Applying terror management theory as a framework to understand the impact of heightened mortality salience on children, adolescents, and their parents: A systematic review.

Terror Management Theory (TMT) posits that controlling death anxiety is a driving force behind many aspects of social behavior. The objective in this systematic review was to explore how TMT is used to explain children's, adolescents', and parents' behavior when exposed to situations that increase mortality salience. A systematic search identified 2484 papers; 14 studies met eligibility criteria. Key topics explored were mortality salience, death thoughts, and distal defenses. Findings indicate that adolescents comprehend death and have mortality salience reactions like adults, highlighting the potential for TMT to be used to explain children's and adolescents' social behavior in high-stress situations.

Health care workers' experience of personal protective equipment use and associated adverse effects during the COVID-19 pandemic response in Singapore.

AIM: One of the greatest challenges in responding to the COVID-19 pandemic is preventing staff exposure and infection by ensuring consistent and effective use of personal protective equipment (PPE). This study explored health care workers' experience of prolonged PPE use in clinical practice settings and their concerns regarding PPE supply, effectiveness and training needs. DESIGN: A descriptive cross-sectional design was adopted in this study. METHODS: Health care workers (N = 592) from an acute care hospital completed an online survey from July to September 2020 assessing: (i) usage frequencies, side effects and interference with patient care; and (ii) perceptions of access to PPE, likelihood of exposure to infection and adequacy of PPE training. RESULTS: PPE-related side effects were reported by 319 (53.8%) participants, the majority being nurses (88.4%) and those working in high-risk areas such as the emergency department (39.5%), respiratory wards (acute 22.3% and non-acute 23.8%) and COVID-19 isolation ward (13.8%). The average time wearing PPE per shift was 6.8 h (SD 0.39). The most commonly reported symptoms were from donning N95 masks and included: pressure injuries (45.5%), mask-induced acne (40.4%) and burning/pain (24.5%). Some 31.3% expressed that PPE-related side effects had negatively affected their work. The odds of having PPE-associated side effects was higher in women (OR 2.10, 95% CI [1.29-03.42], p = .003) and those working in high-risk wards (OR 3.12, 95% CI [2.17-4.60], p < .001]. Most (90.1%) agreed that PPE supplies were readily available, sufficient for all (86.1%) and there was sufficient training in correct PPE use (93.6%). Only 13.7% of participants reported being 'highly confident' of overall PPE protection. CONCLUSIONS: Prevention and management of PPE-related adverse effects is vital to: preserve the integrity of PPE, improve adherence and minimize viral transmission. IMPACT: The high incidence of PPE-associated pressure injuries and perception that PPE use can interfere with clinical care should inform future development of PPE products, and strategies to better equip health care workers to prevent and manage PPE-related side effects.

Nurses' role in recognising and responding to clinical deterioration in surgical patients.

AIM AND OBJECTIVES: To explore nurse' role in recognising and responding to deteriorating post-operative patients. BACKGROUND: Clinical deterioration is a significant problem in acute care settings. Nurses play a vital role in post-operative patient monitoring; however, there is limited understanding of the nurses' role in recognising and responding to clinical deterioration in surgical patients. METHODS: This qualitative exploratory study was conducted at a metropolitan teaching hospital in Melbourne, Australia. Data were collected through focus groups from 1 September to 31 October 2014. Four focus groups of 2-5 surgical nurses (n = 14) were conducted to explore the nurses' perception of their role in managing deterioration over the first 72 hr postoperatively. Qualitative data were recorded, transcribed and key themes identified. RESULTS: Nurses demonstrated a high level of awareness of their role in recognising and responding to early signs of deterioration. The themes that arose from the focus group interviews were "struggling with blood pressure," and "we know our patient is sick." The nurses were confident about the clinical indicators of deterioration and the appropriate channels to use to escalate care. Using track and trigger observation charts enabled nurses to identify deteriorating patients prior to the patient fulfilling rapid response system escalation criteria. CONCLUSIONS: These findings highlight the importance of a collective team approach to preventing, recognising and responding to clinical deterioration across the whole patient journey. Initiatives to ensure accurate written and verbal communication between medical and nursing staff warrants further assessment. RELEVANCE TO CLINICAL PRACTICE: Nurses working in acute surgical wards are highly engaged in the process of recognising and responding to clinical deterioration in post-operative patients. Many nurses reported being able to anticipate deterioration occurring but are required by current organisational frameworks to escalate care to rapid response systems. How nurses anticipate and manage deterioration prior to the patient fulfilling rapid response system criteria warrants further investigation.

