Nursing assessment of mental health issues in the general clinical environment: A descriptive study.

AIMS: To evaluate the effectiveness of a mental health screening form for early identification and care escalation of mental health issues in general settings. A secondary aim was to explore general nurses' use of the form and their confidence to discuss mental health issues with patients. METHODS: A cross-sectional design comprising a review of clinical records to determine use of the form, instances of missed care and escalation to the mental health team. The survey focused on nurses' confidence in general settings to engage in discussions with patients about mental health. Data were collected from April to December 2022. The Strengthening the Reporting of Observational Studies in Epidemiology Statement guided this study. RESULTS: Of 400 patient records, 397 were analysed; 293 (73.8%) of those had mental health screening by nurses. Age was a significant factor, with younger patients more likely to be screened although concerns were typically recognized in older patients. Of the 20 patients identified with mental health concerns, 9 (45%) were referred for further evaluation by the Clinical Liaison Team. While nurses were proactive in assessing physical risks, assessing risk factors that required deeper conversations with patients, including psychiatric history, was lacking. The survey highlighted fewer than half of the respondents (46%, n = 10) felt competent to engage in discussions about mental health; however, most (59%, n = 13) knew when to seek a mental health referral. CONCLUSIONS: General nurses have a role in the early identification and referral of patients with mental health challenges. However, training is imperative to facilitate deeper patient interactions concerning mental health. Integrating mental health checks within general settings is crucial for early detection and intervention, aligning with global quality care standards. REPORTING METHOD: STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: We received feedback that shaped the research protocol from a consumer representative.

Prevalence of frailty and pain in hospitalised cancer patients: implications for older adult care.

A hospital-wide point prevalence study investigated frailty and pain in patients with a cancer-related admission. Modifiable factors associated with frailty in people with cancer were determined through logistic regression. Forty-eight patients (19%) with cancer-related admissions were 2.65 times more likely to be frail and 2.12 more likely to have moderate pain. Frailty and pain were highly prevalent among cancer-related admissions, reinforcing the need for frailty screening and importance of pain assessment for patients with cancer.

Frailty and pain in an acute private hospital: an observational point prevalence study.

Frailty and pain in hospitalised patients are associated with adverse clinical outcomes. However, there is limited data on the associations between frailty and pain in this group of patients. Understanding the prevalence, distribution and interaction of frailty and pain in hospitals will help to determine the magnitude of this association and assist health care professionals to target interventions and develop resources to improve patient outcomes. This study reports the point prevalence concurrence of frailty and pain in adult patients in an acute hospital. A point prevalence, observational study of frailty and pain was conducted. All adult inpatients (excluding high dependency units) at an acute, private, 860-bed metropolitan hospital were eligible to participate. Frailty was assessed using the self-report modified Reported Edmonton Frail Scale. Current pain and worst pain in the last 24 h were self-reported using the standard 0-10 numeric rating scale. Pain scores were categorised by severity (none, mild, moderate, severe). Demographic and clinical information including admitting services (medical, mental health, rehabilitation, surgical) were collected. The STROBE checklist was followed. Data were collected from 251 participants (54.9% of eligible). The prevalence of frailty was 26.7%, prevalence of current pain was 68.1% and prevalence of pain in the last 24 h was 81.3%. After adjusting for age, sex, admitting service and pain severity, admitting services medical (AOR: 13.5 95% CI 5.7-32.8), mental health (AOR: 6.3, 95% CI 1. 9-20.9) and rehabilitation (AOR: 8.1, 95% CI 2.4-37.1) and moderate pain (AOR: 3.9, 95% CI 1. 6-9.8) were associated with increased frailty. The number of older patients identified in this study who were frail has implications for managing this group in a hospital setting. This indicates a need to focus on developing strategies including frailty assessment on admission, and the development of interventions to meet the care needs of these patients. The findings also highlight the need for increased pain assessment, particularly in those who are frail, for more effective pain management.Trial registration: The study was prospectively registered (ACTRN12620000904976; 14th September 2020).

Effectiveness of nurse-led volunteer support and technology-driven pain assessment in improving the outcomes of hospitalised older adults: protocol for a cluster randomised controlled trial.

