Exploration of how youth justice staff perceive the speech-language pathology role and service provision in an Australian youth justice setting.

PURPOSE: The aims of this project were to explore how youth justice staff perceive the speech-language pathology role and provision in an Australian youth justice setting, including the speech-language pathologist's role in supporting young people to participate in the activities of the youth justice service studied. METHOD: A narrative inquiry approach was employed to guide semi-structured interviews with youth justice staff. Perceptions and experiences were analysed via reflexive thematic analysis, with member checking and inter-rater coding utilised for rigour. RESULT: Seven semi-structured interviews were conducted. Interviewees worked in either the custodial setting (n = 3) or the community setting (n = 4) for the youth justice service studied, though most had worked in both settings. Six themes and six subthemes were identified from the interview data and related to factors that supported improved participation in the activities of the youth justice service studied. These factors were the speech-language pathology skillset and approach, and that there were systemic barriers within the service. All participants perceived speech-language pathology input as valuable for the young people in the service studied. There was also acknowledgement by the participants of how speech, language, and communication needs of the young people impacted their participation in the activities of the service studied. These findings were despite the perceived need for organisation-wide education on the speech-language pathologist role and offering. CONCLUSION: Increased understanding of how youth justice staff perceive the role and benefits of speech-language pathology in supporting young people in contact with the youth justice system will assist with service planning, inform education strategies, and may support policy change.

Child maltreatment and psycho-social impairments among child laborers in rural Bangladesh.

PURPOSE: The current study focused on exploring the impact of maltreatment of child laborers on their psychosocial health condition from the views of their parents. METHODS: A total of 100 parents of child laborers were recruited using snowball sampling. The structured questionnaire comprised two validated scales including ISPCAN Child Abuse Screening Tool (ICAST-P), and Paediatric Symptom Checklist (PSC) were used for the survey. Factor analysis and multivariable linear regression analysis were performed to examine the data using SPSS version 26, and Stata version 16.1. RESULTS: A three-factor model consisting of internalizing, externalizing, and attention associated psycho-social impairments of child laborers were derived from the 35-item scale of PSC tool and represented a good fit to the data. A mean estimate of maltreatment indicates that a majority of child laborers are maltreated psychologically, followed by physical maltreatment and neglect. The factor analysis resulted that maltreated child laborers are highly prone to exhibit internalized psycho-social difficulties, followed by externalized and attention-associated emotional and behavioral difficulties among child laborers. The regression model further depicts that child laborers, who had been physically and psychologically maltreated, are significantly more likely to be affected by internalized and attention-related psycho-social impairments. CONCLUSIONS: The study concluded that victimized child laborers exhibited significant internalized, as well as attention-related problems. These findings may be useful for future studies that examine emotional and behavioral problems among maltreated child laborers and, therefore, for developing prevention strategies.

Interventions to promote the health and well-being of children under 5s experiencing homelessness in high-income countries: a scoping review.

OBJECTIVES: Homelessness among families with children under 5 residing in temporary accommodation is a growing global concern, especially in high-income countries (HICs). Despite significant impacts on health and development, these 'invisible' children often fall through the gaps in policy and services. The study's primary objective is to map the content and delivery methods of culturally sensitive interventions for children under 5 experiencing homelessness in HICs. DESIGN: A scoping review guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SOURCES: Databases include PubMed, Medline, SCOPUS, The Cochrane Library and Google Scholar were searched up to 24 March 2022. ELIGIBILITY CRITERIA: This scoping review includes studies that describe, measure or evaluate intervention strategies aimed at improving child health programmes, specifically those yielding positive outcomes in key areas like feeding, nutrition, care practices and parenting. DATA EXTRACTION AND SYNTHESIS: Articles were selected and evaluated by two independent reviewers, with a dispute resolution system involving a third reviewer for contested selections. The methodological quality of the studies was assessed using various tools including the Risk of Bias (RoB) tool, Cochrane RoB V.2.0, the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), each selected according to the type of article. RESULTS: The database search yielded 951 results. After deduplication, abstract screening and full review, 13 articles met the inclusion criteria. Two predominant categories of intervention delivery methods were identified in this research: group-based interventions (educational sessions) and individual-based interventions (home visits). CONCLUSION: This review highlights effective interventions for promoting the health and well-being of children under 5 experiencing homelessness, including educational sessions and home visits. Research has supported the importance of home visiting to be instrumental in breaking down language, cultural and health literacy barriers.

