This study explored personal hygiene options of renal patients that maintain the integrity of central venous catheter exit site dressings between dialysis sessions. Background: Infection is a major life-limiting risk for patients undergoing haemodialysis via a central venous catheter. Meticulous attention to keeping the exit site dressings clean and dry is an essential defence in preventing local and systemic infections. It is difficult to maintain the integrity of water-resistant dressings in tropical environments. Study Design: A three-phase exploratory study was conducted in a northern Australian Renal Service. Methods: Phase 1 employed a cross-sectional, anonymous, online survey of renal nurses about the acceptability and feasibility of two hygiene options for patients: bathing wipes and a waterproof dressing cover. The survey also canvassed their concerns about the options. Descriptive statistics were used to summarise Likert-scale responses and content analysis was used for responses to open-ended survey questions. Phase 2 used conversational-style interviews with patients about their hygiene preferences, how they endeavoured to keep their dressings dry, and their impressions regarding the proposed options. Phase 3 was a series of case studies of patients trialling the provided options over a six-week period. Participants were progressively recruited to this phase and were provided with the product/s of their choice at each dialysis session; renal nurses also assessed the integrity of the dressings at each dialysis session. Research nurses discussed with the participants their experiences with the options. Results: Phase 1: Nurses (N=37, response rate 58.7%) considered both options acceptable and feasible for patients, noting some practical concerns related to their use. Phase 2: Patients (N=27, 100% participation rate) described hygiene preferences and difficulties they encountered with keeping dressings dry. Only one participant had a bath, as per written advice. All were enthusiastic about trying the proposed options. Phase 3: Patients (N=22) appreciated being able to shower without wetting their exit site dressings. Individuals were inventive in modifying the application and use of the waterproof cover according to their body shape and the central venous catheter exit site location. Although participants liked both options, the waterproof covering was most popular and most frequently used. Intactness of the dressings was 83% during the trial; there were no central venous catheter-associated infections during the study. Conclusion: Self-management and choice were motivating factors for participants. Patients embraced being able to keep their dressings dry and intact during personal hygiene in a tropical environment. Implications for research, policy, and practice: Patients demonstrated their willingness to undertake a more active role in their dressing care, while exercising choice with respect to personal hygiene. Studies that further increase patients’ participation in other aspects of their self-care warrant further investigation. The organisation is pursuing options for the ongoing provision of the products used in this study and how their use can be monitored in clinical practice. What is already known about the topic? Intact dressings provide an important line of defence against infection in the vulnerable population of patients receiving dialysis via central lines. Hygiene needs are also an important consideration for quality of life, empowerment, and autonomy. Patients’ current attempts to meet their own hygiene needs often result in a disruption to the intactness of the dressing site and predispose them to systemic infections. What this paper adds This study facilitated exploration of two feasible hygiene options in an open and culturally safe manner, from both patients’ and nurses’ perspectives. The opportunity to perform personal hygiene according to individual preferences resulted in a willingness of participants to undertake a more active role in the care of their dressing. The identification of two acceptable and feasible personal hygiene options has the potential of removing one of the many lifestyle modifications faced by people who undergo haemodialysis via a central venous catheter.

Objective: To investigate the perspectives of Australian nursing educators on the preparation of Bachelor of Nursing students for the care of older people's oral health. Background: The Australian population is ageing. Older people with poor oral health are at increased risk of worsening health and chronic disease conditions. Nurses can and need to take a leadership role in improving and maintaining older Australians' oral health in community, hospital, and residential care settings. Thus, it is important to investigate the perspectives of nursing educators on the preparation of nursing students for the care of older people's oral health. Study design and methods: Semi-structured interviews were conducted with 13 participants, including course coordinators, lecturers, directors, and researchers at 10 universities delivering accredited Bachelor of Nursing programs across seven different states in Australia. Data were analysed thematically. Results: Four themes were identified in nursing educators’ perspectives: (1) the education of nursing students in providing oral healthcare is important, (2) there are notable gaps in nursing students' oral health education, (3) there are both internal and external barriers to strengthening oral health education across nursing programs, and (4) there is a need to develop and promote a shared oral health curriculum that includes interprofessional education and collaborative practice. Inherent in these themes was the need for a clear definition of the role of nurses in oral healthcare. Discussion and Conclusion: It is recommended that administrators and policymakers develop nursing accreditation standards that specify the role of nurses in oral health education, and the scope of this education including interprofessional and collaborative practice, for the oral healthcare of older people. Infusing such standards in nursing curricula will better educate and prepare nursing students for effective practice and leadership in gerontological care. What is already known about the topic? Older people frequently have oral diseases that adversely affect chronic health conditions and increase the risk of poorer general health. Even though oral healthcare is an essential part of nursing for older people, the provision of such care is implied rather than stated specifically in Australian Nursing and Midwifery Accreditation Council (ANMAC) standards. What this paper adds: The education and preparation of students to provide oral healthcare appears to be expected rather than required in Australian nursing curricula. Based on the perspectives of nursing educators, this paper suggests that many nursing students may not be well prepared to provide evidence-based oral care and lead oral health initiatives. The paper identifies ways these issues can be addressed. The paper discusses the importance of developing and promoting a clear oral health curriculum that includes interprofessional collaborative practice to strengthen nursing students' education and prepare them to provide effective oral healthcare for older people. The paper outlines a needed definition of the role of nurses in providing oral healthcare.