Post resuscitation management of cardiac arrest patients in the critical care environment: A retrospective audit of compliance with evidence based guidelines.

BACKGROUND: There is a clear relationship between evidence-based post resuscitation care and survival and functional status at hospital discharge. The Australian Resuscitation Council (ARC) recommends protocol driven care to enhance chance of survival following cardiac arrest. Healthcare providers have an obligation to ensure protocol driven post resuscitation care is timely and evidence based. OBJECTIVES: The aim of this study was to examine adherence to best practice guidelines for post resuscitation care in the first 24h from Return of Spontaneous Circulation for patients admitted to the intensive care unit from the emergency department having suffered out of hospital or emergency department cardiac arrest and survived initial resuscitation. METHOD: A retrospective audit of medical records of patients who met the criteria for survivors of cardiac arrest was conducted at two health services in Melbourne, Australia. Criteria audited were: primary cardiac arrest characteristics, oxygenation and ventilation management, cardiovascular care, neurological care and patient outcomes. FINDINGS: The four major findings were: (i) use of fraction of inspired oxygen (FiO2) of 1.0 and hyperoxia was common during the first 24h of post resuscitation management, (ii) there was variability in cardiac care, with timely 12 lead Electrocardiograph and majority of patients achieving systolic blood pressure (SBP) greater than 100mmHg, but delays in transfer to cardiac catheterisation laboratory, (iii) neurological care was suboptimal with a high incidence of hyperglycaemia and failure to provide therapeutic hypothermia in almost 50% of patients and (iv) there was an association between in-hospital mortality and specific elements of post resuscitation care during the first 24h of hospital admission. CONCLUSION: Evidence-based context-specific guidelines for post resuscitation care that span the whole patient journey are needed. Reliance on national guidelines does not necessarily translate to evidence based care at a local level, so strategies to ensure effective guideline implementation are urgently required.

Australian emergency nurses' experiences of working with personal protective equipment during the COVID-19 pandemic. A qualitative study.

INTRODUCTION: The COVID-19 pandemic has exposed a need to understand the challenges associated with wearing Personal protective Equipment (PPE). The aim in this study was to explore emergency nurses' experiences early in the COVID-19 pandemic in Australia and the impact of PPE use on their practice. METHODS: An explorative descriptive qualitative study was conducted between January 2022 and April 2022. Eighteen emergency nurses and six leaders participated. Semi-structured interviews (n = 21) and one focus group were conducted. Interview transcripts were analysed using Braun and Clarke's framework. RESULTS: Two major themes were identified. The first theme was: (1) The shifting ground of the COVID-19 pandemic response. Associated sub-themes were: i) What's the go with PPE today? ii) In the beginning we were scrambling for masks; iii) Emergency is the true frontline. The second theme was: (2) Physical and emotional impacts of emergency nursing work. Sub-themes were: (i) Facing the fear of exposure; (ii) By the end of the shift I am just absolutely spent; iii) Discomfort of wearing PPE impacts on compliance. CONCLUSIONS: Healthcare leaders need to secure PPE supply chains and evaluate the effectiveness and side-effects of different PPE designs to minimise occupational harms associated with prolonged PPE use.

Post implementation quarantine recommendations that support preparedness: A systematic review and quarantine implementation capability framework.

