Mental deterioration of refugees and asylum seekers with uncertain legal status in Australia: Perceptions and responses of legal representatives.

BACKGROUND: Many developed countries have introduced strict measures designed to deter people seeking asylum. Measures such as held detention, insecure visas, restrictions work and services all impact the mental health of asylum seekers. In 2014 Australia introduced a 'fast track assessment' (FTA) system of processing refugee claims for asylum seekers who arrived by boat, those found to be refugees were only eligible for temporary residence. Legal professionals play a pivotal role in protecting the rights of asylum seekers and gain unique insight into the impact of the legal system has on clients mental health. AIM: To investigate how legal professionals in Australia perceived the impact of the FTA process on their clients. METHODS: Mixed methods comprising of two phases - (i) an online survey and (ii) follow-up focus groups and interviews with legal professionals involved in assisting asylum seekers in the FTA process. An inductive thematic analysis was used to analyse the data. RESULTS: Survey results were obtained from 38 legal professionals. Follow up in depth qualitative focus groups and interviews were conducted with 16 survey participants. The data demonstrate that legal professionals encounter clients in complex seemingly insurmountable mental health crises including deepening mental distress and deterioration, feelings of hopelessness, defeat and entrapment. Interviewees shared compelling examples of what they believed constituted a direct connection between asylum seekers experiencing uncertainty and deteriorating mental health over time with fluctuations in hopelessness, anger, withdrawal and suicidality. These negative impacts were often compounded by separation from family. CONCLUSIONS: The legal framework for determining whether an asylum seeker is a refugee can have a detrimental impact on the mental health of asylum seekers. The mental distress of asylum seekers and refugees is exacerbated by uncertainty linked to both delays in processing accompanied by sustained and ongoing uncertainty of legal status.

Developing the Next Generation of Nursing Disciplinary Leaders in Higher Education: Protocol for a Sequential Mixed Methods Study.

BACKGROUND: Leading nurse education and research in the higher education (HE) sector has become increasingly challenging over the last decade with many universities in Australia and New Zealand having undergone academic restructuring. The future of HE faces many challenges including recruitment of suitably qualified staff to lead teaching and research and advance professional disciplines. Increasing cultural diversity of the Nursing workforce and the communities' nurses serve, and the identification of cultural attributes in the context of racial inequities exposed by the pandemic and the climate emergency suggest different forms of leadership may be required in the future by those leading nurse education in the HE sector. Currently, there is a dearth of research evidence that identifies the qualities, behaviors, and characteristics (collectively identified as core attributes) required by nurse academic leaders. OBJECTIVE: This research aims to identify an evidenced based set of core attributes that are required to lead the discipline of Nursing in the Australian and New Zealand HE sectors. METHODS: This research is using a 2-phase sequential mixed methods design incorporating a scoping review; and Delphi technique. In phase 1, a scoping review will be undertaken to identify the qualities, behaviors, and characteristics that can influence the evolution of the next generation of academic nurse leaders. A set of draft statements and questions will be prepared based on analysis of findings from the review. Phase 2 uses Delphi technique consisting of e-survey rounds with experts in leading nursing faculties in Australia and New Zealand. An Expert Advisory Group will consider the initial set of draft statements and questions from phase 1. Consistent with Delphi technique, a series of "rounds" will then occur using an e-survey method. Established leaders (Professors and Associate Professors who are members of the Council of Deans Australia and New Zealand) will rate their level of agreement to statements on the qualities, behaviors, and characteristics required to lead the discipline of nursing in the HE sector in Australia and New Zealand. RESULTS: The findings of the scoping review will identify what is currently known about the qualities, behaviors, and characteristics of academic nurse leaders. Quantitative and qualitative results from the Delphi study will initially be reported in separate manuscripts for publication. It is projected that a final paper will be prepared from aggregated research data and outline how the findings can inform the preparation of future academic nurse leaders. CONCLUSIONS: The generation of an evidenced-based set of core attributes will serve to inform the next generation of academic nurse leaders including informing recruitment processes and postgraduate nurse leadership programs. It is anticipated that the data sets and findings will be transferrable to other disciplines within HE to aid in future-proofing discipline-based expertise and leadership in the context of academic restructure. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40677.

