Transforming personally and professionally through global cultural experience: A grounded theory study.

BACKGROUND: Participation in international educational programs during nurses' and midwives' preregistration education provides an opportunity to experience healthcare in different cultures. Short-term outcomes of participation have been reported; however, little has been published regarding long-term outcomes and theoretical processes for nurses and midwives who participate in such programs. PURPOSE: To provide in-depth understandings through a theoretical model of long-term outcomes and impacts for nurses and midwives who participate in international educational programs during their preregistration education. METHODS: Constructivist grounded theory methodology was employed in this study. Thirteen general nurses, two mental health nurses, three midwives, and four dual-qualified nurse/midwives from eight different countries were interviewed. CONCLUSION: The substantive theory, "Transforming personally and professionally through global cultural experience," presents an explanation of processes and long-term impacts for those who participated in international programs during their preregistration education.

Nurses' and nursing students' reasons for entering the profession: content analysis of open-ended questions.

BACKGROUND: Global nursing shortages require effective recruitment strategies and understanding of individuals' motivations to enter the profession. These can be complex and bound by numerous factors such as gender and culture. While much research around this has been conducted, little has been undertaken in non-Western cultures where motivations could be different. AIM: To explore Indonesian nurses' and nursing students' motivations for entering the nursing profession. DESIGN: Online survey with closed and open-ended questions drawn from two different studies. This paper reports findings from one similar open-ended question. METHODS: As part of two larger surveys, nurses from 13 hospitals across one private health care group and nursing students with clinical experienced enrolled in a baccalaureate nursing program in Indonesia were asked the question, Why do you want to be a nurse? Responses were translated into English and back-translated into Indonesian prior to being subjected to summative content analysis. RESULTS: In total, 1351 nurses and 400 students provided responses to the question, representing 98.72% and 99.70% respectively of those completing the survey. Both groups were primarily influenced by desire to serve others and God, personal calling and influence of family members and others. Nurses identified a desire to work in the health field and with the sick, in a noble and caring profession. CONCLUSIONS: Nurses and nursing students were motivated by traditional perspectives on nursing. These should be considered in future recruitment activities. However, more research is needed to understand how these factors influence career choice.

Training healthcare providers to respond to intimate partner violence against women.