Maltreatment of child labourers in Bangladesh: Prevalence and characteristics of perpetrators.

Background: Child labourers are highly prone to maltreatment mostly perpetrated by members of their immediate family as well as employers and co-workers. This maltreatment is considered to be a serious public health issue. However, little is known about this form of violence. Purpose: This study aimed to explore the views of key informants on the prevalence and attributes of perpetrators of the maltreatment of child labourers in Bangladesh. Methods: The key experts were paediatricians, journalists, academics, and government bureaucrats such as policy makers and Non-Government Organisation employees working in the area of child abuse or labour relations. Interviews were purposefully conducted via TEAMS with 17 expert participants. A thematic analysis using NVivo was used to analyse the data. Results: The key informants were of the opinion that the prevalence of the maltreatment of child labourers was unknown. However, they were of the view that physical maltreatment of child labourers occurred between 70% and 100% of the time, while emotional abuse and neglect was estimated to be 100% followed by 50% for financial exploitation. Child maltreatment is more likely to occur in informal workplace environments. Biological and foster parents were considered the primary perpetrators, while employers and adult co-workers were considered secondary perpetrators. Perpetrators of child labour maltreatment were often characterized as having a history of childhood maltreatment themselves, a lack of knowledge of social awareness and parenting, and suffer from economic difficulties. Conclusion: The finding also calls into question the validity of key informant interviewing. Only the journalists, academics and medical experts had first-hand knowledge of the maltreatment of child labourers with experts in the NGO sector and government policy makers lacking detailed knowledge of the field.

Logic modelling as hermeneutic praxis: Bringing knowledge systems into view during comprehensive primary health care planning for homelessness in Australia.

Logic modelling is used widely in health promotion planning for complex health and social problems. It is often undertaken collaboratively with stakeholders across sectors that hold and enact different institutional approaches. We use hermeneutic philosophy to explore how knowledge is 'lived' by - and unfolds differently for - cross-sectoral stakeholders during comprehensive primary healthcare service planning. An Organisational Action Research partnership was established with a non-government organisation designing comprehensive primary health care for individuals experiencing homelessness in Adelaide, Australia. Grey literature, stakeholder input, academic feedback, a targeted literature review and evidence synthesis were integrated in iterative cycles to inform and refine the logic model. Diverse knowledge systems are active when cross-sectoral stakeholders collaborate on logic models for comprehensive primary health care planning. Considering logic modelling as a hermeneutic praxis helps to foreground and explore these differences. In our case, divergent ideas emerged in how health/wellbeing and trust were conceptualised; language had different meanings across sectors; and the outcomes and data sought were nuanced for various collaborators. We explicate these methodological insights and also contribute our evidence-informed, collaboratively-derived model for design of a comprehensive primary health care service with populations experiencing homelessness. We outline the value of considering cross-sectoral logic modelling as hermeneutic praxis. Engaging with points of difference in cross-sectoral knowledge systems can strengthen logic modelling processes, partnerships and potential outcomes for complex and comprehensive primary health care services.

Nursing students' experience of workplace violence in clinical practice: A qualitative systematic review.