Suicide deaths following police contact: A review of coronial inquest findings.

We analyzed 10 years of Australian coronial inquest documents on people who died by suicide or suspected suicide following recent contact with the police. We identified 149 cases of suicide or suspected suicides via coronial websites, 34 of which contained recommendations. We developed four themes from these recommendations, the most common of which was for police to change current practices or policies and modify police officer training. Coroners considered effective working relationships with external stakeholders able to assist police an important means of reducing risk of suicide.

A trauma informed response to COVID 19 and the deteriorating mental health of refugees and asylum seekers with insecure status in Australia.

COVID-19 brings increased risk to the mental health of asylum seekers and refugees in Australia on temporary visas. Rapid government changes due to the COVID-19 pandemic are resulting in significant and sustained hardship on this already vulnerable group. This discursive paper is both an explainer and a resource for mental health nurses and health professionals with scope of practice in primary care and emergency departments responding to this population. The aim of this paper is to alert clinicians to the drivers of mental and suicide related distress and to provide recommendations as to how to therapeutically engage and support this group. Drivers include complex intersections between legal uncertainty, economic, social and mental health stress as drivers of entrapment, acute mental distress and suicidal ideation. Information about the COVID-19 related factors as drivers contributing to worsening states of distress may help guide clinicians to consider protective factors designed to mitigate the onset or worsening of mental distress, plus aid in the development of health policy and service-delivery arrangements of support and therapeutic engagement.

Technical and contextual barriers to oral care: New insights from intensive care unit nurses and health care professionals.

Oral care for intubated patients in the intensive care unit (ICU) is known to reduce bacterial colonization in oropharyngeal cavities decrease development of ventilator associated pneumonia (VAP) and the associated costs of managing this complication (1-4). Provision of oral hygiene by nurses is a fundamental aspect of care in the ICU (5). However, such a basic nursing activity can be devalued or rendered invisible by nurses when there is a greater emphasis on managing and maintaining biotechnology and/or a failure to underpin practice with research evidence that demonstrates the importance of fundamental care (5). A Canadian study by Dale and colleagues (6) to explore clinicians' knowledge of, and experiences with, delivering oral care in intubated patients is a timely reminder that the complexity of performing oral care in the ICU should not be underestimated or undervalued.

Health advice and education given to overweight patients by primary care doctors and nurses: A scoping literature review.

Health advice for overweight patients in primary care has been a focus of obesity guidelines. Primary care doctors and nurses are well placed to provide evidence based preventive health advice. This literature review addressed two research questions: 'When do primary care doctors and nurses provide health advice for weight management?' and 'What health advice is provided to overweight patients in primary care settings?' The study was conducted in the first half of 2018 and followed Arksey and O'Malley (2005) five stage framework to conduct a comprehensive scoping review. The following databases were searched: Emcare, Ovid, Embase, The Cochrane library, Proquest family health, Health source (nursing academic), Joanna Briggs Institute EBP database, Medline, PubMed, Rural and remote, Proquest (nursing and allied health) and TRIP using search term parameters. Two hundred and forty-eight (248) articles were located and screened by two reviewers. Twenty-three research papers met the criteria and data were analysed using a content analysis method. The results show that primary care doctors and nurses are more likely to give advice as BMI increases and often miss opportunities to discuss weight with overweight patients. Body Mass Index (BMI) is often wrongly categorised as overweight, when in fact it is in the range of obese, or not recorded and when health advice is given, it can be of poor quality. Few studies on this topic included people under 40 years, practice nurses as the focus and those with a BMI of 25-29.9 without a risk factor. A 'toolkit' approach to improve advice and adherence to evidence based guidelines should be explored in future research.