BACKGROUND: Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a profoundly gendered issue, perpetrated most often by men against women. IPV may result in substantial physical and mental health impacts for survivors. Women affected by IPV are more likely to have contact with healthcare providers (HCPs) (e.g. nurses, doctors, midwives), even though women often do not disclose the violence. Training HCPs on IPV, including how to respond to survivors of IPV, is an important intervention to improve HCPs' knowledge, attitudes and practice, and subsequently the care and health outcomes for IPV survivors. OBJECTIVES: To assess the effectiveness of training programmes that seek to improve HCPs' identification of and response to IPV against women, compared to no intervention, wait-list, placebo or training as usual. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and seven other databases up to June 2020. We also searched two clinical trials registries and relevant websites. In addition, we contacted primary authors of included studies to ask if they knew of any relevant studies not identified in the search. We evaluated the reference lists of all included studies and systematic reviews for inclusion. We applied no restrictions by search dates or language. SELECTION CRITERIA: All randomised and quasi-randomised controlled trials comparing IPV training or educational programmes for HCPs compared with no training, wait-list, training as usual, placebo, or a sub-component of the intervention. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures outlined by Cochrane. Two review authors independently assessed studies for eligibility, undertook data extraction and assessed risks of bias. Where possible, we synthesised the effects of IPV training in a meta-analysis. Other analyses were synthesised in a narrative manner. We assessed evidence certainty using the GRADE approach. MAIN RESULTS: We included 19 trials involving 1662 participants. Three-quarters of all studies were conducted in the USA, with single studies from Australia, Iran, Mexico, Turkey and the Netherlands. Twelve trials compared IPV training versus no training, and seven trials compared the effects of IPV training to training as usual or a sub-component of the intervention in the comparison group, or both. Study participants included 618 medical staff/students, 460 nurses/students, 348 dentists/students, 161 counsellors or psychologists/students, 70 midwives and 5 social workers. Studies were heterogeneous and varied across training content delivered, pedagogy and time to follow-up (immediately post training to 24 months). The risk of bias assessment highlighted unclear reporting across many areas of bias. The GRADE assessment of the studies found that the certainty of the evidence for the primary outcomes was low to very low, with studies often reporting on perceived or self-reported outcomes rather than actual HCPs' practices or outcomes for women. Eleven of the 19 included studies received some form of research grant funding to complete the research. Within 12 months post-intervention, the evidence suggests that compared to no intervention, wait-list or placebo, IPV training: · may improve HCPs' attitudes towards IPV survivors (standardised mean difference (SMD) 0.71, 95% CI 0.39 to 1.03; 8 studies, 641 participants; low-certainty evidence); · may have a large effect on HCPs' self-perceived readiness to respond to IPV survivors, although the evidence was uncertain (SMD 2.44, 95% CI 1.51 to 3.37; 6 studies, 487 participants; very low-certainty evidence); · may have a large effect on HCPs' knowledge of IPV, although the evidence was uncertain (SMD 6.56, 95% CI 2.49 to 10.63; 3 studies, 239 participants; very low-certainty evidence); · may make little to no difference to HCPs' referral practices of women to support agencies, although this is based on only one study (with 49 clinics) assessed to be very low certainty; · has an uncertain effect on HCPs' response behaviours (based on two studies of very low certainty), with one trial (with 27 participants) reporting that trained HCPs were more likely to successfully provide advice on safety planning during their interactions with standardised patients, and the other study (with 49 clinics) reporting no clear impact on safety planning practices; · may improve identification of IPV at six months post-training (RR 4.54, 95% CI 2.5 to 8.09) as in one study (with 54 participants), although three studies (with 48 participants) reported little to no effects of training on identification or documentation of IPV, or both. No studies assessed the impact of training HCPs on the mental health of women survivors of IPV compared to no intervention, wait-list or placebo. When IPV training was compared to training as usual or a sub-component of the intervention, or both, no clear effects were seen on HCPs' attitudes/beliefs, safety planning, and referral to services or mental health outcomes for women. Inconsistent results were seen for HCPs' readiness to respond (improvements in two out of three studies) and HCPs' IPV knowledge (improved in two out of four studies). One study found that IPV training improved HCPs' validation responses. No adverse IPV-related events were reported in any of the studies identified in this review. AUTHORS' CONCLUSIONS: Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self-perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories. The sustained effect of training on these outcomes beyond 12 months is undetermined. Our confidence in these findings is reduced by the substantial level of heterogeneity across studies and the unclear risk of bias around randomisation and blinding of participants, as well as high risk of bias from attrition in many studies. Further research is needed that overcomes these limitations, as well as assesses the impacts of IPV training on HCPs' behavioral outcomes and the well-being of women survivors of IPV.

Translation, Adaptation and Psychometric Validation of the Indonesian Version of the Readiness for Hospital Discharge Scale for Parents of Low Birth Weight Infants.

PURPOSE: Parental readiness is a requirement for discharge of the high-risk infant from the hospital. Currently, in Indonesia, there are no standard tools to measure parental readiness according to parents' perceptions. This study aimed to undertake cross-cultural adaptation and psychometric validation of the original version (English) of the Readiness for Hospital Discharge Scale (RHDS)-Parent into Bahasa Indonesia. DESIGN AND METHODS: The cross-cultural adaptation was comprised of seven steps: forward translation, forward translation review, blind-back translation, back translation review, pilot testing of the pre-final version with mothers of low birth weight (LBW) infants, expert panel for conceptual and content equivalence, and initial psychometric testing. In the fifth and sixth steps, content validity index was estimated. In the seventh step, exploratory factor analysis (EFA) and internal consistency reliability were conducted. In total, 146 mothers of LBW infants were included in the psychometric testing using convenience sampling. RESULTS: The 22 item Bahasa-RHDS-Parent emerged in a four-factor structure evident from EFA. This version has good reliability with Cronbach alpha values for knowledge and coping ability (0.92), physical-emotional readiness (0.89), pain and power (0.83), expected support (0.80) and 0.90 across the total Bahasa-RHDS-Parent. CONCLUSION: The Bahasa-RHDS-Parent presents good cross-cultural adaptation and initial psychometric properties for assessing parental readiness in parents with LBW infants before hospital discharge. PRACTICE IMPLICATIONS: This questionnaire can be used by nurses to measure readiness for discharge of parents of low birthweight babies. Further testing is needed with a larger sample and parents of children of other ages and conditions for instrument improvement.

Nursing students' perceptions of peer learning through cross-cultural student-led webinars: A qualitative study.