BACKGROUND: During COVID-19, countries utilised various quarantine systems to achieve specific outcomes. At different stages and durations, voluntary and mandatory quarantine occurred in homes, hotels and facilities based on local and national elimination strategies. Countries are incorporating quarantine lessons from COVID-19 into revising pandemic plans as part of the World Health Organization's Preparedness and Resilience for Emerging Threats (PRET) activities. This review aimed to amalgamate quarantine post implementation recommendations from a whole-of-system perspective. METHODS: This review utilised MEDLINE, Embase, CINAHL, APA, and PsycINFO. To capture all pandemics, no date restriction was applied. Recommendations were synthesised and inductively grouped into quarantine capability categories. This review was registered in PROSPERO (CRD42023420765). RESULTS: A total of 449 published articles were screened, with 51 articles included and 156 recommendations extracted. Recommendations were grouped into 15 quarantine capability categories, comprising governance, preparation, infection prevention and control, ventilation, compliance, data, information and technology, safety-quality-risk, communication, healthcare model, home quarantine, hotel quarantine, facility quarantine, workforce, and resident considerations. The capability categories were further consolidated into strategic, structural, and operational domains to support the whole-of-system perspective. CONCLUSION: The quarantine implementation capability framework generated provides comprehensive and deeper insights into the essential capabilities required for quarantine systems to support governments in PRET activities, including reviewing and revising pandemic plans and developing quarantine preparedness exercises.

Gender-based differences in assessment and management of acute abdominal pain in the emergency department: A retrospective audit.

BACKGROUND: Previous research has identified gender-based differences in acute pain management in the emergency department [ED]. The aim of this study was to compare pharmacological management of acute abdominal pain in the ED by gender. METHODS: A retrospective chart audit was conducted at one private metropolitan ED including adult patients (18-80 years) who presented with acute abdominal pain in 2019. Exclusion criteria included: pregnancy, repeat presentation within the study period, pain-free at initial medical review or documented refusal of analgesia, and oligo-analgesia. Comparisons by gender included: (1) analgesia type and (2) time to analgesia. Bivariate analysis was undertaken using SPSS. RESULTS: There were 192 participants: 61 (31.6 %) men and 131 (67.9 %) women. Men were more likely to get combined opioid and non-opioid medication as first line analgesia (men: 26.2 % n = 16; women: 14.5 % n = 19, p = .049). Median time from ED presentation to analgesia was 80 min for men (IQR: 60) versus 94 min for women (IQR: 58), (p = .119). Women (25.2 % n = 33) were more likely to receive their first analgesic after 90 min from ED presentation compared to men versus men (11.5 %, n = 7 p = .029). In addition, women waited longer before receiving second analgesia (women: 94, men: 30 min, p = .032). CONCLUSION: Findings confirm there are differences in pharmacological management of acute abdominal pain in the ED. Larger studies are required to further explore differences observed in this study.

Impact of the COVID-19 pandemic on emergency department team dynamics and workforce sustainability in Australia. A qualitative study.

INTRODUCTION: The COVID-19 pandemic has challenged health care professionals and changed our approach to care delivery. The aim in this study was to explore nurses' experiences providing care in the ED during the COVID-19 pandemic in Australia and the impact of this on ED team functioning. METHODS: A qualitative explorative descriptive study was conducted using thematic analysis strategies. Participants comprised: Registered Nurses (n = 18) working in clinical roles in the Emergency Department and Leadership Registered Nurses (n = 6) within the organisation. One on one interviews (n = 21) and one focus group interview were conducted utilising semi-structured, conversational style, in-depth interviews between January 2022 and April 2022. RESULTS: Two major themes were identified that described the impact on ED team dynamics and longer-term impacts on the ED nursing workforce. The first major theme was: 'Changed Emergency Department team identity and dynamics' and included four sub-themes: i) PPE is a barrier to team camaraderie; ii) outsiders versus insiders - ambivalence to PPE spotter role; iii) personal safety comes first in a pandemic; and iv) using PPE depersonalises the whole patient experience. The second major theme was: 'This pandemic caught everyone off guard' and had three sub-themes. The associated sub-themes were: i) People outside ED have no understanding of what it has been like; ii) COVID-19 is here to stay - Permanent changes to care delivery and nursing practice; and iii) tenacity of a true profession. CONCLUSIONS: Study findings illuminated the dynamics and functionality of ED nursing, encompassing the unique qualities of camaraderie, autonomy, resilience and tenacity.

