Background: Many of the overseas qualified nurses educated work as health care assistants and support workers for a decreased wage without scope for professional advancement. There is an imperative to ease their entry to the nursing register. Aim: To gather and provide evidence to the regulatory bodies regarding the demographics of this cohort of nurses and the challenges they face in attempting to register as a nurse. Design: This study used a mixed-method explanatory sequential design. The survey was completed by 857 unregistered nurses followed by five in-depth interviews. Results from both phases were triangulated. Results: The results signpost to the characteristics and challenges of these nurses working as unqualified grades of staff for a decreased wage without scope for professional advance. Discussion and conclusion: The downward occupational spiral of internationally educated nurses underscores the paradoxical nature of the pedagogical application of transition theory, as these nurses are compelled to revert to a novice status.

Background Sepsis is a frequent cause of global deaths with time critical diagnosis and treatment impacting outcomes. Prehospital emergency nurses are pivotal in assessment that influences timely diagnosis. Aim To gain a deep understanding of nurse’s experiences when caring for those with suspected sepsis. Design and Methods A qualitative study using semi-structured interviews and inductive content analysis according to the Elo Kyngäs method. Findings Early identification of sepsis by prehospital emergency nurses (n = 13) was augmented through a combination of clinical experience and the implementation of practice guidelines. There were three key components to practice improvement a) clinical experience, b) continuous education and c) explicit guidelines. Conclusions Identification of sepsis in the prehospital environment can shorten the time to treatment for patients with sepsis. Early identification can be achieved by continuous education in the Emergency Medical Service (EMS), ensuring experienced personnel and including the EMS in medical guidelines.

Background: Australia provides education services to international students which includes international students completing a health professional education (HPE) degree. Studying for a HPE degree can be challenging for most students. There are specific challenges for international students when completing a degree with clinical placements. The challenges international students can face include receiving adequate and timely information, understanding health service access, and receiving the correct information from education providers and agents. Objectives: To gain an in-depth understanding of the challenges for international health professional education students in accessing healthcare, understanding the requirements of compliance to attend clinical placements and the difficulties with attending clinical placements. Design: A semi-structured interview schedule based on findings from a survey (N = 318 participants) was used to explore international student perspectives in one-on-one interviews. Methods: Data were collected from international HPE students from a single Australian metropolitan multi-campus university using a questionnaire, which included qualitative open-ended questions, in addition to semi-structured follow-on interviews. Data collection took place between March and October 2021 and qualitative data were inductively thematically analysed. Results: Challenges reported in interviews by six international students were focused on understanding the navigation of new administrative systems and compliance processes. Students noted gaps in the communication of understanding legislative compliance requirements to attend clinical placements, difficulties accessing healthcare and making use of overseas student health cover, organisational issues, and transport issues when attending clinical placements. Conclusions: Higher education providers and international education agents must address communication deficits in course requirements linked to clinical placement prerequisites. This study highlights gaps in commencing international students’ understanding, and higher education providers' communication of clear, timely detailed information.

Background Moral injury occurs when one witnesses or perpetrates an act that transgresses strongly held moral beliefs and expectations. First documented among active military and veterans, moral injury is increasingly studied in healthcare personnel impacted by the coronavirus pandemic. Measurement of moral injury among this population, particularly nurses, is still in its infancy. Objective To develop the Moral Injury Symptom Scale – Clinician-Short Form and validate it among United States based acute care nurses. Methods The Moral Injury Symptom Scale – Military Version was modified for a healthcare audience. 174 acute care nurses responded to a survey package including the scale and related instruments. Reliability and validity, including convergent and discriminant validities, were assessed, and a cutoff score was calculated using the area under the receiver operating characteristic curve. Results Reliability (Cronbach α = .75) and validity were established and a cutoff score of 41, based on functional impairment caused by moral injury, demonstrated 86.4% sensitivity and 69.6% specificity. Nurses who screened positive for moral injury experienced higher depression, anxiety, work exhaustion, interpersonal disengagement, emotional exhaustion, and depersonalization. Conclusions The Moral Injury Symptom Scale – Clinician Version – Short Form is a valid and reliable instrument with strong psychometric properties that can assess moral injury in acute care nurses, a population at risk due to the challenges of providing care during the pandemic. Appropriate measurement and establishing prevalence should prompt support and intervention from healthcare organizations.

Background: Patient harm from unsafe care is an increasingly global phenomenon leading to death or disability. Drawing on their expertise, Advanced Practice Nurses provide the opportunity to improve care quality and safety. Aim: To explore Nurse Practitioners and Clinical Nurse Consultants’ experiences in patient safety. Design: A qualitative design was used involving six audio-visually recorded focus group interviews. Participants working in an acute or community adult nursing speciality were involved. Methods: Twenty-eight Advanced Practice Nurses (female 82.1%, mean age 47.5 ± 10 years) were recruited by convenience and snowball sampling. After transcription of interview data, qualitative content analysis was conducted. Results: Six categories were identified: patient safety as the highest priority (1), special contribution to patient safety (2), patients/relatives role in safety (3), multidisciplinary team approach (4), government regulation in safety (5), and further needs to improve safety (6). Advanced Practice Nurses saw themselves as role models and leaders for other healthcare staff through their expertise and professional experience and thus able to see the bigger picture in health. They identified as change agents at the system-level due to their decision-making ability and multi-professional team connectivity. Conclusions: This study emphasises the key position of extended nursing roles and the need for future development of patient safety strategies in hospitals and community care. As influential leaders, Advanced Practice Nurses are best placed to identify improvements. They play a central role in guiding the multi-professional team, the patient and their family, educating nursing staff, and identifying and addressing system-wide safety gaps to improve patient safety.