AIMS: To explore nursing students' perception of peer learning during cross-cultural learning activities through student-led webinars. DESIGN: An exploratory qualitative study. METHODS: Thematic analysis of data collected from reflective journals and focus-group interviews of participating nursing students across three international universities in Australia, Hong Kong, and Sweden during autumn 2017. RESULTS: Three themes were identified: peer learning as creation of friendship; peer learning from interactions that went beyond what was originally intended; and peer learning as empowered learning. CONCLUSION: Combining peer learning as an educational approach with cross-cultural and student-led webinars provided new perspectives. On-line learning across global boundaries, based on a sound educational model, creates new opportunities for internationalization without straining individual and institutional financial resources.

Nurse and midwifery education and intimate partner violence: a scoping review.

AIMS AND OBJECTIVES: This scoping review aims to identify the scope of current literature considering nurse/midwife educational practices in the areas of intimate partner violence to inform future nursing/midwifery educational policy and practice. BACKGROUND: Intimate partner violence is a global issue affecting a significant portion of the community. Healthcare professionals including nurses/midwives in hospital- and community-based environments are likely to encounter affected women and need educational strategies that support best practice and promote positive outcomes for abused women and their families. DESIGN: Scoping review of relevant literature from January 2000 to July 2015. METHOD: Search of databases: CINHAL, MEDLINE, EMBASE, PROQUEST Central and COCHRANE Library. Reference lists from included articles were searched for relevant literature as were several grey literature sources. RESULTS: This review demonstrates low levels of undergraduate or postregistration intimate partner violence education for nursing/midwifery staff and students. Existing intimate partner violence education strategies are varied in implementation, method and content. Outcomes of these educational programmes are not always rigorously evaluated for staff or client-based outcomes. CONCLUSIONS: Further research is needed to evaluate existing intimate partner violence education programmes for nurses/midwives and identify the most effective strategies to promote improved clinical practice and outcomes for abused women and their families. RELEVANCE TO CLINICAL PRACTICE: Intimate partner violence has a significant social and public health impact. The World Health Organization has identified the need to ensure that healthcare professionals are adequately trained to meet the needs of abused women. Intimate partner violence education programmes, commencing at undergraduate studies for nurses/midwives, need to be implemented with rigorously evaluated programmes to ensure they meet identified objectives, promote best practice and improve care for abused women.

Emergency healthcare experiences of women living with intimate partner violence.

AIM AND OBJECTIVES: To explore healthcare experiences of Australian women living with intimate partner violence (IPV) and consider how these influence their understanding of IPV and sense of self. BACKGROUND: Despite international campaigns condemning violence against women, IPV remains a worldwide problem and recent Australian community attitudes demonstrate ongoing beliefs condemning women in abusive relationships. Women experiencing IPV are over-represented in healthcare-seeking populations; however, they are rarely identified as experiencing abuse and are often not provided care directed towards achieving ongoing safety. While women seek empathetic healthcare, disclosure of abuse often results in being judged negatively or blamed. DESIGN: A grounded theory study drawing on Clarke's (Sage Publications, London, 2005) analytic approach of situational analysis. METHODS: Semi-structured interviews conducted with seven women. Data was analysed using NVIVO 8 software within a Situational Analysis framework. RESULTS: Four major categories were identified: Accessing healthcare: challenges and barriers; Care women need vs. care women receive; Discourses of IPV and constructions of self; and Acknowledging IPV: moving on and re-constructing self. Women faced significant challenges in accessing emergency healthcare and healthcare then often lacked empathy. Women created an understanding of self from a world dominated by an abusive partner and needed assistance re-labelling their experiences as IPV. Healthcare professionals who provided empathetic care were instrumental in assisting this process, enhancing women's abilities to explore options for limiting abuse and assisting them to enhance their self-efficacy and reconstruct a positive sense of self. CONCLUSIONS: Healthcare is one of the few avenues women living with IPV have to receive emotional and physical support. Healthcare that ignores psychosocial issues further damages women's sense of self. RELEVANCE TO CLINICAL PRACTICE: Women require timely information and empathetic support from healthcare professionals to assist them in understanding and labelling their experiences as IPV. This enhances women's ability to feel deserving of, and ideally achieve, a life without violence.

Recognizing and Adapting to Cultural Differences: Influence of International Educational Programs on Future Nursing and Midwifery Practice.

