IMPLICATIONS FOR NURSING MANAGEMENT: The findings of this study will help nursing leaders drive positive change concerning bed allocations and support advocacy for patient rights. Future studies should explore the patient perspective of mixed-gender accommodation.

Factors influencing Australian chiropractors who choose not to join national professional associations: a qualitative study.

BACKGROUND: Professional associations (PAs) are perceived to promote their professions and support their members. Despite these advantages, about 1 in 3 Australian chiropractors choose not to belong to either of the two PAs. Our study had two objectives: 1) to explore the views of non-member chiropractors about PAs in general; 2) seek to understand the motivations of non-member Australian chiropractors about not joining a PA. METHODS: This qualitative descriptive study utilised in-depth semi-structured interviews with open-ended questions for thematic analysis and was conducted from January to April 2020. Nine participants were interviewed before no new themes were articulated. Participants had to be registered chiropractors who had not been members of a PA for at least three years. Recruitment was through a Facebook advertisement and snowball sampling. Interviews were transcribed and imported into NVivo qualitative analysis software, allowing identification of key concepts surrounding non-membership of chiropractic PAs. RESULTS: Five themes were identified. 1) A tarnished image, suggested the profession has a poor standing in the eyes of the public and other health professionals. 2) Not worth the money, expressed the annual membership dues were not viewed as good value for money. 3) Going it alone / what's in it for me? indicated there was no direct benefit or anything deemed essential for practice. 4) Two warring factions, reflected not wanting to be seen to be part of the internal conflict between conservative and evidence-based practitioners. 5) Lack of visibility, described no visible presence or strong communication that clearly displayed the advantages of membership. CONCLUSIONS: Non-members are looking for PAs to enhance the respectability of the profession in a manner that ultimately results in increased patient volume and the provision of readily accessible day-to-day resources and information. These results can inform the construction of a survey for the broader chiropractic non-membership community to confirm and expand upon these findings and potentially improve PAs.

A Mixed-Methods Study on Patient Safety Insights of New Graduate Registered Nurses.

BACKGROUND: New graduate nurses transition with limited experience, and with anxiety and stress. They present an increased risk of contributing to preventable errors or adverse events. PURPOSE: The purpose was to develop an understanding of new graduate registered nurses' (RNs) patient safety knowledge and actions within the first year of registration. METHODS: The longitudinal mixed-methods study was conducted using a questionnaire delivered at 3 time points (n = 68). Qualitative data were collected by semistructured interviews (n = 11). RESULTS: Self-reported knowledge of medical error decreased over the 3 time points. Themes emerging from qualitative data include patient safety and insights, time management, making a mistake, experiential learning, and transition. CONCLUSIONS: Medical errors and time management persist during transition to the RN role. New graduates reported moderate knowledge of safety and quality issues; however, questioning their own abilities overshadowed growth in their involvement in patient safety.

Interventions to increase resilience in physicians: A structured literature review.

AIMS AND OBJECTIVES: To critically appraise available literature on interventions to increase resilience in physicians. BACKGROUND: The increasing rate of burnout in physicians has sparked interest in interventions that increase their resilience. Research on improving resilience among health professionals is still in its infancy, yet understanding what interventions are effective in counteracting burnout is vital to ensuring a resilient medical workforce. DESIGN: A focused review of research literature. METHODS: The review used key terms and Boolean operators across a five-year time frame in PsycINFO, MEDLINE, CINAHL and Google Scholar for relevant articles. Ten articles are included in the structured literature review. RESULTS: Interventions were tested in eight of the 10 studies, with mindfulness a common theme. Results for effectiveness of training programs were mixed, with some studies reporting significant improvements in resilience and others not. Some group, online and coaching interventions were found to be effective in increasing resilience. The percentage of physicians participating in these studies varied, and results regarding physicians were not always reported separately. CONCLUSIONS: This review examined a range of interventions, with varying measures of effectiveness. Common limitations in the reviewed studies included self-selection bias, lack of a control group, and uncertainty over whether changes could be attributed to the intervention. The findings presented were not limited to physicians, but included a broader range of health professionals. It is not possible to generalize the results of these studies to physicians. Further research is needed to refine interventions and pinpoint precisely what increases resilience in physicians.