Background Type 2 diabetes can lead to severe foot complications, making self-care education, guided by clinical guidelines, crucial. However, fragmented and dispersed recommendations challenge effective implementation of these guidelines. Bringing together recommendations and presenting them according to a self-care model can provide a solid framework and facilitate the interpretation of results. Aims to map the international guidelines that provide recommendations to nurses to enable people with type 2 diabetes for foot self-care and synthesize the recommendations according to the key concepts of the middle-range theory of self-care for chronic diseases. Design A scoping review was undertaken, using the methodological guidance of the Joanna Briggs Institute. Data Sources Databases were searched between September 2022 and June 2023, including PubMed, CINAHL, PsycINFO, Scopus, Web of Science Core Collection, ProQuest Dissertations and Theses Global, guideline websites and related professional association websites. The databases were chosen for their comprehensive coverage of the area. Methods Eligible articles included guidance documents providing foot care recommendations for diabetes, published or updated between 2013 and 2023. Two reviewers summarized the recommendations presented in at least two guidelines according to the key concepts of the self-care model. The PRISMA-ScR checklist was used. Results Seventeen guidelines were included. In total, we synthesized 175 recommendations. The recommendations were framed in three dimensions and their respective categories: Self-care maintenance (education for prevention, control of risk factors, daily foot care, footwear, and socks), Self-care monitoring (foot inspection, detection of signs of infection, and detection of other diabetes-related foot disease complications), and Self-care management (responses to signs and symptoms, foot wound care, follow-up with health professionals, and health services). Conclusions The main aspect of foot care revolves around daily care, including cleaning, moisturizing, nail care, selecting appropriate footwear, and regular inspection of both feet and footwear.

Background The turnover of new and mid-career nurses has been increasing, leading to challenges in recruiting and retaining nursing staff. Objectives Securing and retaining mid-career nurses is crucial for ensuring high-quality care. However, little is known about mid-career nurses’ experiences regarding turnover. This study aimed to understand the experiences of mid-career nurses and identify strategies to enable mid-career nurses to maintain long-term employment in health services. Design Colaizzi’s phenomenological methodology was adopted to illuminate the subjective meaning derived from the work-related challenges of mid-career nurses, leading to turnover. Focus group interviews were conducted to delve into the work challenges faced by mid-career nurses. Method The participants were 23 mid-career nurses working in one tertiary hospital and six secondary hospitals across three Korean cities, recruited using purposive and snowball sampling. The inclusion criteria entailed a minimum of three years of nursing experience and current employment within a designated department or clinical area within the hospital environment, commonly known as a nursing unit. Such units encompassed a range of clinical settings, including medical-surgical units, intensive care units, and emergency rooms. The interview data were transcribed verbatim, and significant statements were extracted from abstract sentences to derive themes through an analytical process. Results Analysis of the work experiences of 23 mid-career nurses in medical institutions yielded 15 themes and 4 theme clusters derived from 353 meaningful statements. These theme collections were identified as ‘Difficulties endured as a mid-career nurse’, ‘Meaningless and regrettable new graduate nurses’ education’, ‘An inexpressibly poor work environment’, and ‘Systems and policies needed to remain in the hospital’. Conclusions Difficulties faced by mid-career nurses including the establishment of an education and career development system, provisions for guaranteed leave, a diverse and flexible work system, opportunities for effective communication, and engagement with the opinions of mid-career nurses should promptly be addressed.

Background: Globally, nurses and midwives have a higher rate of being overweight/obese than the general population, influenced by workplace environments that impact dietary habits. Objective: This systematic review aimed to identify barriers/facilitators to healthy eating among nurses in clinical settings. Design: This systematic review followed Joanna Briggs Institute's guidelines for qualitative systematic reviews. Methods: Eight electronic databases: PROQUEST CENTRAL, SCIENCEDIRECT, MEDLINE, CINAHL, PsycINFO, WEB SCIENCE, PUB MED, and SCOPUS were searched. Articles were screened using JBI SUMARI®, and quality assessment was done using the JBI critical appraisal checklist. Data were extracted using the JBI data extraction tool. Results: Nine qualitative studies were reviewed, involving 488 nurses, concluding 37 distinct findings. Two synthesised findings emerged: barriers, and facilitators to healthy eating, related to organisational (shift work/long working hours), personal, physical workplace environment, and social factors. Conclusions: The review emphasises the necessity of promoting attainable healthy eating practices at organisational, personal, environmental, and social levels within the workplace. Registration: PROSPERO International prospective register of systematic reviews, ID: CRD42022309259.