Police response to individuals displaying suicidal or self-harming behaviours: An integrative review.

Police are increasingly being called upon to respond to people experiencing suicidal crisis. Such incidents are a challenging aspect of modern policing. This paper reports on an integrative review study that aimed to investigate police responses to individuals displaying suicidal or self-harming behaviours. Six electronic databases were searched for peer-reviewed articles published between 2007 and 2017 relating to police responses to individuals in suicidal crisis. The review identified 12 studies that met the inclusion criteria. A content analysis was conducted to identify and describe the key characteristics emerging from the literature, which identified four themes: "characteristics of individuals"; "the use of violence and weapons"; "contact with police prior to suicide"; and, "police officer training". Findings from this study indicate that individuals involved in incidents of suicidal and self-harm crisis with police are often male, aged between 35 and 40 years, single and/or having relationship issues, with a history of mental health issues and in recent contact with police prior to the incident of suicidal crisis-either as a victim or a perpetrator. The results highlight that large proportions of individuals in suicidal crisis within a community located incident are likely to present with violent or aggressive behaviour and in many situations are armed with a weapon used to either threaten or injure police and/or bystanders or self-harm. Training and education can have a positive impact from the perspective of police responding to individuals in suicidal crisis. Limitations in the current evidence are identified and implications for future research are outlined.

Authentic practice environments to support undergraduate nursing students' readiness for hospital placements. A new model of practice in an on campus simulated hospital and health service.

This paper reports on a unique practice based learning model to prepare undergraduate nursing students for clinical placement. The learning and teaching model described in this paper outlines the establishment of an entire on-campus simulated hospital and health service (SHHS) at the University of South Australia, School of Nursing and Midwifery. The model is pedagogically structured to immerse students in an authentic clinical environment to achieve deep learning in preparation for safe practice. A quality improvement cycle was used to evaluate the outcomes of the model in two phases: Phase 1: Purposive sampling of first and second year Bachelor of Nursing students from 2012 to 2015 who were surveyed about their satisfaction with the model of learning. Bachelor of Nursing students were invited to complete a survey about their experience with the teaching and learning model employed in the SHHS in response to the question, 'What aspects of the SHHS are the most important to your success?' Phase 2: External clinical stakeholders working with nursing students in clinical placements were asked to respond to questions about the preparedness of students educated in this model to transition to employment. The evaluation showed that the SHHS model positively influenced students' satisfaction and confidence and increased the perception of clinicians of the work readiness of students.

Lethal hopelessness: Understanding and responding to asylum seeker distress and mental deterioration.

The mental deterioration of the so called 'legacy caseload' (asylum seekers who arrived in Australia by boat between August 2012-December 2013) has become a national concern and is garnering international attention. Prolonged uncertainty is contributing to mental deterioration and despair. There have been at least 11 deaths by suicide since June 2014. Social support services have been limited and legal assistance in short supply; this is associated with lengthy delays with visa applications. Thwarted belongingness, purpose and identity, a shortage of available services, and barriers to legal support for processes attendant upon Refugee Status Determination increase the likelihood that the mental health of asylum seekers will deteriorate further, potentially developing into worsening decline, which will lead to increased self-harm and suicide. This article summarises recent suicide deaths in Australia, positing practical assistance and support for asylum seekers living in the community. Therapeutic engagement should be trauma-informed wherever possible, helping asylum seekers to reframe their sense of lethal hopelessness.

Visibility and meanings of partnership in health care for older people who need support to live at home.