INTRODUCTION: Hospitalised older adults are prone to functional deterioration, which is more evident in frail older patients and can be further exacerbated by pain. Two interventions that have the potential to prevent progression of frailty and improve patient outcomes in hospitalised older adults but have yet to be subject to clinical trials are nurse-led volunteer support and technology-driven assessment of pain. METHODS AND ANALYSIS: This single-centre, prospective, non-blinded, cluster randomised controlled trial will compare the efficacy of nurse-led volunteer support, technology-driven pain assessment and the combination of the two interventions to usual care for hospitalised older adults. Prior to commencing recruitment, the intervention and control conditions will be randomised across four wards. Recruitment will continue for 12 months. Data will be collected on admission, at discharge and at 30 days post discharge, with additional data collected during hospitalisation comprising records of pain assessment and volunteer support activity. The primary outcome of this study will be the change in frailty between both admission and discharge, and admission and 30 days, and secondary outcomes include length of stay, adverse events, discharge destination, quality of life, depression, cognitive function, functional independence, pain scores, pain management intervention (type and frequency) and unplanned 30-day readmissions. Stakeholder evaluation and an economic analysis of the interventions will also be conducted. ETHICS AND DISSEMINATION: Ethical approval has been granted by Human Research Ethics Committees at Ramsay Health Care WA|SA (number: 2057) and Edith Cowan University (number: 2021-02210-SAUNDERS). The findings will be disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER: ACTRN12620001173987.

Moving on after critical incidents in health care: A qualitative study of the perspectives and experiences of second victims.

AIMS: To gain a deeper understanding of nurses and midwives' experiences following involvement in a critical incident in a non-critical care area and to explore how they have 'moved-on' from the event. DESIGN: An interpretive descriptive design guided inductive inquiry to interpret the meaning of moving-on. METHODS: Purposive sampling recruited 10 nurses and midwives. Data collection comprised semi-structured interviews, memos and field notes. Data were concurrently collected and analysed during 2016-2017 with NVivo 11. The thematic analysis enabled a coherent analytical framework evolving emerging themes and transformation of the data into credible interpretive description findings, adhering to the COREQ reporting guidelines. RESULTS: The findings revealed five main themes: Initial emotional and physical response, the aftermath, long-lasting repercussions, workplace support and moving-on. CONCLUSION: This study shed light on the perceptions of nurses and midwives who lived through the impact of critical incidents. Through their lens, the strategies engaged in to move-on were identified and their call for organizational and collegial support received a voice.

Education and support for erectile dysfunction and penile rehabilitation post prostatectomy: A qualitative systematic review.

BACKGROUND: The incidence of prostate cancer is increasing across the world, with over 1.2 million men diagnosed in 2018. Survival rates have increased significantly however the morbidity remains high. Men do report unmet sexual health needs post prostatectomy, despite this, many do not pursue treatment. OBJECTIVES: To explore men's perceptions of the education and support they receive surrounding post-prostatectomy erectile dysfunction and penile rehabilitation. DESIGN: Systematic review and qualitative analysis based on Joanna Briggs Institute's methodology for conducting synthesis. METHODS: Based on the protocol registered with PROSPERO, data were collected from the following electronic databases: MEDLINE, Web of Science, CINAHL, Psycinfo, The Cochrane Library and Embase. Titles and abstracts were screened against the inclusion and exclusion criteria, full texts were then screened, and the methodological quality of included studies was assessed using the Joanna Briggs Institutes Critical Appraisal Checklist for Qualitative Research by two independent reviewers. RESULTS: Synthesised findings were extracted from 13 articles; four synthesised findings were identified from nine categories with 57 findings and 108 illustrations. The findings related to a perceived lack of education and support regarding all aspects of sexuality post prostatectomy. Practitioners' knowledge of gay, bisexual and single men's needs was particularly lacking. Nurses and nurse practitioners were considered to contribute positively to educational needs. CONCLUSIONS: The synthesised findings demonstrated that men do not receive sufficient education and support to initiate penile rehabilitation post-prostatectomy. Men need a holistic approach to altered sexuality and practitioners should facilitate education and treatment in a non-judgmental and all-inclusive approach.

