'You don't see what I see': Co-designing simulation to uncover and address cognitive bias in healthcare.

EDUCATIONAL CHALLENGE: Each year, adverse events are reported in healthcare, of which many relate to healthcare workforce cognitive bias. The active involvement of workforce and consumers in the review and co-design of effective training for the healthcare workforce to recognise, monitor, and manage unconscious bias is required. PROPOSED SOLUTION: We used participatory action research to co-design an innovative, interprofessional simulation based on 'real world' clinical incidents and lived experiences to improve the delivery of safe, high quality, consumer-focused healthcare. Following ethics approval, content analysis of serious adverse patient safety events involving cognitive bias was conducted. These data informed audio-recorded interviews with the healthcare workforce and consumers to explore their experiences of cognitive bias. Following thematic analysis, key themes of communication, stigma, diagnostic overshadowing, and fragmented systems were uncovered. Guided by consumers, these themes were interwoven into a simulation scenario that included real places, stories, and verbatim quotes delivered through mixed media artefacts. This heightened the immersive and experiential learning that aimed to uncover unconscious bias and help learners recognise its impact on clinical decisions and practice. POTENTIAL BENEFITS AND NEXT STEPS: To our knowledge, this is the first interprofessional, co-designed simulation to specifically address cognitive bias in current and future healthcare workforce. Plans to translate this research into a practical framework on how to work with key stakeholders (including consumers) to identify 'real-world' health service risks and co-design targeted simulations to address these gaps are described, including lessons learned.

Barriers to communication with people with developmental disabilities: A reflexive thematic analysis.

People with Intellectual Disability and/or autism internationally experience some of the worst health outcomes of any population group. Registered nurses have been identified as having educational deficits in this domain, which include knowledge of adjustments to communication. This study aimed to explore perceived barriers to communication with people with Intellectual Disability and/or autism. A thematic analysis of data from an open-ended free-text survey question exploring barriers to communicating in a cross-sectional survey of 279 Australian registered nurses conducted in 2020 was undertaken. Six interrelated themes were identified. Increased educational content in undergraduate and postgraduate level nursing courses is indicated. The findings identify the benefit of educational design based on the foundation of understanding the diversity in thinking and information processing represented by the forms of neurodiversity in Intellectual Disability and Autism Spectrum Disorder.

Partnering with healthcare organisations to teach pre-registration health professions students about quality improvement: A systematic review.

AIMS AND OBJECTIVES: To describe what higher education and healthcare organisation partnerships can be identified in the published literature to teach pre-registration health professions students quality improvement and the impact of these partnerships. BACKGROUND: Quality improvement has been gaining traction in the Western world and has been incorporated in varying degrees into the curricula for pre-registration health professions students. Providing quality improvement education in partnership with healthcare organisations has been found to be a valuable experiential learning solution, but the impacts of higher education and healthcare organisation partnerships have not been explored. DESIGN AND METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was undertaken using the Ovid MEDLINE, Emcare, CINAHL, Scopus and Eric databases. Studies were subject to quality appraisal using the Critical Appraisal Skills Program validated tools and a thematic analysis and narrative synthesis was undertaken. RESULTS: Eight studies were included in this review. Features of existing quality improvement partnerships included experiential learning, time pressures and barriers to successful quality improvement partnerships. The impacts of quality improvement partnerships were demonstrated by an increase in quality improvement knowledge and understanding, students leading change and the implementation of quality improvement projects. CONCLUSION: Several key elements were identified that may act as barriers or enablers to successful implementation of quality improvement partnerships. This review advances understandings of the need for a shift in focus that pays attention to the culture of teaching quality improvement in education partnerships and how this can be achieved in a mutually beneficial way. RELEVANCE TO CLINICAL PRACTICE: The development of quality improvement partnerships has been found to increase student knowledge and understanding, potentially improving patient outcomes, systems performance and professional development. More research is required on the establishment of quality improvement partnerships and the benefit these collaborations have on students, staff and patients.

A scoping review of registered nurses' delegating care and support to unlicenced care and support workers.