INTRODUCTION: International educational programs build cultural humility and safety skills in nursing and midwifery students; however, long-term outcomes of these programs are unclear. The purpose of this study was to explore the impact of international educational programs on nurses' and midwives' future professional practice. METHOD: Using grounded theory informed by Charmaz, 13 general nurses, two mental health nurses, three midwives, and four dual-qualified nurse/midwives across eight different countries were interviewed. Three categories evolved from the analysis. This article reports on the category Recognizing and adapting to cultural differences. FINDINGS: Participants developed cultural safety and awareness from participation in programs extending into future practice. Experiencing and adapting to cultural similarities and differences, they developed culturally congruent practices many years after program completion. DISCUSSION: International programs contributed to participants' professional practice. Positive and ongoing influences are important for employers to promote patient safety and culturally congruent quality care. Findings are also relevant for education providers to inform quality cultural learning.

The experiences and barriers in addressing type 2 diabetes mellitus-associated erectile dysfunction: a mixed method systematic review.

INTRODUCTION: Experiences and determinants connected with type 2 diabetes mellitus-associated erectile dysfunction (T2DMED) in health appointments are not well understood and infrequently reported. This systematic review was undertaken to synthesise evidence of the experiences, facilitators, and barriers around screening ED in men with T2DM during health service consultations. METHODS: The review report was based on the guidelines provided by the Joanna Briggs Institute for conducting mixed-method systematic reviews. Eight electronic databases were searched, including Web of Science, Embase via Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO, ProQuest, PubMed, PsychInfo via Ovid, MEDLINE via Ovid, Portal Garuda. Additionally, the review manually looked through the reference lists of the studies we included. Erectile dysfunction, type 2 diabetes mellitus, screening and barriers were initially used as keywords in the search strategy. All identified primary studies written in English and Bahasa Indonesia, and published between 2001 and 2022 were meticulously screened following an agreed set of inclusion criteria. FINDINGS: Out of 3468 papers screened, only six were chosen for the review. These included three cross-sectional studies, two qualitative studies, and one mixed-method study. The study quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Based on the checklist criteria, the studies ranged between 5/10 to 9/10 in terms of quality. After synthesizing the findings, four main categories were identified including the willingness to discuss T2DMED, the barriers experienced and perceived, the limited understanding of T2DMED, and the support expected by men with T2DM. DISCUSSION: Many men kept quiet about their struggles with T2DMED, hoping to bring it up as a topic of discussion during healthcare consultations. Barriers such as embarrassment, a sense of helplessness and reluctance to seek help, financial constraints, and dismissive healthcare professionals hindered them from addressing this issue. Both the participating men and healthcare professionals lacked a comprehensive understanding of T2DMED. RECOMMENDATIONS: It is important to provide education tailored to men's specific needs and improve awareness about T2DM-associated ED. Creating a more T2DMED-friendly environment could be a potential solution to increase early screening and management. Future research should investigate potential barriers that prevent HCPs from identifying and addressing T2MED since their absence in the identified studies highlights this need. SYSTEMATIC REVIEW REGISTRATION: CRD42021292454.

Women's empowerment and contraceptive use: Recent evidence from ASEAN countries.

BACKGROUND: A fundamental element of gender equity are women's rights to reproductive choice. Women's empowerment is often linked to enabling decisions around contraceptive use and reduced fertility worldwide, although limited evidence is currently available around contraceptive use and decision making in ASEAN countries. OBJECTIVE: To examine the association between women's empowerment and contraceptive use in five selected ASEAN member states. METHODS: Data from the latest Demographic and Health Survey of Cambodia, Indonesia, Myanmar, The Philippines, and Timor-Leste were used. The main outcome was contraceptive use among married women (15-49 years) from these five countries. We considered four indicators of empowerment: labor force participation; disagreement with reasons for wife beating; decision-making power over household issues; and knowledge level. RESULTS: Labor force participation was found to be significantly associated with contraceptive use in all nations. Disagreement with justification of wife beating was not significantly related to contraceptive use in any country. Decision-making power (higher) was only associated with contraceptive use in Cambodia, while higher knowledge levels were associated with contraceptive use in Cambodia, and Myanmar. CONCLUSION: This study suggests women's labor force participation is an important determinant of contraceptive use. Policies designed to open the labor market and empower women through education should be implemented to enable women's participation. Gender inequality may also be tackled by engaging women in decision-making processes at national, community and family levels.

Non-medical and non-invasive interventions for erectile dysfunction in men with type 2 diabetes mellitus: A scoping review.