Forecasting pandemic quarantine in New Zealand and Australia: A scoping review of quarantine characteristics and capabilities within preparedness plans and pandemic exercise reports from 2002 to 2019.

BACKGROUND: This scoping review aims to identify and critically review quarantine preparedness in New Zealand and Australia pre-COVID-19 by categorising, comparing, and evaluating quarantine information contained within pandemic plans and exercises from both countries. METHODS: Parliamentary websites, including Archives New Zealand, ParlInfo and Google Scholar, were searched for publicly available plans and exercise reports from 2002 to 2019. Data were extracted from documents meeting the inclusion criteria and analysed using directive content analysis based on the Australian Disaster Preparedness Framework categories. This scoping review followed the Joanna Briggs Institute methodology for scoping reviews, which guided the data extraction, analysis, and presentation of results. RESULTS: A total of 16 documents mentioned quarantine and were included in this scoping review. The emphasis and level of detail regarding quarantine characteristics and capabilities varied between New Zealand's five documents (one plan and four exercise reports) and Australia's 11 documents (one Influenza pandemic plan, eight state plans and two exercise reports). New Zealand's plan forecasted the need for both voluntary quarantine at home and involuntary quarantine in facilities for incoming travellers, whilst the Australian Influenza pandemic plan and state plans primarily considered voluntary quarantine within private residences. Capability gaps identified during exercises were not consistently incorporated into revised plans. Some government documents containing information on quarantine may not be publicly available, limiting the available evidence for this review. CONCLUSION: This scoping review highlights the need to incorporate a range of possible quarantine options into plans and preparation activities to test and identify gaps in government and responsible agencies' capabilities. Pandemic preparedness will be strengthened by incorporating quarantine scale and duration variables into exercise scenarios.

Effect of communication skills training on documentation of shared decision-making for patients with life-limiting illness: An observational study in an intensive care unit.

Objectives: This article aims to examine the association between a shared decision-making (SDM) clinical communication training program and documentation of SDM for patients with life-limiting illness (LLI) admitted to intensive care. Methods: This article used a prospective, longitudinal observational study in a tertiary intensive care unit (ICU). Outcomes included the proportion of patients with SDM documented on an institutional Goals of Care Form during hospital admission, as well as characteristics, outcomes, and factors associated with an SDM admission. Intervention: Clinical communication skills training (iValidate) and clinical support program are the intervention for this study. Results: A total of 325 patients with LLI were admitted to the ICU and included in the study. Overall, 184 (57%) had an SDM admission, with 79% of Goals of Care Form completed by an iValidate-trained doctor. Exposure to an iValidate-trained doctor was the strongest predictor of an ICU patient with LLI having an SDM admission (odds ratio: 22.72, 95% confidence interval: 11.91-43.54, p < 0.0001). A higher proportion of patients with an SDM admission selected high-dependency unit-level care (29% vs. 12%, p < 0.001) and ward-based care (36% vs. 5%, p < 0.0001), with no difference in the proportion of patients choosing intensive care or palliative care. The proportion of patients with no deterioration plan was higher in the non-SDM admission cohort (59% vs. 0%, p < 0.0001). Conclusions: Clinical communication training that explicitly teaches identification of patient values is associated with improved documentation of SDM for critically ill patients with LLI. Understanding the relationship between improved SDM and patient, family, and clinical outcomes requires appropriately designed high-quality trials randomised at the patient or cluster level.

Frequency and Characteristics of Medical Complications in Rehabilitation Settings: A Scoping Review.