AIMS: To systematically identify, appraise and synthesise qualitative studies investigating Registered Nurse students' (RNS) experiences of workplace violence (WPV) while on clinical placement. It is expected that the literature review findings will guide the development of targeted programs and policies to address WPV against RNS. BACKGROUND: WPV affects RNS during clinical placements as they are vulnerable to violence due to their limited experience and skills to challenge abusive behaviour. In this review, RNS are students enrolled in a Bachelor of Nursing program to become registered nurses and exclude students who are enrolled in nursing program that does not lead to registration as a registered nurse. For example, enrolled in nursing programs and postgraduate nursing programs. RNS are chosen for their scope of practice and the training requirements. RNS reported experiencing WPV mainly from colleagues, staff, teachers, doctors and supervisors, which resulted in leaving nursing practice, impacting students' progression and healthcare systems. This review examines all types of violence RNS face irrespective of the abuser. METHODS: A qualitative systematic review of existing literature was conducted through a comprehensive database search of eight databases MEDLINE, CINAHL, Web of Science, Scopus, Embase, Cochrane Central and ProQuest. Furthermore, reference lists of included studies were searched to identify further research. English language qualitative primary studies of any study design were searched from inception to 6th June 2022 and included if they met the inclusion criteria. Double review process utilised from screening until data synthesis reported according to PRISMA. JBI critical appraisal tools were used to assess the studies, and data extraction utilised JBI QARI tool and screened for credibility and confidence in findings. RESULTS: A total of 18 studies met the inclusion criteria, and the studies were conducted in nine countries. Five main themes relating to RNS experiences of WPV while on clinical placement were identified, including: 'Types of workplace violence', 'Perpetrators', 'Causes', 'Consequences' and 'Management of workplace violence'. CONCLUSIONS: This qualitative systematic review provides new and significant knowledge in understanding the phenomenon of WPV experienced by RNS while on clinical placement. RELATIVE TO CLINICAL PRACTICE: This review highlights the unwillingness of RNS to reach out to instructors or clinical placement leaders in many situations and identifies avenues of support and awareness that are crucial to empower and enabling students to seek support.

Do nurses receive any support following incidents of workplace violence? A qualitative study.

AIM: We aim to investigate nurses' perceptions of support after incidences of Workplace Violence. BACKGROUND: Nurses experience workplace violence daily. Adequate support following incidents of violence can reduce adverse impacts. Current support systems for coping with workplace violence are lacking. METHODS: Focus group interviews were conducted with 23 nurses working in a regional Queensland Hospital. Qualitative data was transcribed and thematically analyzed to determine themes. The consolidated criteria for reporting qualitative research checklist was followed. RESULTS: The primary source of support after a violent incident was from other nurses. Support was needed immediately to empower nurses to be able to continue their caring role. Often the support was not provided nor were nurses aware of the support services available. Although personal family and friends were a valuable support, most nurses were reluctant to disclose their experiences to protect them. CONCLUSIONS: This paper discusses nurses' experience of support following violence incidents at work as part of findings from a more extensive study that explored the perceptions of nurses regarding violence, strategies and support in a regional Queensland Hospital. Hospital support following a violent incident was perceived as inadequate and nurses felt unsupported immediately following an incident. IMPLICATIONS FOR NURSING MANAGEMENT: After an incidence of workplace violence, appropriate effective support may mitigate the enduring impacts of experiencing violence. There is the need for hospital management to provide effective support services and improve staff awareness of available support services.

Aboriginal children and family connections to primary health care whilst homeless and in high housing mobility: observations from a Nurse Practitioner-led service.

AIM: This article documents the impact of a Nurse Practitioner-led primary health service for disadvantaged children living in housing instability or homelessness. It identifies that First Nations children miss out on essential primary care, particularly immunisation, but have less severe health conditions than non-First Nations children living in housing insecurity. BACKGROUND: Health services for homeless populations focus on the 11% of rough sleepers, little is done for the 22% of children in Australia living in housing instability; many of whom are from First Nations families. Little is known of the health status of these children or their connections to appropriate primary health care. METHODS: This research implemented an innovative model of extended health care delivery, embedding a Nurse Practitioner in a homeless service to work with families providing health assessments and referrals, using clinically validated assessment tools. This article reports on proof of concept findings on the service that measured immunisation rates, developmental, medical, dental and mental health needs of children, particularly First Nations children, using a three-point severity level scale with Level 3 being the most severe and in need of immediate referral to a specialist medical service. FINDINGS: Forty-three children were referred by the service to the Nurse Practitioner over a 6-month period, with nine identifying as First Nations children. Differences in severity levels between First Nations/non-First Nations children were Level 1, First Nations/non-First Nations 0/15%; Level 2, 10/17%; and Level 3, 45/29%. Forty-five percent of First Nations children had no health problems, as compared to 29% on non-First Nations children. Immunisation rates were low for both cohorts. No First Nations child was immunised and only 9% of the non-First Nations children. While numbers for both cohorts are too low for valid statistical analysis, the lower levels of severity for First Nations children suggest stronger extended family support and the positive impact of cultural norms of reciprocity.