AIM: To scope the international literature about registered nurses delegated models of care to unlicenced workers, identify gaps and reflect upon how the evidence relates to nursing in multiple contexts. DESIGN: Scoping review of the peer reviewed literature from the year 2000 onwards, using the PRISMA-ScR checklist. METHODS: The study searched the following databases in February 2022: CINAHL, Medline, ProQuest, and SCOPUS, and included keywords, Boolean operators and subject headings relevant to registered nurses delegating the provision of care to unlicenced workers. RESULTS: A total of 49 articles met the eligibility criteria for this study, and relevant data were extractedThree models of delegation were highlighted within the literature: direct, indirect and a mixture of both. The data highlighted that direct delegation mainly occurred in acute contexts, with delegation decreasing with increasing patient acuity and/or complexity but the threshold of when this would occur was not clear. There was one intervention study that measured patient outcomes which could aid in the determination of what is effective delegation. For studies that did report on it (n = 6), there were few examples of better patient outcomes in cases where care was delegated from registered nurses to unlicenced workers. CONCLUSIONS: The scoping review highlighted heterogeneity in practice areas and methods of delegation practice. A key gap in literature is the absence of studies focusing on patient outcomes, with a clear baseline to measure and identify effective delegation practices. Additionally, the legal and logistical implications presented in both direct and indirect delegation practices is not evident in the literature. IMPLICATIONS FOR THE PROFESSION: Decisions related to delegation are often made at the service level and prescribed to those who work within the service, suggesting that models of indirect delegation are in fact not delegation at all, rather a re-distribution of nurses' work. RELEVANCE TO CLINICAL PRACTICE: Delegation is a vital component of the scope of practice of registered nurses. This review has highlighted unique differences in delegation by practice context, where the proliferation of unlicensed workers in certain contexts places a vastly different professional and legal burden on the registered nurse.

A scoping review to inform an auditing framework evaluating healthcare environments for inclusion of people with intellectual disability and/or autism.

People with intellectual disability and/or autism are likely to be in hospital more often, for longer, and have poorer health outcomes. Few audit tools exist to identify their barriers in mainstream healthcare environments. This study aimed to identify evidence of audit characteristics of healthcare contexts specifically for people with intellectual disability and/or autism, for conceptual development of an auditing framework. A scoping review of evaluations of healthcare environments was completed in January 2023. Findings were presented using the PAGER framework. Of the sixteen studies identified, most originated in the UK, nine focused on intellectual disability, four on autism, and three were concerned with mixed diagnosis. Six domains for auditing healthcare environments were identified: care imperatives, communication to individuals, understanding communication from individuals, providing supportive environments of care, supporting positive behaviour, and actions to make things go well. Further research is recommended to refine an audit framework.

Registered nurses' awareness and implementation of reasonable adjustments for people with intellectual disability and/or autism.

AIM: To describe Australian registered nurses' awareness, and implementation of reasonable adjustments within their practice when caring for people with intellectual disability and/or autism. Additionally, the association between key demographic, workforce, and respondent variables and familiarity of the term and regularity of use was explored. DESIGN: Cross-sectional survey. METHODS: Survey data were collected between August and October 2020 using an online survey tool. Data were analysed using descriptive and inferential statistics. RESULTS: Familiarity of the concept of reasonable adjustments was relatively low, compared to respondents who report applying adjustments when caring for people with intellectual disability and/or autism. Higher levels of confidence, comfort, and knowledge when caring for this cohort were associated with greater awareness and application of reasonable adjustments. CONCLUSION: A higher volume, and diversity in type of, nursing education related to care for people with intellectual disability and/or autism is indicated.

A cross-practice context exploration of nursing preparedness and comfort to care for people with intellectual disability and autism.