OBJECTIVE: To synthesize the available evidence on medical complications occurring in adult patients in subacute inpatient rehabilitation, and to describe the impact on subacute length of stay and readmission to acute care. DESIGN: Scoping review. SUBJECTS: Adult patients, within the inpatient rehabilitation environment, who experienced medical complications, clinical deterioration and/or the requirement of transfer to acute care. METHODS: A systematic search of MEDLINE and CINAHL electronic databases was undertaken to identify primary research studies published in English and French during the period 2000-2021. Study reporting followed the standards indicated by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist (PRISMA-ScR). RESULTS: A total of 47 studies were identified for inclusion. Key results included differences in the type and frequency of complications according to admission type, the proportion of patients experiencing at least 1 complication, and complications associated with transfer to acute care. CONCLUSION: Patients admitted for inpatient rehabilitation are at high risk of medical complications and may not be medically stable during their admission, requiring care by clinicians with expertise in functional rehabilitation, and ongoing management by members of the multidisciplinary team with expertise in acute general medicine, infectious diseases and recognition and response to clinical deterioration.

Environmental cleaning and infection prevention and control: The role of Patient Service Assistants.

BACKGROUND: In Australia, Patient Service Assistants are an integral part of all health care settings, yet there is a paucity of studies considering their understandings and perceptions of their role about infection prevention and control. The aim in this study was to explore haematology Personal Service Assistants' experience, understanding and perceptions of their role in improving patient safety through environmental cleaning. METHODS: A qualitative exploratory descriptive design was utilised to collect data from cleaning staff via focus groups. Three semi-structured focus groups were conducted. RESULTS: Seven Patient Service Assistants participated in the study out of 11 employed. Two key themes emerged from the thematic analysis: (1) Playing a major role in Infection Prevention and Control, and (2) prioritising good interpersonal relationships over promoting infection prevention and control. Patient Service Assistants emphasised the importance of their involvement in keeping the ward clean, including patients' rooms and surroundings, to prevent cross infection. Most participants underlined the dilemmas they faced when visitors and/or informal cleaning employees or casual ward staff did not adhere to ward infection prevention and control norms. CONCLUSION: Patient Service Assistants were employing key infection prevention and control principles in their ward cleaning routine, with the aim of achieving a safer patient environment although they were reluctant to challenge observed practice deviations. The role of Patient Service Assistants highlights the widely held misconception that patient safety is solely dependent on healthcare workers.

A Nurse-Led Multimedia Intervention to Increase Patient Participation in Recovery After Knee Arthroplasty: Hybrid Type II Implementation Study.

BACKGROUND: Advances in digital technology and the use of multimedia platforms to deliver information provide clinicians with a unique opportunity to develop innovative ways to consistently provide high-quality, accessible, and evidence-based information to support patient participation. Introducing new technologies into everyday acute care clinical practice can be difficult. OBJECTIVE: The aim of this paper was to provide a description of an implementation strategy and the subsequent evaluation undertaken to examine the contextual factors important to the successful adoption of new technology by nurses in the context of acute postoperative care. METHODS: Implementation of the intervention and process evaluation was undertaken in 3 phases: phase 1, preimplementation stakeholder engagement and identification of barriers and enablers to implementation; phase 2, supported implementation of the intervention; and phase 3, evaluation of uptake, usability, and acceptability of the intervention in clinical practice. RESULTS: The outcomes of the implementation of the multimedia intervention in the context of acute postoperative care were positive. Of the 104 patients in the intervention group, 103 (99%) received the intervention. All 103 patients completed the 8-item intervention questionnaire and 93.3% (97/103) were interviewed on day 3 to evaluate usability, uptake, and acceptability. Of these 97 patients, almost all (n=94, 91%) found the program easy to use and most (n=64, 62%) could view the MyStay Total Knee Replacement program as often as they wanted. The findings also suggest that the time to implement the program was minimal (5-10 minutes). Collaboration with nurses and patients before and during implementation to identify potential barriers to successful implementation of the intervention was essential to develop timely strategies to overcome these barriers. To ensure end-user engagement, careful consideration was given to nurses' views on who was responsible for facilitating this intervention. CONCLUSIONS: The findings provide evidence that the structured implementation of the multimedia intervention was robust and successful in terms of patient participant recruitment and application; however, it was difficult to assess the level of engagement by nurse clinicians with the program. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000340639; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000340639.