A Nurse Practitioner service designed to address the health needs of children living in housing instability: A non-randomised, concurrent mixed methods study protocol.

In 2019-2020 we conducted a pilot study of a Nurse Practitioner clinic working with housing insecure children (0-18 years) that found high levels of developmental delay, missed immunizations and dental caries. This present non-randomized, concurrent mixed-methods study protocol explains the next phase of the research designed proving proof of concept for a Nurse Practitioner model of care for these vulnerable children. Focusing on identifying and understanding clinic admission processes, tracking referral pathways and uptake, and how many vulnerable children miss potential care and why. This will help us to understand and address gaps in health service delivery for this cohort. DESIGN: The study uses a concurrent mixed- method design where both qualitative and quantitative data are collected during the same period (between January 2021 and March 2022 as per the funding timeline). METHODS: The concurrent mixed-method design will collect data from: A comprehensive assessment tool used by the Nurse Practitioner to evaluate the child accessing specialist homeless services, which assess their mental, physical and social health needs. Documentation about the child's referral needs and uptake by disadvantage families. Interviews with housing insecure families, and staff/managers of the specialist homeless service. A review of Nurse Practitioner case notes. Surveys of families with children accessing the Nurse Practitioner service. DISCUSSION: Addressing the childhood impacts of family homelessness is of global importance. Structural equation modelling, from the surveys and in-depth health assessments along with the thematic analysis of the interviews with parents and staff/managers provide an understanding of the relationships between referral uptake and variables such as education, homelessness and transport accessibility. Investigating the enablers and barriers to the usual health access and our extended referral uptake impacted by family homelessness enables a better understanding of the current health gaps. IMPACT: Just over one fifth of Australian children live with their families in some form of housing instability including homelessness. These children, aged from birth to 18 years, are often disconnected from health and similar social institutions, making them an underserviced population. Our research investigates a Nurse Practitioner services that helps reconnect children with services to help avoid poor long-term health outcomes.

Beyond Kayaking - A qualitative investigation of parents and facilitators views regrading an outdoor, activity-based, multi-session parenting intervention program.

The Beyond Kayaking program is a free, outdoor activity-based, parenting intervention delivered across multiple sessions to vulnerable families in regional South Australia. Current literature on outdoor activity-based interventions have demonstrated improvements in family communication, problem-solving, bonding and trust. However, these studies are mostly based on single session interventions from the United States. This study explored the subjectively reported benefits of a multi-session intervention delivered in an Australian setting including how families perceived their relationships had changed (if at all) through participation in the program. This was accomplished through the use of open-ended, qualitative interviews with 20 parents who participated in the Beyond Kayaking program between 2016 and 2017. Additionally, a one-off focus group with three members of Beyond Kayaking staff was conducted to give context to the research. Thematic analysis of the data identified three dominant themes regarding participants' experiences of the Beyond Kayaking program. The first theme was 'building family capacity' and identified how kayaking produced an environment that helped families to communicate and problem solve together, which improved family understanding overall. The second theme was 'local culture' which discussed how education on local Indigenous culture helped build awareness in non-Indigenous people while helping Indigenous families to connect. The final theme 'support and shared circumstances' discussed the benefits of participants meeting people in similar circumstance, which helped them both improve, and feel better about, their own situation. Importantly, this study demonstrates that learning a new skill while being unsure and vulnerable in front of others strengthens family relationships - thus improving understanding of how activity-based interventions aid families. However, longitudinal research that follows up with participants is needed to better understand the lasting impacts of the improvements witnessed in this research.

Where is community during COVID-19? The experiences of families living in housing insecurity.