The nursing care of people with class III obesity in an acute care setting: a scoping review.

BACKGROUND: Patients with Class III obesity pose unique challenges to health care staff and organisations. Care requirements of this population are unique and require specialised equipment and knowledge to meet these needs, maintain the quality of care, as well as the safety of patients and staff. AIM: To synthesise the evidence on the nursing care of Class III obese patients in acute care settings. METHODS: A scoping review informed by JBI. CINAHL Plus, Medline, Scopus, Proquest Central, Web of Science and Embase were searched for primary research articles about the nursing management of people classified as Class III obese in acute care. Methodological quality of included studies was assessed; data extracted and synthesised into themes. RESULTS: Fourteen studies were included in the review. The synthesis generated three themes: Access to equipment, knowledge and training, patient care, and opportunities to improve care. CONCLUSIONS: A paucity of high-quality evidence informs the nursing care of people with Class III obesity in acute care. Access to appropriate equipment dominated the findings of this review. Adequate provision of equipment and education on its use are required. Education to promote engagement with patients, adapting clinical practice and promotion of self-care could improve care and outcomes.

A delirium prevalence audit and a pre and post evaluation of an interprofessional education intervention to increase staff knowledge about delirium in older adults.

BACKGROUND: Delirium is more prevalent in older people and estimated to occur in up to 50% of the hospital population. Delirium comprises a spectrum of behaviours, including cognitive and attention deficits, and fluctuating levels of consciousness, often associated with an underlying physiological disturbance. Delirium has been increasingly associated with adverse outcomes. Although often preventable or can at least be mitigated, delirium may not be a standard part of assessment and thus may not be recognized in the early stages when it is most likely to be treated successfully. The aim of this study was to evaluate the level of knowledge of delirium amongst clinicians caring for patients at high risk of developing delirium and to determine whether education can improve clinical assessment of delirium. METHODS: Two hundred and forty-six case notes were audited before and 149 were reviewed after the education intervention and implementation of a delirium screening tool. Clinicians at the hospital were invited to complete a questionnaire on knowledge of delirium. The questionnaire was based on a validated tool which contained 39 questions about delirium. The questionnaire also contained 28 questions on delirium knowledge. Additional questions were included to gather demographic information specific to the hospital. Descriptive statistics, chi square and independent t-tests were conducted to test for differences in knowledge between the pre and post periods. The Squire Checklist Reporting Guidelines for Quality Improvement Studies informed the preparation of the manuscript. RESULTS: The audit demonstrated that the use of a cognitive assessment tool overall increased from 8.5% in pre education to 43% in the post education period. One hundred and fifty-nine staff completed the questionnaire in total, 118 the pre and 41 post. The knowledge subscale score was high pre and post education and no statistically significant difference was observed. The greatest increase in knowledge was related to knowledge of the risk factors subscale. The increase in knowledge (6.8%) was statistically significant. CONCLUSION: An interprofessional approach to delirium education was effective in not only increasing awareness of the factors associated with this syndrome but also increased the use of a delirium assessment tool.

Prevalence of frailty and pain in hospitalised adult patients in an acute hospital: a protocol for a point prevalence observational study.

INTRODUCTION: Frailty and pain are associated with adverse patient clinical outcomes and healthcare system costs. Frailty and pain can interact, such that symptoms of frailty can make pain assessment difficult and pain can exacerbate the progression of frailty. The prevalence of frailty and pain and their concurrence in hospital settings are not well understood, and patients with cognitive impairment are often excluded from pain prevalence studies due to difficulties assessing their pain. The aim of this study is to determine the prevalence of frailty and pain in adult inpatients, including those with cognitive impairment, in an acute care private metropolitan hospital in Western Australia. METHODS AND ANALYSIS: A prospective, observational, single-day point prevalence, cross-sectional study of frailty and pain intensity of all inpatients (excluding day surgery and critical care units) will be undertaken. Frailty will be assessed using the modified Reported Edmonton Frail Scale. Current pain intensity will be assessed using the PainChek smart-device application enabling pain assessment in people unable to report pain due to cognitive impairment. Participants will also provide a numerical rating of the intensity of current pain and the worst pain experienced in the previous 24 hours. Demographic and clinical information will be collected from patient files. The overall response rate of the survey will be reported, as well as the percentage prevalence of frailty and of pain in the sample (separately for PainChek scores and numerical ratings). Additional statistical modelling will be conducted comparing frailty scores with pain scores, adjusting for covariates including age, gender, ward type and reason for admission. ETHICS AND DISSEMINATION: Ethical approval has been granted by Ramsay Health Care Human Research Ethics Committee WA/SA (reference: 2038) and Edith Cowan University Human Research Ethics Committee (reference: 2020-02008-SAUNDERS). Findings will be widely disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER: ACTRN12620000904976.