Objective: To present and discuss options for upskilling registered nurse supervisors to ultimately improve the quality and consistency of nursing student placements. Background: Many studies have examined clinical learning in nursing, with evidence that student learning and registered nurse clinical supervision experiences can be improved. An independent review of nursing education in Australia confirmed gaps in the preparation and support of supervising registered nurses that may negatively impact students’ learning. Study design and methods: This paper discusses contemporary insights around 1) the current situation in Australian nursing student clinical placements regarding learning, 2) registered nurse clinical supervisor experiences and 3) professional options for recognising role excellence, offered by Australian and international nursing and healthcare specialities. Discussion: Nursing students’ placement experiences are at times sub-optimal. One way to improve learning experiences could be to offer clinical supervisors professional development programs. Now is the time to consider a certification process to recognise excellence in registered nurses’ education capabilities and to better support students’ clinical learning. Conclusion: Upskilling registered nurses for clinical supervision may be assisted through formal and informal education programs specific to the professional nursing context in Australia. Implications for research policy and practice: Upskilling registered nurse clinical supervisors should be a priority on the national agenda of improving students’ clinical learning experiences. This commentary provides contemporary insights to the current situation regarding Australian students’ clinical placement and supervisor experiences. The ways that some nursing specialities recognise excellence in practice are discussed as options for improving clinical supervision. What is already known about the topic? Nursing students’ clinical placements need improvement; students continue to report less than optimal experiences. There are no requirements in Australia for registered nurse clinical supervisors to undertake assessment of capability for the role. National and international processes exist to recognise supervisor capabilities and role excellence. What this paper adds: Options for recognising capability and practice excellence in nursing clinical supervision. A discussion around clinical supervisors engaging with formal and informal education and processes that recognise excellence in role capabilities.

Objective: This study was carried out to determine the effect of self-management support given to patients diagnosed with hypertension on the hypertension knowledge level, treatment adherence and self-care management, and to examine the changes in patients' blood pressure after the self-management support. Background: The rise of chronic diseases such as hypertension necessitates the equipment of patients with sufficient knowledge and skills necessary to manage their disease and self-care. Methods: This randomised controlled research was conducted with a total of 137 patients, including 69 intervention and 68 control patients. Data were collected using the “Patient Information Form”,