Effect of a multidisciplinary rehabilitation program for patients receiving weight management interventions on eating behaviours and health-related quality of life.

The rapid rise in obesity prevalence is life-style related and tackling this problem requires a pro-active multi-faceted approach to management. A private health care provider in Melbourne, Australia, developed a multidisciplinary rehabilitation program for patients who had undergone bariatric surgery or receiving pharmacological weight loss treatments. The study aim was to assess the programs' effect on patients' quality of life, mental well-being, and eating behaviours. METHODS: A prospective, observational, before and after study design was used. A total of 54 patients, 27 who had bariatric surgery and 27 receiving pharmacotherapy participated. Outcome measures were: change in weight and BMI, intuitive eating scale, impact of weight on quality of life scale and the depression, anxiety and stress scale. RESULTS: Both medical and surgical patients reported improvements in their health-related quality of life and eating behaviours. Despite this, at program completion 71.4% of patients who had bariatric surgery reported severe anxiety and 52.4% severe stress levels. CONCLUSION: Participation in a rehabilitation program that provided patients with peer support and access to expert advice supported patients to make healthy eating choices and improved their quality of life. The high prevalence of stress and anxiety related symptoms highlights the need to provide individuals who have undergone bariatric surgery with ongoing mental health support.

Evaluation of the effectiveness of an eLearning program in the nursing observation and assessment of acute surgical patients: A naturalistic observational study.

AIM/OBJECTIVE: The aim of this study was to evaluate the effectiveness of an eLearn program in changing surgical nurses' approach to clinical assessment. BACKGROUND: Nurses need to have the knowledge and skills to recognise and respond to changes in patients' physiological condition in a timely manner. A private health service in Melbourne, Australia developed an online (eLearn) program highlighting the importance of clinical assessment and provided nurses with an overview of the Airway,Breathing, Circulation, Disability, Exposures ('ABCDE') approach. DESIGN: A before and after study design that involved naturalistic observation of nurse-patient interactions and nurses' performing patient clinical assessments was undertaken on two surgical wards. METHODS: The intervention ward nurses received standard education and exposure to the eLearning program. The comparison ward nurses received standard workplace education on patient assessment. The nurses were observed from May to August 2018. RESULTS: Following completion of the eLearn, intervention ward nurses were observed to spend more time with their patients conducting clinical assessment. On both wards, not all nurses performed comprehensive ABCDE assessment and there was variability associated with the sequencing of ABCDE assessment. CONCLUSIONS: This study provides some evidence that completion of an eLearn can change clinical practice, however the intensity of the intervention was insufficient to achieve optimal practice in the conduct of clinical assessments.

Paediatric nurses', children's and parents' adherence to infection prevention and control and knowledge of antimicrobial stewardship: A systematic review.