AIMS AND OBJECTIVES: To compare the self-perceived preparedness, knowledge, comfort and confidence of Australian Registered Nurses when caring for people with ID and/or ASD across contexts of practice: primary care and community, intensive care, acute hospital, emergency department, paediatrics and ID/ASD. BACKGROUND: There is limited research comparing nursing preparedness and competency when caring for people with intellectual disability (ID) and/or autism (ASD) across nursing contexts of practice. A greater understanding of the differed educational preparedness, confidence and comfort across contexts of practice can aid the development of tailored educational programmes to improve nursing capacity to care for this cohort. DESIGN: Cross-sectional descriptive study. METHODS: A descriptive survey tool of registered nurses (n = 69.3). Comparative inferential analysis was undertaken between the independent categorical variable of six nursing contexts of practice across several dependent variables including age, years since registration, educational content and exposure, knowledge, comfort and confidence. This cross-sectional study was undertaken according to the STROBE Statement checklist of items. RESULTS: Occupying an ID/ASD nursing role was significantly associated with higher reported levels of educational preparedness, professional development and postgraduate education relevant to caring for people with ID and/or ASD. Levels of self-reported knowledge of care issues, confidence and comfort when undertaking healthcare tasks was significantly associated with the context of practice, with nurses working in ID/ASD settings reporting the highest levels across all variables. CONCLUSION: The findings of the study highlight an association between greater educational exposure to content relevant to working with people with ID/ASD and subsequently working in that field. RELEVANCE TO CLINICAL PRACTICE: This study has highlighted that professional development programmes aiming to improve nursing capacity to care for people with ID and/or ASD, should be informed by and address differing gaps in confidence, comfort and educational preparedness across nursing contexts of practice.

Exploring health care graduates' conceptualisations of preparedness for practice: A longitudinal qualitative research study.

INTRODUCTION: Although preparedness for practice (P4P) has been variously described, little shared understanding exists about what P4P is across the health professions. How P4P is conceptualised matters, because this shapes how stakeholders think, talk about and act towards it. Further, multiple understandings can result in diverse expectations for graduate performance. This study therefore explores health care learners' solicited and unsolicited conceptualisations of P4P over their early graduate transition. METHODS: We conducted longitudinal qualitative research including individual and group entrance interviews (phase 1: n = 35), longitudinal audio-diaries (phase 2: n = 30), and individual and group exit interviews (phase 3: n = 22) with learners from four disciplines (dietetics, medicine, nursing and pharmacy). We employed framework analysis to interrogate data cross-sectionally and longitudinally. RESULTS: We found 13 conceptualisations of P4P (eg knowledge, confidence), broadly similar across the disciplines. We found some conceptualisations dominant in both solicited and unsolicited talk (eg skills), some dominant only in solicited talk (eg competence) and others dominant only in unsolicited talk (eg experience). Although most conceptualisations appeared relatively stable across time, some appeared to dominate at certain time points only (eg employability and skills in phases 1 and 2, and competence in phase 3). DISCUSSION: This novel study extends previous uniprofessional work by illustrating a broader array of conceptualisations, differences between professions, solicited versus unsolicited talk and longitudinal cohort patterns. We encourage health care educators to discuss these different P4P understandings in graduate transition interventions. Further research is needed to explore other stakeholders' conceptualisations, and over a duration beyond the early graduate transition.

Exploring the roles of advanced practice nurses in the care of patients following fragility hip fracture: A systematic review.

AIM: This study aimed to explore the role and impact of advanced practice nurses (APNs) in care of patients following fragility hip fracture by systematically reviewing the available evidence. REVIEW DESIGN: Systematic review. DATA SOURCES: A search of the databases Ovid Medline, CINAHL, Embase, Emcare, Cochrane Library, and Google Scholar was conducted from January-February 2019. METHOD: This systematic review adhered to The PRISMA Statement. Study selection was managed using the Covidence software platform and quality was assessed using JBI Critical appraisal tools. Studies included adults >18 years and described the role and impact of APNs in care of patients following fragility hip fracture on clinical and non-clinical outcomes. RESULTS: There were 19 papers identified that met the inclusion/exclusion criteria. Quality was graded as moderate to low risk of bias. Six characteristics of APNs were identified: (1) coordination; (2) collaboration; (3) education; (4) assessment, investigation and treatment recommendations; (5) discharge planning, support and follow up; and (6) documentation. Overall mortality and LOS improved when characteristics of the APN role were present. CONCLUSION: Key findings from this systematic review showed: (1) The APN title and role are not clearly defined, but characteristics of the APN role are evident; (2) characteristics of APNs promote the delivery of best practice hip fracture care and have a positive impact on mortality and LOS; and (3) innovative service delivery models involving APNs should be considered to address future projections of hip fracture rates and improve outcomes. IMPACT: This systematic review provides evidence of the role characteristics of APNs in fragility hip fracture and the impact of the role on outcomes. Findings from this research could be used to develop service delivery models using APNs to care for patients following fragility hip fracture and to inform practice where APN roles may improve outcomes for other patient cohorts.