The enablers and barriers to children visiting their ill parent/carer in intensive care units: A scoping review.

AIM: The aim of the study was to identify the enablers and/or barriers to children visiting their ill parent/carer in intensive care units by examining the visiting policies as practiced or perceived by nurses and experienced or perceived by parents and caregivers. REVIEW METHOD: This is a scoping review following Joanna Briggs Institute Protocol Guidelines. DATA SOURCES: An extensive literature search of Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, PsychINFO, PubMed, and Excerpta Medica dataBASE databases, using key terms, was conducted between May 2019 and July 2020; studies published between 1990 and 2020 were considered for inclusion. Double screening, extraction, and coding of the data using thematic analysis and frequency counts were used. RESULTS: Fifteen barriers, 19 facilitators, nine situationally contingent factors, and six personal judgement considerations were identified that influenced children visiting their ill parent/carer in intensive care units. Most barriers (n = 10) were related to organisational factors including restrictive policies, nurses' level of education, age, working hours, nurses' attitudes, and lack of required skills to promote emotional resilience and/or to communicate with children. Family perception factors relating to parents' perceptions, attitudes and concerns of staff/parents, and anticipated behaviours of children were also identified as both barriers and facilitators. CONCLUSIONS: There is a lack of consistency in the application of policies and procedures to facilitate children visiting their loved ones in an intensive care unit. Without key involvement from the nurses and healthcare team, there may have been opportunities lost to optimise family-centred care practices in critical care settings.

Comparing an eHealth Program (My Hip Journey) With Standard Care for Total Hip Arthroplasty: Randomized Controlled Trial.

BACKGROUND: The role of eHealth programs to support patients through surgical pathways, including total hip arthroplasty (THA), is rapidly growing and offers the potential to improve patient engagement, self-care, and outcomes. OBJECTIVE: The aim of this study is to compare the effects of an eHealth program (intervention) versus standard care for pre- and postoperative education on patient outcomes for primary THA. METHODS: A prospective parallel randomized controlled trial with two arms (standard care and standard care plus access to the eHealth education program) was conducted. Participants included those who underwent THA. Outcome measures were collected preadmission, at 6 weeks, and at 3 and 6 months after surgery. The primary outcome was the Hip Dysfunction and Osteoarthritis Outcome Score. Secondary outcomes were a 5-level 5-dimension quality of life measure and the self-efficacy for managing chronic disease scale. Demographic and clinical characteristics were also collected. A satisfaction survey was completed by all participants 6 weeks after surgery, and those in the intervention arm completed an additional survey specific to the eHealth program. RESULTS: A total of 99 patients were recruited: 50 in the eHealth program (intervention) and 49 in standard care (control). Clinical improvements were demonstrated in both groups across all time points. Per-protocol analysis demonstrated no differences between the groups for all outcome measures across all time points. Participants in the eHealth program reported that the program was accessible, that they felt comfortable using it, and that the information was helpful. CONCLUSIONS: This study demonstrated that the eHealth program, in addition to standard care, had no additional benefit to THA recovery compared with standard care alone. The study found that the eHealth program was highly valued by participants, and it supported the preoperative preparation, recovery, and postoperative rehabilitation of participants. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12617001433392; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373657.

The impact of critical incidents on nurses and midwives: A systematic review.