INTRODUCTION: Infection prevention and control precautions help to decrease microbial transmission, and through the appropriate use of antibiotics, Antimicrobial Stewardship programs aim to decrease the prevalence and emergence of Antimicrobial Resistance. METHODS: A systematic review was undertaken to critically appraise and synthesise evidence for nurses', children's and parents' knowledge and understanding of antimicrobial stewardship, and of infection prevention and control in acute paediatric care settings. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guided the review. Studies were included if they examined the factors that contributed to nurses' adherence to, or consumers' practice in relation to, antimicrobial stewardship and infection prevention and control. RESULTS: Of the 16,957 papers identified, 50 studies conducted in acute paediatric settings met the eligibility criteria, and were included. Most studies were of low methodological quality. Fourteen studies evaluated nurses' knowledge and self-reported adherence to Infection Prevention and Control principles and identified consistent practice gaps by nurses. Six studies evaluating the effectiveness of education programs reported modest improvements in nurses' knowledge and adherence to infection prevention and control. There were 15 studies, that investigated consumers' involvement in infection prevention and control that identified the following themes: Consumer knowledge and attitudes to infection prevention and control and transmission-based precautions, and parents' willingness to take an active role in infection prevention. Six studies focused on paediatric nurses' role in antimicrobial stewardship, exploring the following themes: (1) nurses' understanding and beliefs of antimicrobial stewardship roles, and (2) barriers to nurses taking a greater role in antimicrobial stewardship. Nine studies explored the role of consumers in antimicrobial stewardship and identified consumers' misconceptions about the benefits and downplayed concerns regarding antibiotic use. DISCUSSION: Although consumers articulated a willingness to be actively involved in infection prevention, observed practice remained lower than that required to consistently prevent infection transmission. CONCLUSION: These findings highlight a critically important gap in current practice. In relation to optimal use of antimicrobials, although paediatric nurses were involved in supporting antimicrobial stewardship processes and educating consumers, they identified limited antimicrobial stewardship knowledge. Consumers appeared to lack understanding about the benefits of antibiotics and negated concerns regarding antibiotic use.

An investigation into nursing students' application of infection prevention and control precautions.

BACKGROUND: Undergraduate education of Health Care Workers is pivotal to ensuring that frontline clinicians have appropriate knowledge and skills in Infection Prevention and Control (IPC). OBJECTIVES: The aim of this study was to describe undergraduate nursing students' self-reported compliance with Standard Precautions and to explore the psychosocial factors that influence adherence in clinical practice. DESIGN: A cross-sectional survey design was used. SETTING: The study was conducted in the School of Nursing and Midwifery at an Australian University. PARTICIPANTS: All undergraduate nursing students were invited to participate in an online survey; 321 participated, mean age 25.7 years (SD = 8.4). The majority, 196 (61%), had no healthcare work experience, 54 (17%) were patient-care assistants, 40 (13%) enrolled nurses, and 31 (9%) were nurses registered overseas. METHODS: Two validated instruments were used: the Compliance with Standard Precautions Scale (CSPS) and the Factors Influencing Adherence to Standard Precautions Scale- Student version (FIASPS-SV). Linear regression was used to measure the impact of psychosocial factors on self-reported compliance. RESULTS: Overall self-reported compliance with prevention of cross-infection was 83%, use of Personal Protective Equipment (81%), correct disposal of sharps (83%) and general waste (75%), and equipment decontamination (69%). The predominant factors endorsed on the FIASPS-SV were 'Leadership' (M = 15.21 SD = 5.28) and 'Contextual cues' (M = 19.09 SD = 6.37). Multivariate linear regression demonstrated that after adjusting for age, gender and years of nursing study, the Leadership factor predicted participants' self-reported compliance on the 'prevention of cross-infection' (p < .001), 'use of PPE' (p < .001), 'waste disposal' (p = .021), and 'decontamination of equipment' (p < .001) sub-domains of the CSPS. CONCLUSIONS: These findings highlight that strong clinical leadership and role modelling are essential to ensure all healthcare students prioritise rigorous adherence with infection prevention and control guidelines.

Perceived roles and barriers to nurses' engagement in antimicrobial stewardship: A Thai qualitative case study.

BACKGROUND: Antimicrobial stewardship is the practice of ensuring the optimal use of antibiotics to prevent antimicrobial resistance. A multidisciplinary approach is considered best practice; however, little is known about nurses' contribution. OBJECTIVES: To explore how organisational multidisciplinary leaders and clinical nurses perceive nurses' roles in AMS in a single organisational site case study based in Thailand, within the current governance, educational and practice context, and the barriers to nurses' engagement in AMS. METHODS: A qualitative descriptive study using thematic analysis approach was conducted in a 1000-bed university hospital in Bangkok, Thailand. The combined number of organisational leaders and nurses was 33 including 15 individual organisational leader interviews and three focus groups involving 18 nurses. RESULTS: Nurses currently participate in AMS by supporting system processes, monitoring safety and optimal antibiotic use and patient education. A lack of clear articulation of nurses' role and traditional professional hierarchies limits active participation. Inconsistent engagement was perceived as due to a failure to prioritise AMS activities, a lack of formal policies and a need for further education. CONCLUSION: Nurses do engage in AMS but there are significant governance, hierarchical and educational impediments. These gaps need to be addressed before clearly defined nurse roles in AMS can be developed and embedded into clinical practice.