Background: Erectile dysfunction (ED) often affects men with type 2 diabetes mellitus (T2DM) due to microvascular damage. However, medical interventions are not always appropriate. Aim: This scoping review aimed to answer the following question: What evidence is available about the effects of non-medical and non-invasive healthcare interventions to improve ED in men with T2DM? Method: Potential studies were collected from the Cumulative Index to Nursing and Allied Health Literature via EBSCO, Embase via Ovid, MEDLINE via Ovid, Web of Science, PubMed, ProQuest, and PsycINFO via Ovid. Findings: From 2,611 identified titles, 17 studies, including 11 interventional and 6 observational studies, were included. Four main alternatives to medical interventions were identified from the included studies. Amongst these, four studies recommended patient education on lifestyle modification, twelve studies encouraged dietary changes and physical activities, two studies emphasized the use of vacuum erectile device, and three studies suggested the application of low-intensity extracorporeal shockwave therapy by healthcare professionals. Discussion: Dietary modification and physical activities were promoted as effective interventions to help maintaining the erectile function in men with T2DM. Several methods of patient education were identified as the approach to facilitate lifestyle modification in men with T2DM-associated ED. The positive outcomes of this review support early ED screening to help preventing T2DM complications such as ED in men. Further, T2DM management is a shared responsibility between the men and healthcare professionals. Despite the success of Vacuum Erectile Device and Low-intensity Extracorporeal Shockwave Therapy in regaining erectile function, further research is needed in this area based on the recommendations of the American Urological Association. Moreover, the health and quality of life of men with T2DM must be improved.

Overlooked by nurses: A scoping review on health stressors, problems and coping of migrant domestic workers.

AIM: The first scoping review is to map and synthesize the stressors, problems and coping strategies surrounding the health issues of migrant domestic workers. DESIGN: Scoping review using Arksey and O'Malley's five-stage framework. METHODS: Ten electronic databases were systematically searched by keywords for literature published between January 1995 and December 2019. Data were extracted into tables and collated and summarized into themes for presentation. RESULTS: Twenty-seven reports were included in the final review. Analysis revealed that stressors to health included abuse, poor health service accessibility, ongoing financial hardship despite demanding working conditions and social isolation. Physical and mental health problems were identified for which migrant domestic workers largely depended on social networks and religion to cope with stressors and health problems. Training para-professional peer leaders of migrant domestic workers by community nurses and including them in interprofessional teams is a possible way for nurses to promote their health and well-being.

Becoming an adolescent mother: The experiences of young Indonesian new mothers living with their extended families.

OBJECTIVE: Adolescent motherhood brings many challenges. While much is written about young mothers' transition to motherhood and their support needs, there is little from South-East Asian countries such as Indonesia. The aim of this study was to understand the new motherhood experiences of Indonesian adolescent females living with their extended families. DESIGN: Eleven semi-structured interviews were conducted with new adolescent mothers. SETTING: a large women and children's hospital in Makassar, South Sulawesi, Indonesia. PARTICIPANTS: Purposive sampling was undertaken. Eleven adolescent mother participated in this study. The mean age of the mothers was 17 years, ranging from 16 to 19 years of age. FINDINGS: Four themes emerged: demonstrate transfer of knowledge between generations, sharing tasks with extended family, feeling blessed with extended family and local myth and cultural practice related to caring for the baby. Findingsdemonstrated that transfer of knowledge between generations was important for these adolescent mothers. They shared responsibilities with and felt blessed having their extended families, along with local beliefs and cultural practice related to caring fortheir babies. DISCUSSION AND IMPLICATIONS FOR PRACTICE: Our findings contribute to understandings of experiences to becoming mothers among Indonesian adolescents living with extended family. Results can be used by healthcare providers, especially nurses and midwives, to develop cultural care interventions and educational program for maternity and psychosocial care for adolescent mothers and their families towards success in the transition period and maternal role attainment.

Reported outcomes of nursing or midwifery students participating in international educational programs in their pre-registration education: A narrative systematic review.