AIMS: To synthesise the existing literature, which focuses on the impact of critical incidents on nurses and midwives, and to explore their experiences related to the support they received in the current healthcare environment to move on from the event. DESIGN: Systematic review and qualitative synthesis. DATA SOURCES: The electronic databases CINAHL, MEDLINE, PsycINFO, PubMed, Embase and Nursing and Allied Health (ProQuest) were systematically searched from 2013-2018, and core authors and journals identified in the literature were manually investigated. REVIEW METHODS: Qualitative studies of all research design types written in English were included according to the PRISMA reporting guidelines. The methodological quality of included studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. RESULTS: A total of 7,520 potential publications were identified. After removal of duplicate citations, study selection and appraisal process, 11 qualitative primary research papers progressed to the meta-synthesis by meta-aggregation. The 179 findings and sub-findings from the included studies were extracted, combined and synthesised into three statements addressing three different aspects within the context of critical incidents: the experiences of the impact, the perceptions of support and the ability to move on. CONCLUSION: This review illuminated that moving-on after critical incidents is a complex and wearisome journey for nurses and midwives. More attention should to be drawn to second victims within general nursing and midwifery practice to strengthen their ability to navigate the aftermath of critical incidents and reclaim the professional confidence indispensable to remain in the workforce.

Postgraduate nurse education and the implications for nurse and patient outcomes: A systematic review.

OBJECTIVES: To synthesise the current evidence of the implications of postgraduate nursing qualifications on patient and nurse outcomes. DESIGN: A systematic review. DATA SOURCES: Primary research findings. REVIEW METHODS: A systematic search following PRISMA guidelines and the Joanna Briggs Institute's framework was conducted. A structured and comprehensive search of three electronic databases CINAHL, MEDLINE, PsychINFO, search engine Google Scholar, and a manual-search of reference lists was undertaken. The search was limited to articles in English between 2000 and 2019. The combined search yielded 3710 records. Search records were exported to EndNote X8 and duplicates were removed. Inclusion eligibility was assessed by title, abstract and full text. All team members were involved in selecting the studies and assessing methodical quality. Discrepancies were resolved through rigorous discussion between the reviewers. Twenty studies (quantitative and qualitative) were finally selected as suitable for inclusion in the review. A qualitative descriptive synthesis was undertaken to summarise and report the findings. RESULTS: This systematic review has shown that the empirical evidence to date does not support nurses' perceptions of the implications of postgraduate education. The findings from this review fell into three major themes: perceived implications of postgraduate study, clinical outcomes and patient satisfaction. Nurses perceived that postgraduate qualifications had improved their knowledge and skills and thus clinical practice, patient outcomes and health services. This perception has not been borne out by measurable outcomes as yet. The literature also suggests that postgraduate education should improve career opportunities and progression for nurses. This is not supported by the nurses' perceptions in the research available to date. It should be noted that these findings predominantly came from qualitative data. A few studies did report descriptive statistical analysis: demographics, knowledge levels, qualifications etc. None conducted any inferential statistical analysis. CONCLUSION: Although the literature suggests that postgraduate nursing qualifications improve outcomes for patients, the level of evidence is weak. Exploration methods are suggested to move beyond examining nurses' perceptions, to empirical measures of the value of postgraduate education on nurse and patient outcomes.

A Web-Based Recovery Program (ICUTogether) for Intensive Care Survivors: Protocol for a Randomized Controlled Trial.