The Factors Influencing Adherence to Standard Precautions Scale - Student version (FIASP- SV): A psychometric validation.

BACKGROUND: Standard Precautions have been demonstrated to limit infection transmission in the healthcare setting. Despite their mandated use, adherence by healthcare professionals remains suboptimal. A nursing curriculum embedding infection prevention and control is essential in equipping future healthcare professionals with the skills and knowledge to improve patient safety. There are no psychometrically-validated tools that specifically assess influences on nursing students' adherence to standard precautions. METHODS: The aim in this study was to determine the reliability and validity of the five-factor Factors Influencing Adherence to Standard Precautions within a sample of undergraduate nursing students studying at one Australian University. RESULTS: Data from 321 participants were used to test the 5 factors structure, using Confirmatory Factor Analysis. The goodness of fit indices did not support adequate fit of the data and the data were submitted to a random split-half sample factor analysis process. A four-factor solution was extracted with good to acceptable internal reliabilities (α = .66 -.80). CONCLUSION: There are distinctive differences in the factors that influence student versus registered nurses' behaviour and clinical decision-making in relation to use of SP. The Factors Influencing Adherence to Standard Precautions (Student Version) has good psychometric properties and is suitable for use with nursing students. Having measures specific to students is essential as measures developed for healthcare professionals might not be applicable to a nursing student population.

Six-year trends in postoperative prescribing and use of multimodal analgesics following total hip and knee arthroplasty: A single-site observational study of pain management.

BACKGROUND: Guidelines for acute postoperative pain management recommend administering analgesics in multimodal combination to facilitate synergistic benefit, reduce opioid requirements and decrease side-effects. However, limited observational research has examined the extent to which multimodal analgesics are prescribed and administered postoperatively following joint replacement. METHODS: In this longitudinal study, we used three-point prevalence surveys to observe the 6-year trends in prescribing and use of multimodal analgesics on the orthopaedic wards of a single Australian private hospital. We collected baseline postoperative data from total hip and knee arthroplasty patients in May/June 2010 (Time 1, n = 86), and follow-up data at 1 year (Time 2, n = 199) and 5 years (Time 3, n = 188). During the follow-up, data on prescribing practices were presented to anaesthetists. RESULTS: We found a statistically significant increase in the prescribing (p < 0.001) and use (p < 0.001) of multimodal analgesics over time. The use of multimodal analgesics was associated with lower rest pain (p = 0.027) and clinically significant reduction in interference with activities (p < 0.001) and sleep (p < 0.001). However, dynamic pain was high and rescue opioids were likely under-administered at all time points. Furthermore, while patients reported high levels of side-effects, use of adjuvant medications was low. CONCLUSIONS: We observed significant practice change in inpatient analgesic prescribing in favour of multimodal analgesia, in keeping with contemporary recommendations. Surveys, however, appeared to identify a clinical gap in the bedside assessment and management of breakthrough pain and medication side-effects, requiring additional targeted interventions. SIGNIFICANCE: Evaluation of 6-year trends in a large Australian metropolitan private hospital indicated substantial growth in postoperative multimodal analgesic prescribing. In the context of growing global awareness concerning multimodal analgesia, findings suggested diffusion of best-evidence prescribing into clinical practice. Findings indicated the effects of postoperative multimodal analgesia in real-world conditions outside of experimental trials. Postoperative multimodal analgesia in the clinical setting was only associated with a modest reduction in rest pain, but substantially reduced interference from pain on activities and sleep.