This article explores the understanding of community to families living in insecure housing in one Australian state during the COVID-19 pandemic. Five female-headed families were interviewed during the pandemic and asked to identify what community meant to them. All participants were referred by an agency caring for families experiencing homelessness or housing insecurity. Community was defined using Bourdieu's concept of social capital, allowing for both bonding and bridging relationships to be explored. Bonding relationships refer to close emotional ties with family and friends, while bridging ties establish networks that provide individuals with access to resources. Two themes emerged that shed light on how community is understood during times of crisis: The first suggests that for families experiencing housing insecurity, particularly women escaping family violence, their links with community were primarily maintained by welfare and church agencies. These organisations provided bridging social capital during the pandemic that allowed the women and their children to cope with the isolation and to maximise opportunities. The second themes point to traditional notions of community as family and geographical space. Here the findings are mixed. Resources provided by government, and mediated through the welfare agency, allowed these families to create a safe and comfortable space. However, for First Nations women, the lockdown meant that it was difficult to maintain community obligations, while children who appeared to identify community with attendance at school found the lockdown confusing because of the disruption to their normal social space.

The prevalence and impact of maltreatment of child laborers in the context of four South Asian countries: A scoping review.

BACKGROUND: Child maltreatment is a global health concern, which adversely affects millions of children. Among them, child laborers are highly susceptible to maltreatment due to their economic vulnerability and workplace practices. OBJECTIVES: This review seeks to identify the extent, risk factors and psychological impairments associated with the maltreatment of child laborers in four South East Asian countries. METHODS: A scoping review was adopted, in accordance with the PRISMA framework. Scopus, Medline, PsycINFO, ProQuest, Web of Sciences, and grey literature from relevant institutional websites were searched. Search date parameters were 1960-2020. A thematic synthesis and a proportion test were adopted to analyse data. RESULTS: A total of 9 studies were retrieved. The physical maltreatment against child laborers (15.14 %) was found across all studies with high heterogeneity (from 2.3%-73.27%). The prevalence of emotional maltreatment was more than three times that of physical abuse. Sexual abuse rate was measured (16.82 %) followed by neglect against child laborers (12.9 %). Witness victimization, financial exploitation, forced work, and work intensification were also observed as notable forms of maltreatment. A thematic analysis suggests that the victims and caregivers' characteristics and socio-cultural practices are strong predictors of maltreatment. Parental dysfunctions were also associated with rates of child labor victimization followed by poverty. The review found maltreated children were often traumatized and manifest specific phobias (38.79 %), social phobias (30.2 %), conduct disorders (20.6 %), and obsessions (18.21 %), which are significantly associated (p < 0.05) across studies. CONCLUSIONS: While the methodical study base is limited, the results of this review can inform further research on violence against child laborers.

Hope in Iranian mothers of children with cancer: a descriptive correlational study.

PURPOSE: This study aims to examine the relationship between the level of hope in mothers who have a child with cancer and its related factors in Iran. METHOD: A cross-sectional and descriptive correlational design was used in this study. A demographic questionnaire and the Herth Hope Index (HHI) were administered to a sample of 240 mothers who have a child with cancer to assess level of hope. Mothers were also asked to indicate their highest priority hopes such as view of their supportive resources including financial support, psychosocial support, religiosity and spirituality. Data was analysed using descriptive statistics, Spearman's rho, independent sample t test and one-way ANOVA. RESULTS: The mean HHI score was 35.44 (n = 237). There was a positive correlation between HHI total score and spirituality (r = 0.267, P < 0.001), and psychosocial support (r = 0.281, P < 0.001). No significant differences were found between HHI total score and respondents who saw themselves as a religious person and the family financial support. There was a significant difference in HHI total scores for a mother who has a disabled child (M = 32.92, SD = 2.75; t (235) = 2.00, P = 0.046) and mothers of a child who do not have any disability besides their cancer (M = 35.59, SD = 4.91). No significant differences were found in the HHI total score and different group of the child's diagnoses and the mother's age or/and child's age. CONCLUSION: Mothers who have a child with cancer with better psychosocial and spiritual support showed a higher level of hope. A thorough knowledge of factors associated with hope in mothers caring for children suffering from cancer could provide a means to further advance the support delivered and the available resources given to the parents, especially the mothers.