BACKGROUND: Those who experience a critical illness or condition requiring admission to an intensive care unit (ICU) frequently experience physical and psychological complications as a direct result of their critical illness or condition and ICU experience. Complications, if left untreated, can affect the quality of life of survivors and impact health care resources. Explorations of potential interventions to reduce the negative impact of an ICU experience have failed to establish an evidence-based intervention. OBJECTIVE: The aim of this study is to evaluate the impact of a Web-based intensive care recovery program on the mental well-being of intensive care survivors and to determine if it is a cost-effective approach. METHODS: In total, 162 patients that survived an ICU experience will be recruited and randomized into 1 of 2 groups. The intervention group will receive access to the Web-based intensive care recovery program, ICUTogether, 2 weeks after discharge (n=81), and the control group will receive usual care (n=81). Mental well-being will be measured using the Hospital Anxiety and Depression Scale, The Impact of Events Scale-Revised and the 5-level 5-dimension EuroQoL at 3 time points (2 weeks, 6 months, and 12 months post discharge). Family support will be measured using the Multidimensional Scale of Perceived Social Support at 3 time points. Analysis will be conducted on an intention-to-treat basis using regression modeling. Covariates will include baseline outcome measures, study allocation (intervention or control), age, gender, length of ICU stay, APACHE III score, level of family support, and hospital readmissions. Participants' evaluation of the mobile website will be sought at 12 months postdischarge. A cost utility analysis conducted at 12 months from a societal perspective will consider costs incurred by individuals as well as health care providers. RESULTS: Participant recruitment is currently underway. Recruitment is anticipated to be completed by December 2020. CONCLUSIONS: This study will evaluate a novel intervention in a group of ICU survivors. The findings from this study will inform a larger study and wider debate about an appropriate intervention in this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/10935.

A collaborative approach to the implementation of a structured clinical handover tool (iSoBAR), within a hospital setting in metropolitan Western Australian: A mixed methods study.

The aim of this study was to determine the effectiveness of an education intervention for the implementation of the clinical handover tool iSoBAR, in an acute setting. A quantitative, descriptive survey design, using pre and post survey data before and after the implementation of an education intervention was used. Twenty nine nurses, doctors and allied health personnel employed at the study site participated in the study. The educational intervention consisted of an electronic presentation plus simulated video recorded exemplars of clinical handover. Outcome measures were the efficacy of the education intervention on the confidence of practitioners using the iSoBAR handover tool. Participants' understanding of the iSoBAR tool using Mann-Whitney U test was 2.54 pre-intervention and 4.32 post-intervention. Confidence in using the tool also increased post educational intervention from 2.7 (pre-intervention) to 4.07 (post-intervention). Focus groups identified several factors relating to the implementation of iSoBAR, creating two dominant themes: challenges concerning patient factors and change management processes and systems. Opportunities were identified: Practice enhancement, patient centred care, professional practice, and grassroots initiatives. The use of an interprofessional educational program increased the confidence and understanding of a range of health care practitioners when using the clinical handover tool iSoBAR.

An eHealth Program for Patients Undergoing a Total Hip Arthroplasty: Protocol for a Randomized Controlled Trial.

BACKGROUND: Total hip arthroplasty is an effective surgical procedure commonly used worldwide for patients suffering the disabling effects of osteoarthritis when medical therapy is unsuccessful. Traditionally pre- and postoperative information for patients undergoing a hip arthroplasty has been provided by paper-based methods. Electronic health (eHealth) programs to support individualized patient education on preoperative preparation, in-patient care, and home rehabilitation have the potential to increase patient engagement, enhance patient recovery, and reduce potential postoperative complications. OBJECTIVE: The aim of this study is to compare the addition of an eHealth program versus standard care for pre- and postoperative education on patient outcomes for primary total hip arthroplasty. METHODS: One hundred patients undergoing a primary elective total hip arthroplasty will be recruited from a metropolitan hospital in Western Australia to participate in a 6-month parallel randomized control trial. Participants will be randomized to either the standard care group (n=50) and will be given the education booklet and enrolled to attend a 1-hour education session, or the intervention group (n=50), and will receive the same as the standard care plus access to an eHealth program titled "My Hip Journey." The eHealth program encourages the patient to log in daily, from 2 weeks prior to surgery to 30 days postsurgery. The information on the platform will be aligned with the patient's individual surgical journey and will include exercises to be completed each day for the duration of the program. The primary outcome measure is the Hip Dysfunction and Osteoarthritis Outcome Score, version LK 2.0. Secondary outcome measures include the EuroQoL EQ-5D-5L, a 5-level 5-dimension quality of life measure, and the Self-Efficacy for Managing Chronic Disease Scale. Data will be collected at pre-admission (presurgery) and at 6 weeks, 3 months, and 6 months postsurgery. A patient satisfaction survey will be completed 6 weeks postsurgery and Web-based analytics will be collected 6 months postsurgery. A cost-effectiveness analysis, using the intention-to-treat principle, will be conducted from the hospital's perspective. RESULTS: Enrollment in the study commenced in January 2018 with recruitment due for completion towards the end of the year. The first results are expected to be submitted for publication in 2019. CONCLUSIONS: The outcomes and cost of using an eHealth program to support a patient's recovery from a hip arthroplasty will be compared with standard care in this study. If the eHealth program is found to be effective, further implementation across clinical practice could lead to improvement in patient outcomes and other surgical areas could be incorporated. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001433392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373657&isReview=true (Archived by WebCite at http://www.webcitation.org/6yzoTuggx). REGISTERED REPORT IDENTIFIER: RR1-10.2196/9654.