INTRODUCTION: Problems experienced by older people with complex needs to live at home have been reported in the literature. This qualitative study builds on previous research and investigates enduring issues older people face when interacting with healthcare services. AIM: To gain an in-depth understanding of what is involved in providing good quality health care for older people who need support to live at home. METHODOLOGICAL DESIGN: We adopted an interpretive descriptive approach and conducted semi-structured interviews with older people (n = 7), carers (n = 8) and key informants (n = 11). Initial and secondary analysis of qualitative data was completed. FINDINGS: Major themes emerged about meanings of partnership in health care, and invisibility of the older person as a partner in health care. Partnership in health care was understood to mean being treated as an equal, being involved in decision-making, and making contributions which impact on health care and health systems. The metaphorical concept of 'invisibility' related to the older person not being seen and heard as a partner in health care, as well as being a recipient of care. CONCLUSIONS: We concluded that older people who need support to live at home are not highly visible to health providers, policymakers and researchers as a central partner and consumer to be meaningfully engaged in shaping their health care. Opportunities to address persistent issues with quality of health care may in future be achieved through stronger partnerships between older people and health providers, to find new ways to improve the quality of care for older people.

Experiences of health care for older people who need support to live at home: A systematic review of the qualitative literature.

Perceived experiences of health care for older people who need support to live at home can illuminate areas needing improvement in quality of care, and guide towards better ways to support ageing populations to live at home. This systematic review synthesized findings from the qualitative literature about perceived experiences of health care for older people who need support to live at home, from the perceptions of older people, carers and health providers. Searches of electronic databases and eligibility screening produced 46 included studies for review. Thematic synthesis revealed how health care impacts on the older person's sense of autonomy, both in health care decisions and everyday life. Autonomy is empowered by the older person's own capacity and by respectful conduct of health providers. Engagement between older people, carers and health providers is a negotiated interaction, affected by multiple factors.

The patient experience of remote telemonitoring for heart failure in the rural setting: a literature review.

BACKGROUND: Remote telemonitoring is utilised to provide specialised care to people with heart failure living in rural locations. There is limited research into the patients' experience of telemonitoring. OBJECTIVE: This literature review was completed to examine the available evidence and inform the development of a telemonitoring service. METHODS: Cochrane Database of Systematic Reviews; Medline; CINAHL database, Joanna Briggs Institute, AMED, EMBASE were searched using the key words. A thematic analysis was applied. RESULTS: Forty-six studies reviewed, 11 met inclusion criteria. Individual health status, use of technology, and effect on lifestyle influenced the patient experience. CONCLUSION: Limited literature was available addressing the patient experience of telemonitoring and no studies were found that specifically investigated the experiences of patients with heart failure in rural locations. Further research is required to examine the patient/user perspective of this type of service, and explore the feasibility of including telemonitoring in usual care.

Benefit of hindsight: systematic analysis of coronial inquest data to inform patient safety in hospitals.

Objective The aim of the present study was to explore the potential of coronial inquest data to inform patient safety improvement in hospitals at a system level. Methods A retrospective analysis of 20 years of South Australian (SA) coronial inquest findings was performed using both qualitative content analysis methods and statistical descriptive analyses. Results In all, 113 cases were analysed. More than one-third of deaths (39%) were associated with emergency care. Analysis revealed 11 recurrent themes and two notable contributing factors that highlighted specific areas of concern for SA hospitals over that time period. The most common action recommended by coroners (49.6%; n=56 cases) was the review or development of policy, protocol, procedure or guidelines designed to improve patient care. In almost one-quarter (24%) of deaths reviewed, coroners alerted health authorities to poor standards of care and/or instructed individual clinicians to review the standard of their clinical practice. Conclusions The analysis provided a retrospective review of coronial inquest data associated with hospital care over a 20-year period. The findings highlight specific areas of concern for patient safety over that time. More broadly, this analysis contributes to an emerging body of evidence in the Australian academic literature that demonstrates the value of systematic analysis of coronial data at a system level to inform patient safety improvement in Australian healthcare. What is known about the topic? Australian coroners have an important role to play in public health and safety. Many areas of social inquiry across Australia use coronial inquest data to identify recurrent hazards and assist in the development of relevant social policy. However, there is very little research reported in the academic literature that associates analyses of coronial data with patient safety improvement in healthcare. Although coronial recommendations made from individual cases of avoidable death are considered by health authorities, there is no evidence in the academic or grey literature that any systematic analysis of coronial inquest data is undertaken at a national or state or territory level to contribute to patient safety improvement. The few cases that are reported in the Australian academic literature provide valuable evidence of the benefits in terms of identifying recurrent hazards and prompting practice change. What does this paper add? This paper provides a descriptive overview of 20 years of coronial inquest data associated with hospital care in one Australian state. It provides evidence of recurrent themes and noteworthy contributing factors that highlight specific areas of concern for patient safety in hospitals. The methods used in the analysis can be applied across other settings in Australian healthcare. In addition, the paper adds to an emerging body of research evidence in the Australian academic literature illustrating the benefits of reviewing coronial inquest data to inform patient safety initiatives. What are the implications for practitioners? Findings from this analysis can be used to further the knowledge and understanding of health practitioners working in hospital settings as to the type of patients, clinical incidents and medical management issues that have featured repeatedly in avoidable deaths reported by coroners.