Antenatal Dads and First Year Families program: a qualitative study of fathers' and program facilitators' experiences of a community-based program in Australia.

AIM: Currently, there is limited knowledge on the impact of father-only sessions or parenting programs supporting impending fatherhood. This research explored an antenatal dads program aimed at fathers to assess the benefits of such interventions. BACKGROUND: Literature regarding parenting programs and early childhood education initiatives, especially those aimed at children and families in disadvantaged circumstance, have been demonstrated to act as a buffer to poorer health and lifestyle outcomes in later life. METHODS: A qualitative research approach was used to explore the experiences of 16 fathers and 6 staff of a community-based parenting program with sessions focusing on fatherhood. FINDINGS: Four main themes were identified from the data regarding the experiences of groups engaged with the Antenatal Dads and First Year Families program. The first theme 'Knowledge and Capacity Building' stated that the information provided in the program helped fathers to be better informed and prepared for their impending fatherhood. The second theme was 'Mental Health Awareness' and identified the importance of raising awareness of depression and suicide in fathers, including where and how to get help. The third theme was 'Soft-Entry' and highlighted how the attendance at one service helped participants to learn about additional services through word of mouth and targeted promotion. The final theme was 'Feeling Connected', which helped fathers to feel more connected with the process of childbirth and development including playing and engaging with their children. Overall, the fathers found that the male-only sessions assisted them by supporting frank discussions on fatherhood. Additionally, the study helped identify the advantages of fathers meeting other fathers through attendance in the program, or even other couples in similar situations that helped fathers to feel less lonely regarding their situation.

Assessing levels of student nurse learning in community based health placement with vulnerable families: Knowledge development for future clinical practice.

BACKGROUND: Community services work with vulnerable families to assist them to link with health, education and welfare services. Community placements provide nursing students with understandings of the health impacts of social circumstances on broad population's. Nurses provide health care for vulnerable populations so it is important for students to gain experience in dealing with various population groups in a variety of settings. Community placements can increase student confidence to provide care for all people in the acute care setting. OBJECTIVES: The research project explored the use of a community placement to assist nursing students in applying psychosocial theories to practice; determining the affect of nursing students to the community service; and if the learning achieved in the placement was applicable to their future nursing practice were also objectives of the research. DESIGN: The mixed methods design used placement suitability focused questionnaires, and student, staff and clinical supervisor one-to-one interviews. SETTINGS: In 2015 a community based homelessness service which provides a home visiting service approached the School of Nursing and Midwifery to provide a community placement for nursing students. The urban homelessness service caters for 350 homeless clients per month. PARTICIPANTS: Eight second year nursing students and six fulltime homelessness staff, mainly social workers, participated in the surveys and interviews. METHODS: Nursing students were 'buddied' with a social worker and visited individuals and families recently placed in emergency housing. The student nurses (8) and homelessness staff (6) were surveyed and interviewed about their knowledge, skills and perceptions about the value of community based placements. RESULTS: Findings indicate student's recognition of the skills to be learned in a non-acute setting are applicable to all clinical settings and enhance student knowledge and potential future care. The staff in the homelessness service espouse the enhancement provided by the expertise of the nursing students working with vulnerable populations. This paper highlights the benefits as perceived by students on often undervalued community based placements. CONCLUSIONS: It is essential that universities collaborate with industry and consumers to ensure that the undergraduate programs offer a high standard of care and address current trends in the health care industry. There is a growing need for workforce development in primary healthcare and an increased understanding about how adversity can lead to ill health.

How do nurse practitioners work in primary health care settings? A scoping review.