Open visiting in adult intensive care units - A structured literature review.

BACKGROUND: Open visitation in adult intensive care units report benefits such as reduced frequency and duration of deliriums, improved patient and family satisfaction, and reduced anxiety and depression of family members. 'Being close' is one of the most basic and important needs of family members of critically ill patients. Open visitation provides an increased opportunity of being at the bedside with the patient, however, it is not universally embraced by adult intensive care units worldwide. AIM: To critically appraise the literature concerning open visitation in adult intensive care units. DESIGN: A structured literature review. METHOD: This review was guided by the methodology by Kable et al. (2012). Sixteen articles are included in the review. RESULTS: Despite the documented benefits, several challenges exist which hinder broad application of open visitation in adult intensive care units. CONCLUSION: This review acknowledged challenges faced in adopting an open visiting policy in adult intensive care units such as negative staff perceptions and attitudes; patient protection; family and cultural consideration, as well as organisational challenges. The lack of a clear and consistent definition of open visitation is problematic, and strategies are urgently needed to support staff to provide holistic patient- and family-centred care.

The delivery of Primary Health Care in remote communities: A Grounded Theory study of the perspective of nurses.

BACKGROUND: Australia has vast areas of desert, wilderness and offshore islands where nurses provide the majority of health care services. The residents of Australia's remote communities generally have poorer health status than their metropolitan counterparts. Despite recognition of Primary Health Care as a comprehensive model of acute and preventative care well suited to areas of high health and social need, there is little known about how nurses employ the Primary Health Care model in practice. OBJECTIVES: This study described and explained from the perspective of nurses, the actions and interactions involved in the delivery of Primary Health Care in remote communities. DESIGN: This study was conducted from a Constructivist Grounded Theory perspective. SETTINGS: The setting was community health centres or Aboriginal Medical Services located in 'remote' or 'very remote' areas. Communities with inpatient health services were excluded. PARTICIPANTS: Twenty four Nurse Practitioners, Registered Nurses and nursing academics participated. Participants had worked or were working, in a variety of remote communities across Australia. Length of service ranged from three months to over 15 years nursing in remote areas. METHODS: Data were collected through 23 telephone interviews and an expert reference group. Theoretical sampling and constant comparative analysis were used to reach theoretical saturation. RESULTS: The core issue participants faced was the inability to provide Primary Health Care. Four conditions impacted on the core issue: understanding the social world of the remote community, availability of resources, clinical knowledge and skill and, shared understanding and support. The process of doing the best you can with what you have, emerged as the way participants dealt with the inability to provide Primary Health Care. The process involved four primary activities: facilitating access to health care, continually learning, seeking understanding, and home-making in a work environment. The outcome of this process was considered to be making compromises to provide Primary Health Care. CONCLUSIONS: This study describes the substantive theory: making compromises to provide Primary Health care services in the remote Australian setting. Understanding the process of making compromises could direct employers and educators in their efforts to improve the provision of Primary Health Care in a variety of settings. Increased attention to the education, resources and support of nurses is likely to increase access to safe, quality care for remote communities.

A perspective on Councils on Chiropractic Education accreditation standards and processes from the inside: a narrative description of expert opinion: Part 2: Analyses of particular responses to research findings.