OBJECTIVE: To identify outcomes of nursing or midwifery students participating in international educational programs in their pre-registration education. DESIGN: A systematic review of the literature was conducted in keeping with JBI methods. DATA SOURCES: A range of databases were searched, including Medline, Embase, ERIC, CINAHL, ProQuest Central and DOAJ. Studies published in English from 2010 to 2020 were considered. STUDY ELIGIBILITY CRITERIA: The review included qualitative and quantitative primary peer-reviewed research studies involving nursing or midwifery students who participated in international educational programs in their pre-registration education. REVIEW METHODS: Thematic analysis informed by Braun and Clarke was used to identify key outcomes emerging. RESULTS: 56 studies were included. The results highlight similarities in outcomes for students who had undertaken international educational programs in three thematic areas: Cultural learning, Personal growth, and Professional development. Short-term outcomes are well documented, however there is a lack of research investigating long-term outcomes. CONCLUSIONS: Further research is required to investigate long-term outcomes of international educational programs and means for measuring the effects on students' future professional practice. In addition, further research is needed to explore the perspectives of, and impact on, others including host communities and universities, and other stakeholders.

Professional development needs of registered nurses in Indonesia: A cross-sectional study.

BACKGROUND: Rapid developments in health care technologies and treatments require nurses to keep abreast of current and best evidence to inform their practice. Continuing professional development is a key component in ensuring knowledge and practice meet contemporary demands and best practice. OBJECTIVE: To examine professional development needs for registered nurses working in Indonesia. METHODS: A cross-sectional survey design using the previously validated Indonesian version of the Hennessy Hicks Training Needs Analysis measurement tool was distributed via digital technologies across thirteen hospitals of one private health care provider in four different regions across Indonesia. RESULTS: A total of 1355 nurses completed the tool. Nurses rated direct care tasks higher on importance, performance and training need, while supporting tasks rated lowest on performance and training need. Nurses with less than one year of experience reported higher need for training. CONCLUSIONS: Most identified performance development needs were similar to those reported by nurses elsewhere. There is a need for specifically and locally tailored education opportunities for outcomes to motivate learning that are meaningful and applicable to practice needs. Future research should seek to examine training needs for nurses working in other settings such as public hospitals and community health settings.

Indonesian mothers' beliefs on caring practices at home for preterm babies after hospital discharge: A qualitative study.

PURPOSE: Premature birth may be associated with infant health problems and frequently requires in-hospital and then at-home specialized care. Studies investigating home-caring experiences of mothers of preterm infants in developing countries are limited. This study was to explore preterm mothers' experiences of caring practices at home 1 month after their infant's discharge from a neonatal unit. DESIGN AND METHOD: A descriptive qualitative study using in-depth interviews with eight purposively sampled mothers who had been discharged home from neonatal unit in one city in Indonesia. All interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. RESULT: Three main themes emerged: (1) transition to independent motherhood, (2) focus on care of infant after discharge, and (3) barriers and enablers for care. The mothers managed their infant care at home by focusing on feeding and managing infant health problems. They faced on myth and culture as one of the barriers. CONCLUSIONS: Comprehensive discharge education for mothers of preterm infants and their families is required to enhance mothers' caring abilities and overcome barriers is sufficient. Nurses/midwives need to improve care related to the well-being of mothers and their infants in preparation for, and after, discharge from the neonatal unit.

Experiences of Healthcare Worker Returnees in Their Home Countries: A Scoping Review.

BACKGROUND: International migration of healthcare workers is a global phenomenon driven by growing demand in developed countries and expectations of healthcare workers from developing countries to have improved employment and lives. This migration has been understood to impact both the individuals and countries involved, with positive and negative consequences. However, little is known about returnees' experiences that could be used to address challenges and optimize benefits. The aim of this review was to understand what is known about experiences of migrant health workers after returning to their home countries. METHODS: A scoping review of primary research addressing experiences of migrant health workers upon their return to their homelands. A range of database were searched including Career and Technical Education Database via ProQuest, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education database via ProQuest, Excerpta Medica Care (EMCare) via Ovid, Education Resources Information Center (ERIC), Excerpta Medica database (EMBASE) via Ovid, MEDLINE and Scopus. A systematic process was performed guided by the work of Arksey and O'Malley. Eight databases were searched and 226 articles were retrieved. After screening articles and abstracts, 15 full-texts were assessed for eligibility, and finally seven studies were further analyzed and synthesized. RESULTS: Five qualitative studies, one quantitative study and one mixed methods study met inclusion criteria. Five themes emerged: (1) reasons to return, (2) upskilling and deskilling, (3) impact on human, financial, and social capital, (4) challenges and opportunities in the home country, and (5) facilitation supports. CONCLUSION: Return migration is portrayed as a complex situation experienced by returnees. Structured policy and supports are required to help healthcare worker returnees prepare, and to adjust to life after their return. This study highlights the importance of comprehensive approach in return migration stage. Return migration policy should support healthcare worker returnees in their home country and facilitate utilization of their skills. Multi-stakeholder partnerships are vital to develop platforms for helping and facilitating returnees in the reintegration process at their home countries.