Background: The COVID-19 pandemic has had widespread impacts on the community and has demanded a rapid response from the aged care sector. System changes for infection control have been required including the use of personal protective equipment, lockdowns, visitor restrictions and changes to activities within aged care facilities. Even prior to COVID-19, the high physical and emotional demands of aged care work were recognised. Objective: This study sought to understand aged care workers’ experiences of the COVID-19 pandemic. Methods: Using a pragmatic paradigm qualitative data about work experiences during COVID-19 was collected from people employed in different aged care organisations in a range of aged care roles and settings from multiple Australian states. Data was collected using focus groups and interviews conducted online between August-October 2020. Inductive thematic analysis was used to identify key themes in the data. Results: Participants included 15 people working across a range of aged care roles including clinical, care and management staff and across both residential and community settings. Five themes were identified which characterised aged care workers thoughts about their jobs during the pandemic. These included intensified procedures and emotional demands, feeling undervalued and detached from the frontline, exposure of existing system deficiencies, recognising teamwork and increased confidence in technology. Conclusion: Reflecting on aged care workers’ experiences of COVID-19 highlights the need to better support workers and acknowledge their important role in caring for older Australians. This includes at an organisational level by providing supportive environments and access to online resources as well as at the community and policy level by recognising aged care workers as frontline workers. The COVID-19 pandemic has also highlighted existing systemic issues in the aged care sector that need to be addressed for the provision of quality aged care in Australia during the COVID-19 pandemic and into the future. What is already known about the topic? While the COVID-19 pandemic is affecting the global community, it is disproportionately impacting the aged care sector with higher rates of severe illness and death and wide-ranging system changes to prevent and control the spread of the virus. Prior to COVID-19, aged care work was associated with high job demands and lack of access to resources to support aged care workers in their role. Survey data on the Australian RACF workforce found workers felt prepared for the pandemic with a wide range of measures to control the spread of COVID-19 but they faced several challenges associated with their additional roles and restrictions. What this paper adds This paper provides qualitative and descriptive insights into the challenges experienced by the Australian aged care workforce during COVID-19 including increased workloads and intensified emotional demands of their roles while at the same time feeling undervalued by the wider community. This study has highlighted the need to better support and acknowledge aged care workers in the community through their portrayal in the media and within their organisations by facilitating supportive team environments and providing access to online resources and training. This paper discusses existing systemic issues that have been highlighted by COVID-19 and the Royal Commission into Aged Care Quality and Safety and need to be addressed for the wellbeing of workers and the provision of quality aged care.

Objective: We report on a qualitative study of community nurse encounters with early relational trauma in parent-infant dyads. Background: Early relational trauma involves interactional or emotional disturbance in the parent infant dyad. Earliest possible detection is needed to mitigate negative impacts on socio-emotional development, but early relational trauma is often challenging for practitioners to detect and respond to. Study design and methods: Maternal and Child Health nurses in Victoria, Australia received workforce training to address this. We interviewed 20 nurses both before and after they received specialist training, to understand their lived experiences in encountering client trauma and perceived changes to their professional confidence and competence post-training. The study comprised two areas of enquiry: i) a phenomenological analysis of nurses’ lived experiences in encountering possible trauma; and ii) a grounded theoretical analysis of the context of trauma encounters at baseline, and perceived change in competence at follow-up. Results: Nurses who coped well when working with trauma maintained a level of emotional distance and were able to draw on a repertoire of well-established practice skills. The specialist workforce training resulted in clear gains in nurses’ confidence and capacity to identify and respond to early relational trauma. Implications: Findings highlight a need for frontline services to provide specialist training and supervision in relational trauma and to cultivate cultures of communication and support. Such programs would optimally be deployed widely, to equip professionals with enhanced knowledge and confidence to create timely change in the face of early relational trauma. What is already known about this topic? Effective recognition of early relational trauma is critical to enable relational repair. Frontline health services are well placed to achieve timely identification of early relational trauma, but it can be challenging for practitioners to detect and respond to the signs of early trauma. Working with relational trauma and feeling uncertain about trauma-related decision-making are distressing, but little is known about the lived experiences of professionals required to detect and respond to parent-infant trauma when lacking specialist knowledge. What this paper adds We interviewed nurses i) before and ii) after they received specialist training in early relational trauma, to understand their lived experiences in encountering possible trauma and their perceived changes to professional confidence and competence post-training. We found that nurses who coped well when working with trauma maintained a level of emotional distance and drew on a repertoire of well-established practice skills. The specialist workforce training described here resulted in clear gains in nurses’ confidence and skills for identifying and responding to early relational trauma, and we interpret findings with reference to recommendations for broader workforce training and supervision.

The article “Coronavirus disease 2019 (COVID-19) Critical Care Essentials course for nurses: development and implementation of an education and implementation of an education program for healthcare professionals” reviews the learning experience of rapidly upskilling registered nurses (RNs) for redeployment into critical care duties during the COVID-19 pandemic, via online education. Whilst respondents were favourable to the online educational model, Jordan et al. (2020) have overlooked the reality and importance of synthesising learning in the clinical practice environment when transitioning RNs into critical care for the first time. Redeployed nurses may feel under-prepared despite online education prior to redeployment. In response to: Jarden R, Scanlon A, Bridge N, McKeever S, Turner R, Prescott H, et al. Coronavirus disease 2019 Critical care Essentials course for nurses: development and implementation of an educational program for healthcare professionals. Aust J Adv Nurs. 2022;39(1):34-43. Available here: https://doi.org/10.37464/2020.391.423