OBJECTIVES: This scoping review explores the work of nurse practitioners in primary health care settings in developed countries and critiques their contribution to improved health outcomes. DESIGN: A scoping review design was employed and included development of a research question, identification of potentially relevant studies, selection of relevant studies, charting data, collating, summarising and reporting findings. An additional step was added to evaluate the methodological rigor of each study. DATA: Data sources included literature identified by a search of electronic databases conducted in September 2015 (CINAHL, Informit, Web of Science, Scopus and Medline) and repeated in July 2016. Additional studies were located through hand searching and authors' knowledge of other relevant studies. RESULTS: 74 articles from eight countries were identified, with the majority emanating from the United States of America. Nurse practitioners working in communities provided care mostly in primary care centres (n=42), but also in community centres (n=6), outpatient departments (n=6), homes (n=5), schools (n=3), child abuse clinics (n=1), via communication technologies (n=6), and through combined face-to-face and communication technologies (n=5). The scope of nurse practitioner work varied on a continuum from being targeted towards a specific disease process or managing individual health and wellbeing needs in a holistic manner. Enhanced skills included co-ordination, collaboration, education, counselling, connecting clients with services and advocacy. Measures used to evaluate outcomes varied widely from physiological data (n=25), hospital admissions (n=10), use of health services (n=15), self-reported health (n=13), behavioural change (n=14), patient satisfaction (n=17), cost savings (n=3) and mortality/morbidity (n=5). CONCLUSIONS: The majority of nurse practitioners working in community settings did so within a selective model of primary health care with some examples of nurse practitioners contributing to comprehensive models of primary health care. Nurse practitioners predominantly worked with populations defined by an illness with structured protocols for curative and rehabilitative care. Nurse practitioner work that also incorporated promotive activities targeted improving social determinants of health for people rendered vulnerable due to ethnicity, Aboriginal identity, socioeconomic disadvantage, remote location, gender and aging. Interventions were at individual and community levels with outcomes including increased access to care, cost savings and salutogenic characteristics of empowerment for social change.

Improving clinical handover in a paediatric ward: implications for nursing management.

AIM: To describe how nursing staff in a paediatric ward improved the conduct of clinical handover, using a practise development approach. BACKGROUND: ISBAR (Identify, Situation, Background, Assessment and Recommendation) is a mnemonic tool to aid the safe transfer of patient information in clinical handover. The nurses identified the need to improve the use of ISBAR, and other issues related to handover that could compromise patient safety and constrain family-centred care. METHOD: Sixty-one percent of nurses on the ward contributed to issue identification and the design of the educational material, including a set of written and video resources and incorporating the role of a handover coach. Staff performance was evaluated before and after access to the resources using self-administered Likert scales, observation and a focus group. RESULTS: After the intervention, there was a stronger relationship between the participants' understanding of ISBAR and their application of it in handover. Further, there were statistically significant increases in improved handover practises, including family inclusion and safety checks. IMPLICATIONS FOR NURSING MANAGEMENT: A practise development approach is useful in the provision of education to guide clinical performance in patient handover. Nurse managers can use this approach to empower their staff to make positive changes to practise.

A Comparison of Sound Levels in Open Plan Versus Pods in a Neonatal Intensive Care Unit.

OBJECTIVE: The objective of this study was to compare the noise levels recorded in two different neonatal intensive care unit (NICU) settings: a pod and an open plan NICU located in the same hospital. BACKGROUND: The NICU is a busy environment with ambient noise levels that often exceed established recommendations. This noise deleteriously affects the physiological stability and developmental outcomes of sick and preterm infants. Pods have reduced numbers of cots (in this case, 6) compared to open plan NICUs (in this case, 11), yet the noise levels in pods have not been reported. METHOD: This study compared real-time decibel (dB) levels in an A-weighted scale, captured continuously by sound dosimeters mounted in both NICU settings for a period of 4 weeks: a pod setting and an open plan NICU. Researchers also collected observational data. RESULTS: The average noise level recorded in the pod was 3 dBs less than in the open plan NICU. This result was statistically significant. However, dB recordings in both areas were over the recommended limits by 4-6 dBs, with isolated peaks between 74.5 dBs (NICU) and 75.9 dBs (pod). Observational data confirmed this correlation. CONCLUSIONS: Further research to evaluate interventions to decrease the noise levels in both settings are needed, especially during times of peak activity. Staff working in these settings need to be more aware that control of acoustic levels is important in the neuroprotection of neonates. Coupling this with careful consideration to structural components and evidence-based design planning may contribute to lowering dB levels in the NICU environment.