Impact of the COVID-19 pandemic on teaching and learning in health professional education: a mixed methods study protocol.

BACKGROUND: Due to the complex nature of healthcare professionals' roles and responsibilities, the education of this workforce is multifaceted and challenging. It relies on various sources of learning from teachers, peers, patients and may focus on Work Integrated Learning (WIL). The COVID-19 pandemic has impacted many of these learning opportunities especially those in large groups or involving in person interaction with peers and patients. Much of the curriculum has been adapted to an online format, the long-term consequence of which is yet to be recognized. The changed format is likely to impact learning pedagogy effecting both students and teachers. This requires a systematic approach to evaluation of online teaching and learning adaptation, in comparison to the previous format, where, in person education may have been the focus. METHODS: The proposed study is a broad based evaluation of health professional education in a major Australian University. The protocol describes a mixed methods convergent design to evaluate the impact of online education on students and teachers in health professional courses including Medicine, Nursing, Allied Health and Biomedical Science. A framework, developed at the university, using Contribution Analysis (CA), will guide the evaluation. Quantitative data relating to student performance, student evaluation of units, quantity of teaching activities and resource utilization will be collected and subjected to relevant statistical analysis. Data will be collected through surveys (500 students and 100 teachers), focus groups (10 groups of students) and interviews of students and teachers (50 students beyond graduation and 25 teachers, for long term follow up to 12 months). Application of CA will be used to answer the key research questions on the short term and long-term impact of online education on teaching and learning approaches. DISCUSSION: The protocol describes the study, which will be widely implemented over the various courses in Health Professional Education and Biomedical Science. It will evaluate how students and teachers engage with the online delivery of the curriculum, student performance, and resources used to implement these changes. It also aims to evaluate longitudinal outcome of student learning attributes and impact on graduate outcomes, which is poorly reported in educational literature.

Nursing students' engagement with social media as an extracurricular activity: An integrative review.

OBJECTIVE: To explore primary research evidence reporting the reason for undergraduate nursing students' engagement with social media as an extracurricular activity. BACKGROUND: The formal integration of social media into nursing education has been discussed extensively in previous research. The influence of social media on nursing students' learning and class engagement has also been explored. However, despite the growing volume of literature examining the formal use of social media by undergraduate nursing students, a broader perspective on how and why nursing students engage with social media as an extracurricular activity has not yet been explored. DESIGN: An integrative review. METHODS: A systematic search was performed to find articles published between 2007-2019 using Ovid MEDLINE, Embase, Ovid Emcare and CINAHL Plus databases and the Google Scholar search engine. The review process is reported according to PRISMA. RESULTS: Twelve papers met the inclusion criteria, revealing that undergraduate nursing students engaged with social media for many reasons external to their formal curricula. They engaged with social media to keep in touch with others and to entertain themselves, promote learning, find social support, develop a professional nursing identity, share their experiences as nursing students and locate job opportunities. CONCLUSION: Undergraduate nursing students engaged with social media for numerous reasons. It supported students in their academic and personal lives by keeping them in touch with people around them. The students used social media to identify with the nursing profession; however, its influence on their professional identity development is yet to be fully explored. RELEVANCE TO CLINICAL PRACTICE: Nursing schools should consider the myriad of reasons students engage with social media in order to optimise their professional development. Understanding how nursing students' professional identity develops via social media may be used to help sustain nursing students and support their transition into practice.

Ventilation bundle compliance in two Australian intensive care units: An observational study.