Exploratory Factor Analysis of the Indonesian Version of the Clinical Learning Environment, Supervision, and Nurse Teacher Scale (CLES + T).

BACKGROUND AND PURPOSE: The purpose of this article is to describe an evaluation of psychometric properties of the Indonesian version of the Clinical Learning Environment, Supervision, and Nurse Teacher (CLES + T) scale, a scale that measures nursing students' perceptions of their clinical learning environment. METHODS: The CLES + T was completed by 292 nursing students. Inter-item correlations, exploratory factor analysis, Cronbach's alpha, and evidence of validity were used to examine reliability and validity. RESULTS: Four factors were extracted that explained 58% of the variance. Cronbach alphas ranged from .86-.95. Wording to describe different titles of supervisors was unclear to some of the participants. CONCLUSION: The Indonesian version of the CLES + T is a reliable version. More research is needed to clarify some of the wording.

Advancing pedagogy of undergraduate nursing students' cultural awareness through internationalization webinars: A qualitative study.

In today's world, nurses increasingly care for individuals from different cultures. Because culturally sensitive care can improve patient satisfaction in care, nurses need to develop cultural competence in their practice. To develop cultural competence, one option is to build cultural awareness by exposing students to nursing practices in other cultures through online internationalization-at-home activities. However, little is known about the process of cultural awareness development through internationalization activities. Therefore, this qualitative study aimed to identify the development process of cultural awareness in nursing students, who participated in a series of internationalization-at-home activities. A total of 31 nursing students from Australia, Hong Kong, and Sweden volunteered to participate in student-led learning groups. Groups consisted of two to four students from each university, who engaged in four weekly webinars and online reflections about nursing practice based on a case scenario. Data were collected from participants' ongoing reflective journal entries, and after the webinars ended, from three focus groups. A semi-structured interview guide was used to understand how the internationalization-at-home activities impacted their cultural awareness and knowledge of nursing. Data were analyzed using interpretive description. Following four levels of thematic analysis (i.e., comprehension, synthesis, theorizing, reconceptualization), we identified four themes in the development of cultural awareness: 1) nurturing reciprocity through comparisons of nursing culture; 2) discovering common ethical values of the nursing profession; 3) developing cultural awareness in nursing ideology and practice; and 4) transforming understanding of nursing in the context of their healthcare systems. By the end of the internationalization activities, students appeared to have developed relational skills to facilitate their own inner dialogue about ethical ideals of "self" and "other" in the context of being part of the global nursing community. Future research should develop and assess teaching strategies that can further facilitate the four themes in cultural awareness development.

Exploring Indonesian adolescent women's healthcare needs as they transition to motherhood: A qualitative study.

BACKGROUND: Marriage and underage childbirth is a phenomenon of increasing incidence globally. Adolescent mothers simultaneously encounter multiple developmental challenges related to transition into adulthood, marriage, pregnancy and mothering responsibilities. Despite this, studies investigating postpartum care needs for adolescent mothers are limited. AIMS: The aim of this study was to explore adolescent mothers' postnatal inpatient experiences and healthcare needs as they moved towards their maternal roles. METHODS: A descriptive qualitative design was adopted to better understand experiences of adolescent mothers during their transition to becoming mothers. Data were collected using in-depth interviews with eleven adolescent mothers in hospital settings in South Sulawesi, Indonesia and analysed using thematic analysis. RESULTS: Four major themes emerged: (1) breastfeeding problems, (2) disempowerment in caring for the baby, (3) health care encounters, and (4) health care needs for adolescent motherhood transition. DISCUSSION: Breastfeeding problems and feeling disempowered in caring for their babies after birth was experienced by all adolescent mothers in this study. Furthermore, the health care provided was limited to mandatory hospital tasks with staff failing to recognize adolescent mothers' broader needs. The findings suggest that adolescent mothers need compassionate health education, support and psychological care from midwives in the postpartum ward before hospital discharge. CONCLUSION: The results highlight important issues in postnatal care provision for adolescent mothers in improving their maternal roles during the transition period. Specific, appropriate interventions for adolescent mothers are needed to support their transition and adaptation to their new roles.