Background: This is the second article reporting on a study that sought the views of people with extensive experience in Councils on Chiropractic Education (CCEs) on research that has raised concerns about variability in accreditation standards and processes for chiropractic programs (CPs) and chiropractic practice in general. Methods: This qualitative study employed in-depth semi-structured interviews that consisted of open-ended questions asking experts about their thoughts and views on a range of issues surrounding accreditation, graduate competency standards and processes. The interviews were audio-recorded, and transcribed verbatim in June and July of 2018. The transcripts were reviewed to develop codes and themes. The study followed the COREQ guidelines for qualitative studies. Results: The interviews revealed that these CCE experts were able to discern positive and negative elements of the accreditation standards and processes. They were, in general, satisfied with CCEs accreditation standards, graduating competencies, and site inspection processes. Most respondents believed that it was not possible to implement an identical set of international accreditation standards because of cultural and jurisdictional differences. This was thought more likely to be achieved if based on the notion of equivalence. Also, they expressed positive views toward an evidence-based CP curriculum and an outcomes-based assessment of student learning. However, they expressed concerns that an evidence-based approach may result in the overlooking of the clinician's experience. Diverse views were found on the presence of vitalism in CPs. These ranged from thinking vitalism should only be taught in an historical context, it was only a minority who held this view and therefore an insignificant issue. Finally, that CCEs should not regulate these personal beliefs, as this was potentially censorship. The notable absence was that the participants omitted any mention of the implications for patient safety, values and outcomes. Conclusions: Expert opinions lead us to conclude that CCEs should embrace and pursue the widely accepted mainstream healthcare standards of an evidence-based approach and place the interests of the patient above that of the profession. Recommendations are made to this end with the intent of improving CCE standards and processes of accreditation.

A perspective on Chiropractic Councils on Education accreditation standards and processes from the inside: a narrative description of expert opinion: Part 1: Themes.

Background: The aim of this study was to report on key informant opinions of Councils on Chiropractic Education (CCE) regarding recent research findings reporting on improving accreditation standards and processes for chiropractic programs (CPs). Methods: This qualitative study employed in-depth semi-structured interviews with key experienced personnel from the five CCEs in June and July of 2018. The interviews consisted of open-ended questions on a range of issues surrounding accreditation, graduate competency standards and processes. All interviews were audio-recorded, and transcribed verbatim. The transcripts were analysed to develop codes and themes using thematic analysis techniques assisted by NVivo coding software. The study followed the COREQ guidelines for qualitative studies. Results: Six themes were isolated from the interview transcripts; they were: professional differences; keep it in the family; to focus on outcomes or be prescriptive?; more resources please; inter-profession integration; and CPs making ends meet. Most respondents saw a need for CCEs standards and processes to improve interdisciplinarity while at the same time preserving the 'uniqueness' of chiropractic. Additionally, informants viewed CCEs as carrying out their functions with limited resources while simultaneously dealing with vocal disparate interest groups. Diverse views were observed on how CCEs should go about their business of assessing chiropractic programs for accreditation and re-accreditation. Conclusions: An overarching confounder for positive changes in CCE accreditation standards and processes is the inability to clearly define basic and fundamental terms such as 'chiropractic' and its resultant scope of practice. This is said to be because of vocal, diverse and disparate interest groups within the chiropractic profession. Silence or nebulous definitions negotiated in order to allow a diversity of chiropractic practice to co-exist, appears to have complicated and hindered the activities of CCEs. Recommendations are made including an adoption of an evidence-based approach to accreditation standards and processes and the use of expertise from other health professions. Further, the focus of attention should be moved away from professional interests and toward that of protection of the public and the patient.

Service gaps related to culturally appropriate mental health care for African immigrants.

The population of overseas-born Australians continues to grow including the recent increase of immigrants and refugees from African countries. Due to this increase, healthcare services need to assess if current available services are culturally appropriate for African immigrant inpatients. This qualitative study, with a quality improvement focus, examined current services to identify key service gaps and consider recommendation to improve care of African immigrant mental health inpatients in the hospital from the point of view of staff working within the organisation. What was revealed is that services currently offered to African mental health inpatients were culturally inappropriate. Emerging themes included inadequate interpreter services, lack of cultural awareness staff training, lack of organisation link with other services, unmet spiritual needs, use of staff/families as interpreters, culturally inappropriate information, and lack of or inadequate culturally appropriate policies and framework. Changes to current practices are recommended to provide culturally appropriate mental health care to African inpatients.

New graduate nurses' clinical safety knowledge by the numbers.