BACKGROUND: The ventilation bundle has been used in adult intensive care units to decrease harm and improve quality of care for mechanically ventilated patients. The ventilation bundle focuses on prevention of specific complications of mechanical ventilation; ventilator-associated pneumonia, sepsis, barotrauma, pulmonary oedema, pulmonary embolism, and acute respiratory distress syndrome. The Institute for Healthcare Improvement ventilation bundle consists of five structured evidence-based interventions: head of the bed elevation at 30-45°; daily sedation interruptions and assessment of readiness to extubate; peptic ulcer prophylaxis; deep vein thrombosis prophylaxis; and daily oral care with chlorhexidine. OBJECTIVES: The objective of the study was to evaluate the use of the ventilation bundle in two intensive care units in Victoria, Australia. METHODS: This is a 3-month prospective observational study in two intensive care units. Patient medical records were reviewed on days 3, 4, and 5 of mechanical ventilation using a prevalidated ventilation bundle checklist. RESULTS: A total of 96 critically ill patients required mechanical ventilation for more than 2 d. Patients had a mean age of 64.50 y (standard deviation = 14.89), with an Acute Physiology, Age, Chronic Health Evaluation (APACHE) III mean score of 79.27 (standard deviation = 27.11). The mean ventilation bundle compliance rate was 88.3% on the three consecutive mechanical ventilation days (day 3 = 79.4%, day 4 = 91.1%, and day 5 = 96.7%). There was a statistically significant difference in the mean APACHE III score between patients who had head of bed elevation and those without head of bed elevation, on days 3 (p = <0.001) and 4 (p = 0.007). CONCLUSION: The ventilation bundle elements were used in Australian intensive care units. The likelihood of having all ventilation bundle elements on day 3 was low if the patient's APACHE III score was high. However, the ventilation bundle compliance rate increased with mechanical ventilation days.

Student dignity during work-integrated learning: a qualitative study exploring student and supervisors' perspectives.

While University students increasingly participate in work-integrated learning (WIL), their dignity is often violated during WIL. The current literature is limited in so far as it typically focuses on student perspectives within healthcare contexts and does not use the concept of 'dignity'. Instead, this study explored student and supervisor perspectives on student dignity during WIL across healthcare and non-healthcare disciplines. Research questions included: What are: (1) types of student dignity experiences and patterns by groups; (2) factors contributing to experiences; (3) consequences of experiences? Sixty-five semi-structured interviews were conducted using narrative interviewing techniques with 30 supervisors and 46 students from healthcare (medicine, nursing and counselling) and non-healthcare (business, law and education) disciplines. Data were analyzed using framework analysis. Nine common narrative types were identified within 344 stories: verbal abuse, right for learning opportunities, care, inclusion, reasonable expectations, right for appropriate feedback, equality, trust, and right to be informed. Factors contributing to dignity experiences and consequences were often at the individual level (e.g. student/supervisor characteristics). We found some salient differences in perceptions of experiences between students and supervisors, but few differences between healthcare and non-healthcare disciplines. This study extends WIL research based on student perspectives in healthcare, and provides practice and further research guidance to enhance student dignity during WIL.

Introduction of an interprofessional gynaecology surgical skills workshop for undergraduate medical and nursing students.

BACKGROUND: Medical and nursing students may feel under-prepared to perform basic surgical and gynaecology procedural skills. There also remains scope within undergraduate programs to integrate interprofessional education, and better prepare students for interprofessional collaboration to improve patient care. AIMS: A simulation-based gynaecology surgical skills workshop program was introduced for undergraduate medical and nursing students. The aim of this study was to explore students' perceptions of a simulation-based interprofessional gynaecological skills program, using students' pre- and post-workshop confidence in taught skills reported in a post-workshop questionnaire as an outcome measure. MATERIALS AND METHODS: One hundred and sixty undergraduate medical (n = 133) and nursing (n = 27) students attended the workshop program at a tertiary university in Melbourne, Australia. A survey was completed by all students immediately after the workshop, addressing students' perceptions of surgical education, the four skill-stations (gowning/gloving, suturing, intrauterine device insertion, and urethral catheterisation), and interprofessional education. A Wilcoxon signed-rank test was performed to compare students' pre- and post-workshop confidence scores. RESULTS: Most medical and nursing students (86%) agreed their course should provide more structured surgical education. There was a statistically significant increase in post-workshop self-reported confidence scores for medical and nursing students in all four taught skills. Confidence in interprofessional behaviours also improved in both cohorts, but the improvement in nursing students did not reach statistical significance. CONCLUSIONS: Simulation-based, interprofessional, gynaecological surgery skills workshops are practical and valuable additions to undergraduate medical and nursing curricula. Further research should explore long-term retention of procedural skills and changes in interprofessional attitudes in clinical practice.