Measurement of Vein Diameter for Peripherally Inserted Central Catheter (PICC) Insertion: An Observational Study.

Choosing an appropriately sized vein reduces the risk of venous thromboembolism associated with peripherally inserted central catheters. This observational study described the diameters of the brachial, basilic, and cephalic veins and determined the effect of patient factors on vein size. Ultrasound was used to measure the veins of 176 participants. Vein diameter was similar in both arms regardless of hand dominance and side. Patient factors-including greater age, height, and weight, as well as male gender-were associated with increased vein diameter. The basilic vein tended to have the largest diameter statistically. However, this was the case in only 55% of patients.

An analysis of Australian graduate critical care nurse education.

BACKGROUND: Preparation of specialist critical care nurses in Australia is at graduate level, although there remains considerable variation in courses offered in relation to qualification, content, assessment and outcomes. As higher education providers must now comply with the Australian Qualifications Framework (AQF) a study was conducted to examine existing critical care courses and graduate practice outcomes. METHODS: Twenty-two critical care courses were reviewed. Data sources included course provider, websites, course curricula and telephone interviews with course coordinators. A framework approach, was used consisting of five key stages: preliminary immersion of raw data, conceptualising a thematic framework, indexing, charting, mapping and interpretation of data. FINDINGS: Analysis revealed considerable variations in course delivery and graduate practice outcomes. Most courses used professional competency standards as a framework for course curricula and clinical assessment, with inconsistency in their translation to graduate practice outcomes. Twenty-one courses included clinical assessment at graduate certificate level with no clinical assessment conducted at master level. The expected practice outcome for fifteen courses was safe practice with graduates not expected to practice at a specialist or team leadership level. Minimum graduate practice standards were not included in three courses as an expected outcome. CONCLUSION: The AQF requires graduate nurse education to be compliant with academic outcome standards. The findings of our study indicate variations between courses and subsequent graduate practice outcomes. It is therefore timely to establish national critical care education graduate practice standards.

The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study.