AIM: To explore new graduate registered nurses' knowledge and attitudes concerning medical error and patient safety, during their first 6 months of professional practice. BACKGROUND: New graduate registered nurses demonstrate basic skills and levels of performance due to limited exposure and experience in actual situations. There is a concern held for their clinical reasoning skills required to recognize patient deterioration, posing a threat to patient safety. METHODS: An online questionnaire was used to survey new graduate registered nurses at three time points during graduate nurse programmes between August 2016 and February 2018. RESULTS: A decrease in self-reported knowledge and attitudes regarding medical errors was noted over the three time points. These results indicate initial confidence in theoretical knowledge and attitudes upon completion of undergraduate education, and prior to commencing professional practice. CONCLUSION: Results suggest that a theory practice gap persists with respect to medical error for transitioning new nurses. IMPACT FOR NURSING MANAGEMENT: New nurses lack confidence around compromised patient safety situations and a knowledge gap around actions related to medical error. Nurse managers and educators should be made aware of this gap to implement strategies to decrease risk during novice nurse transition.

New graduate nurses' understanding and attitudes about patient safety upon transition to practice.

AIMS: To explore the transition experiences of newly graduated registered nurses with particular attention to patient safety. BACKGROUND: New graduate registered nurses' transition is accompanied by a degree of shock which may be in tune with the described theory-practice gap. The limited exposure to clinical settings and experiences leaves these nurses at risk of making errors and not recognising deterioration, prioritising time management and task completion over patient safety and care. DESIGN: Qualitative descriptive approach using semi-structured interviews. METHODS: Data were collected during 2017-18 from 11 participants consenting to face-to-face or telephone semi-structured interviews. Interviews were transcribed verbatim, and data were analysed using thematic analysis techniques assisted by Nvivo coding software. The study follows the COREQ guidelines for qualitative studies (see Supplementary File 1). RESULTS: Key themes isolated from the interview transcripts were as follows: patient safety and insights; time management; making a mistake; experiential learning; and transition. Medication administration was a significant cause of stress that adds to time management anguish. Although the new graduate registered nurses' clinical acumen was improving, they still felt they were moving two steps forward, one step back with regards to their understanding of patient care and safety. CONCLUSION: Transition shock leaves new graduate registered nurses' focused on time management and task completion over patient safety and holistic care. Encouragement and support needed to foster a safety culture that foster safe practices in our new nurses. RELEVANCE TO PRACTICE: Having an understanding of the new graduate registered nurses' experiences and understanding of practice will assist Graduate Nurse Program coordinators, and senior nurses, to plan and provide the relevant information and education during these initial months of transition to help mitigate the risk of errors occurring during this time.

A cross-sectional study of the association between anxiety and temporomandibular disorder in Australian chiropractic students.

OBJECTIVE: This study examined the association between anxiety and temporomandibular disorder (TMD) in Australian chiropractic students, particularly its effect on quality of life. METHODS: Chiropractic students (n = 185) completed online surveys, including the Oral Health Impact Profile for TMDs (OHIP-TMD) and the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. The OHIP-TMD psychometric properties were assessed using principal component analysis. Linear regression models were used to examine demographic predictors for anxiety and TMD. A general linear model assessed the association between anxiety and the psychosocial and function scales identified through analysis of the OHIP-TMD questionnaire. RESULTS: The mean value for the OHIP-TMD and PROMIS was 1.3 (SD = 0.7) and 9.5 (SD = 4.1), respectively. Women reported significantly lower quality of life (QoL) related to TMD symptoms (p = 0.006) and that QoL related to TMD symptoms increased significantly as students progressed through the course (p = .025). Lower levels of anxiety were significantly associated with male gender (p = .000), employment (p = .008), higher program levels (p = .003), and having children (p = .005). General linear model analysis revealed that increased anxiety was significantly associated with higher levels of oral physical function impairment (p = .003) and elevated psychosocial distress (p = .0001). CONCLUSION: Anxiety was significantly associated with psychosocial distress and oral physical function impairment in university chiropractic students. In addition to impacting on oral health-related QoL, anxiety also affects students' engagement with learning and academic performance. It would therefore be beneficial to implement strategies that mitigate students' anxiety levels.