Practice priorities for acute care nursing: A Delphi study.

AIMS AND OBJECTIVES: To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. BACKGROUND: Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. DESIGN: Delphi Method. METHOD: A three-round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. RESULTS: High patient acuity or complexity, as well as inadequate bed space on wards, are "very high" risks that occur "often" and "very often," respectively. The pressure to admit patients, delayed medical review and patient boarding are all "high" risks that occur "often." Though only occurring "sometimes," inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a "very high" risk to patient care. CONCLUSION: The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system-wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. RELEVANCE TO CLINICAL PRACTICE: This study provides a description of the challenges that face acute care nursing in the provision of safe and high-quality care.

Barriers to Engagement in Chronic Heart Failure Rehabilitation: An Australian Survey.

BACKGROUND: While exercise has been shown to improve quality of life and physical function and reduce hospital admission rates in people with chronic heart failure (CHF), engagement is poor in condition specific rehabilitation programs. This project aims to identify barriers to engagement in rehabilitation, strategies to address these, and comprehensively detail CHF rehabilitation practise in Australia. METHODS: An online survey was emailed to all cardiac and chronic heart failure rehabilitation programs in Australia utilising a publicly available database. RESULTS: The survey was completed by 165 respondents: Australian Capital Territory (ACT) = 4, New South Wales (NSW) = 49, Northern Territory (NT) = 2, Queensland (Qld) = 23, South Australia (SA) = 12, Tasmania (Tas) = 2, Victoria (Vic) = 37, Western Australia (WA) = 12, including metropolitan (37%), regional (47%) and remote (9%) locations. Common barriers were themed into four areas: poor condition-specific health literacy, lack of medical professional support, interrupted health care systems, and personal and external deterrents. Strategies to improve engagement and attendance focussed mostly on the patient, with few strategies aimed at improving patient and health professional knowledge and referral processes. Programs generally appeared to follow current Australian Heart Foundation recommendations for CHF rehabilitation. CONCLUSIONS: This survey identifies common barriers that need to be addressed to improve engagement and attendance levels in CHF rehabilitation programs. While patient barriers are already being addressed, strategic planning needs to occur to address poor health literacy including for medical and health professionals, improved flow through the health care system and improving the flexibility of program delivery. Adaptation of home-based and tele-rehabilitation can help with this, while education and advertisement to patients and potential referrers needs to start early in the disease journey.

Workplace violence: Examination of the tensions between duty of care, worker safety, and zero tolerance.

BACKGROUND: Workplace violence (WPV) remains an international problem. This raises challenges for staff in meeting their duty of care to consumers while enforcing zero tolerance for violence directed toward them. PURPOSE: The aim of the study was to expose the values and beliefs underpinning practice and reveal any flawed assumptions or evidence, upon which decisions related to WPV are made. By increasing staff awareness, the secondary aim is to decrease staff stress when confronted with conflicting policies and duty of care responsibilities. METHODOLOGY: Explanatory research as part of a larger descriptive study was used. Semistructured interviews with a sample of managers and staff (n = 99) in Victorian Health Services (Australia) were performed. Initial descriptive analysis identified a tension between duty of care, worker safety, and zero tolerance. This article reports the secondary analysis to examine these relationships in depth. FINDINGS: Feeling obligated and providing care for aggressive patients was difficult while maintaining own safety: "You cannot do both." Although there were contrasting views about the merits of zero tolerance, policies were rarely enacted: "We cannot refuse to treat." Incongruency between legislative requirements creates confusion for decision-making: "Which Act trumps what?" CONCLUSION: Despite policies supporting zero tolerance, staff do not enact these because they prioritize duty of care to consumers before duty of care to self. Zero tolerance, with incongruent legislation, compounds this tension and impairs decision-making. PRACTICAL IMPLICATIONS: This article exposes the underlying values, beliefs, and flawed assumptions underpinning practice related to WPV. Managers need to amend policies to reduce staff confusion, adopt a trauma-sensitive and resilience approach, and develop a clearly written framework to guide decision-making related to duty of care to consumers and staff safety. Incident reports and staff well-being/satisfaction surveys need to evaluate the effects of zero tolerance on staff and consumers. Regulators need to ensue legislative requirements are congruent with staff safety and well-being.