BACKGROUND: Peripherally inserted central catheters (PICCs) are a common vascular access device used in clinical practice. Their use may be complicated by adverse events such as venous thromboembolism (VTE). The size of the vein used for PICC insertion and thus the catheter to vein ratio is thought to be a controllable factor in the reduction of VTE rates in patients who have a PICC. However, an optimal catheter to vein ratio for PICC insertion has not previously been investigated to inform clinical practice. OBJECTIVES: To determine the effect of the catheter to vein ratio (proportion of the vein measured at the insertion point taken up by the catheter) on rates of symptomatic VTE in patients with a PICC and identify the optimal ratio cut-off point to reduce rates of this adverse event. METHOD: Adult patients waiting for PICC insertion at a large metropolitan teaching hospital were recruited between May and December 2013. Vein diameter at the PICC insertion site was measured using ultrasound with in-built callipers. Participants were followed up at eight weeks to determine if they developed symptomatic VTE. RESULTS: Data were available for 136 patients (50% cancer; 44% infection; 6% other indication for PICC). Mean age was 57 years with 54% males. There were four cases of confirmed symptomatic VTE (two involving the deep veins, one peripheral vein and one pulmonary embolism). Receiver operator characteristic (ROC) analysis determined that a 45% catheter to vein ratio was the ideal cut off point to maximise sensitivity and specificity (AUC 0.761; 95% CI 0.681-0.830). When a ratio of 46% or above was compared to one that was less than or equal to 45% using a log binomial generalised linear model it was found that participants with a catheter to vein ratio >45% were 13 times more likely to suffer VTE (relative risk 13, p=0.022; CI 1.445-122.788). CONCLUSION: It was found that a 45% catheter to vein ratio was the optimal cut off with high sensitivity and specificity to reduce the risk of VTE. However, further research is needed to confirm these results as although adequately powered; the number of cases of VTE was comparatively small, resulting in wide confidence intervals.

Development of Australian clinical practice outcome standards for graduates of critical care nurse education.

AIMS AND OBJECTIVES: To develop critical care nurse education practice standards. BACKGROUND: Critical care specialist education for registered nurses in Australia is provided at graduate level. Considerable variation exists across courses with no framework to guide practice outcomes or evidence supporting the level of qualification. DESIGN: An eDelphi technique involved the iterative process of a national expert panel responding to three survey rounds. METHODS: For the first round, 84 statements, organised within six domains, were developed from earlier phases of the study that included a literature review, analysis of critical care courses and input from health consumers. The panel, which represented the perspectives of four stakeholder groups, responded to two rating scales: level of importance and level of practice. RESULTS: Of 105 experts who agreed to participate, 92 (88%) completed survey round I; 85 (92%) round II; and 73 (86%) round III. Of the 98 statements, 75 were rated as having a high level of importance - median 7 (IQR 6-7); 14 were rated as having a moderate level of importance - median 6 (IQR 5-7); and nine were rated as having a low level of importance - median 4 (IQR 4-6)-6 (IQR 4-6). The majority of the panel rated graduate level of practice as 'demonstrates independently' or 'teaches or supervises others' for 80 statements. For 18 statements, there was no category selected by 50% or more of the panel. The process resulted in the development of 98 practice standards, categorised into three levels, indicating a practice outcome level by the practitioner who can independently provide nursing care for a variety of critically ill patients in most contexts, using a patient- and family-focused approach. CONCLUSION/RELEVANCE TO CLINICAL PRACTICE: The graduate practice outcomes provide a critical care qualification definition for nursing workforce standards and can be used by course providers to achieve consistent practice outcomes.

CaLD nurses transition to Australian tertiary hospital practice: Exposing the reality--A mixed methods study.

PURPOSE: To investigate CaLD nurses' transition into the Australian workforce over the first 3 months of employment in tertiary hospitals. DESIGN/METHOD: Descriptive mixed method design, informed by the critical paradigm. Survey questionnaire and a focus group were used for data collection. FINDINGS: The existence of a specific hospital orientation program was identified as a crucial factor in participants' successful transition. DISCUSSION: Without a hospital based orientation program participants were more likely to experience failure to 'fit in'. This led to maladaptive behaviors where they did not actively seek, support or question practice through fear of drawing increased attention to themselves. WORKPLACE IMPLICATIONS: Results from the study raise serious implications for workplace safety of both the CaLD nurses and the patients they nurse. Government and health administrators need to invest in providing specific hospital orientation programs that support CaLD nurses' transition. The development of such hospital orientation programs need to be developed as to the specific learning requirements of these nurses or risk exposing them to maladaptive behaviors and potential adverse events as a result of this learned behavior.