Closing the gap: A whole of school approach to Aboriginal and Torres Strait Islander inclusivity in higher education.

The recruitment and retention of Aboriginal and Torres Strait Islander nurses and midwives is key to the delivery of culturally appropriate health care and improving the health outcomes of Aboriginal and Torres Strait Islander people. A working group to address inclusion and engagement of Aboriginal and Torres Strait Islander students at a West Australian University has impacted on the curricula, faculty staff and Aboriginal and Torres Strait Islander students within the School of Nursing and Midwifery. The University's Reconciliation Action Plan was the foundation and catalysed the group to promote cultural safety education for staff and provide inclusive activities for Aboriginal and Torres Strait Islander students. A conceptual framework was developed to demonstrate the action taken within the School of Nursing and Midwifery to address the inequity for Aboriginal and Torres Strait Islander students that could be seen to exist. Through collaboration with staff and students, both Aboriginal and Torres Strait Islander people and non-Aboriginal people, a shared understanding and goal setting has developed to enable positive action to provide ongoing support for these students at all parts of their journey in higher education. This paper will highlight the process involved to promote the recruitment, retention and academic success of these students.

Surviving ICU: Stories of recovery.

AIM: The aim of this study was to investigate stories of recovery through the lens of intensive care unit (ICU) survivors. BACKGROUND: Survival from ICUs is increasing, as are associated physical and psychological complications. Despite the significant impact on survivors, there is inadequate support provision in Australia and world-wide for this population. DESIGN: An interpretive biographical approach of intensive care survivors' experiences of recovery. METHODS: Data were collected during 2014-2015 from diaries, face to face interviews, memos and field notes. Six participants diarized for 3 months commencing 2 months after hospital discharge. At 5 months, participants were interviewed about the content of their diaries and symbols and signifiers in them to create a shared meaning. Analysis of diaries and interviews were undertaken using two frameworks to identify themes throughout participants' stories and provides a unique portrait of recovery through their individual lens. FINDINGS: Participants considered their lives had irreparably changed and yet felt unsupported by a healthcare system that had "saved" them. This view through their lens identified turmoil, which existed between their surface and inner worlds as they struggled to conform to what recovery "should be". CONCLUSION: The novel biographical methods provided a safe and creative way to reveal survivors' inner thoughts and feelings. Participants' considered creating their stories supported their recovery process and in particular enabled them to reflect on their progress. Findings from this study may lead to increased awareness among health care providers about problems survivors face and improved support services more broadly, based on frameworks appropriate for this population.

Implications for research and practice of the biographic approach for storytelling.

Background Intensive care unit survivors face many physical and psychological difficulties during their recovery following discharge from hospital. These difficulties can significantly affect their quality of life. Healthcare providers and survivors' families often do not understand what recovery means in this population, which may affect the support provided. Aim To consider the potential of the biographical method in helping to create stories that illustrate recovery in intensive care survivors and other populations. Discussion This paper identifies how the biographical approach has provided survivors with a way to uncover the hidden parts of their lives through diaries and interviews, and reveal the hidden stories of intensive care survivorship and recovery. Conclusion The application of the biographical method enabled stories to be created that identified the disruption survivors encounter as they struggle to appear recovered. Implications for practice The biographical method can illuminate experiences uncaptured by other methods. This insight into recovery journeys can help healthcare practitioners and family members to understand and recognise the need for support during recovery.