Setting priorities for health education research: A mixed methods study.

Introduction: Identifying priority research topics that meet the needs of multiple stakeholders should maximize research investment. Aim: To identify priorities for health education research. Methods: A three-stage sequential mixed methods study was conducted. Priorities for health education research were identified through a qualitative survey with 104 students, patients, academics, and clinicians across five health sciences and 12 professions (stage 1). These findings were analyzed using framework analysis and transposed into a quantitative survey whereby 780 stakeholders rated and ranked the identified priorities. Descriptive statistics identified priorities, exploratory factor analysis grouped priorities and differences between stakeholders were determined using Mann-Whitney U tests (stage 2). Six individual or group interviews with 16 participants (stage 3) further explicated the results from previous stages. Results: Of 30 priorities identified, the top were: how best to ensure students develop the required skills for work; how to promote resiliency and well-being in students; and ensuring the curriculum prepares students for work. For the majority of priorities, no significant differences were found between different stakeholder groups. Conclusions: These findings will be used to inform health educational research strategy both locally and nationally. Further research should explore if setting priorities can be translated effectively into education research policy and practice.

Workplace violence perpetrated by clients of health care: A need for safety and trauma-informed care.

AIMS: To examine the relationship between workplace violence perpetrated by clients, their innate neurophysiological response to dis-ease and the resulting interactions with healthcare providers. BACKGROUND: Client-on-worker violence remains a problem globally. Workplace violence risk factors have been documented. A gap remains in understanding what has happened to clients that perpetrate violence, and the link between adverse childhood experiences (ACE), the neuroscience of threat and trauma-informed care. DESIGN: This explanatory study was part of a larger descriptive study. METHODS: Managers, directors, health/safety staff, nurses and educators (n = 99) from Australian rural and metropolitan health services participated in individual and group interviews. Following inductive thematic analysis, a secondary analysis, informed by understandings of ACE, polyvagal theory and trauma-informed care, was conducted. Analysis was guided by the question: What happens to clients that causes them to instigate violence against healthcare workers? Reporting of this research adheres to the COREQ guidelines. RESULTS: Clients can react aggressively when under perceived threat. Themes included are as follows: client stress and trauma, previous client trauma, impact of care provision on client and trauma-informed care. CONCLUSION: Healthcare services can be experienced as stressful environments. Coupled with high incidences of past trauma, clients' assessment of risk and safety can be compromised resulting in inappropriate reactivity when staff are trying to provide care. Care provision can be perceived as a threat to clients' physical and psychological safety, activating the fight protective response resulting in aggression. Understanding and applying neuroscience and implementing a cultural change of trauma-informed care have the potential to reduce workplace violence. Even with these understandings, it is imperative that healthcare staff are protected and feel safe at work. RELEVANCE TO CLINICAL PRACTICE: Understanding trauma and the neuroscience of threat and safety can assist staff to understand what happens to clients that causes them to instigate violence against healthcare providers and implement systems and strategies to respond to such threat.

The trouble with reporting and utilization of workplace violence data in health care.

AIM: The study aimed to evaluate the reporting, monitoring and use of workplace violence data in Victorian health services. BACKGROUND: Surveillance of workplace violence is important in understanding the circumstances in which workplace violence occurs and development of relevant and appropriate prevention and intervention strategies. METHOD: A descriptive exploratory approach was used. Fifteen staff from occupational health and safety, quality and safety, and nurse unit managers, from five major metropolitan health services were interviewed. Recorded interviews were transcribed verbatim and thematically analysed. RESULTS: Three themes were identified: (a) "under-reporting of workplace violence," (b) "inconsistent guidance" caused subjective and variable data coding and (c) "application of data" described how health services used the data available to them, to inform the development and implementation of systems designed to prevent workplace violence. CONCLUSIONS: Improved reporting systems may increase consistency in reporting, enable data sharing across organisations and assist in planning of prevention strategies. IMPLICATIONS FOR NURSING MANAGEMENT: Staff should be encouraged to complete incident reports for each episode of workplace violence. Incident reporting systems must be simplified to reduce the burden of reporting. Nurse managers should advocate for the sharing of health service workplace violence data, to enable improved prevention across all services.