Australian Nurses Research Articles

Paediatric Nurses' Personal Accounts of Being Told Not to Disclose Information to Children With Serious Illness-An Interpretative Phenomenological Study.

To explore the experiences, and perceptions of nurses who are told to withhold clinical information from children diagnosed with serious illnesses. An interpretative qualitative phenomenological design was used for the study. Sampling was purposive and data were collected using semi-structured interviews from nurses working in a paediatric setting within the preceding 5 years. Nurse-participants described their personal experiences of withholding situations ('non-disclosure directives'). Their accounts of specific examples of situations ('personal accounts') were extracted from the interview transcripts and analysed using inductive content analysis to identify patterns and concepts within the descriptions. Data management was supported using Dedoose. Nurse-participants were interviewed face-to face and online between November 2019 and December 2020. Twenty-six Australian nurses who have cared for seriously ill children within the preceding 5 years participated in the study. Thirty-nine accounts of non-disclosure situations (personal accounts) were extracted from interview transcripts. Four types of non-disclosure were identified in the personal accounts: withholding information, temporary withholding, lying and combined withholding/lying. The inductive content analysis identified three key aspects of nurse-participants' accounts: beliefs and perceptions (about the child and parents), the nature of the experience and feelings about the experience. Moral distress occurred when nurses' actions conflicted with their moral values in response to a non-disclosure directive, particularly when asked to directly lie to children. Nurses felt disempowered by the parent's authority and the institutional hierarchy that limited their ability to participate in discussions where a non-disclosure directive was given. Nurse-participants were afforded a platform for reflection which proved valuable in allowing them to process their experiences in a non-disclosure situation. Nurses directed to withhold medical information from children should be afforded opportunities for reflection to mitigate moral distress. Nurses should be included in the planning of ethically appropriate responses to withholding directives.

Expectations for gynaecological cancer nursing guidance development: a qualitative exploration: Part 1 – creating foundational support

PurposeNurses are acknowledged as essential in the delivery of best practice gynaecological cancer care however previous studies have identified challenges in these nursing roles. Recommendations include the development of nursing guidance focused on supporting people with a gynaecological cancer. This study aimed to explore perceptions and expectations for the development of a gynaecological cancer nursing guidance resource in Australia and investigate preferred design and content inclusion. This paper presents the findings on expectations for the resource purpose. MethodsUtilising an exploratory qualitative descriptive design, 20 nurses and seven people with lived experience of gynaecological cancer participated in focus groups or interviews following a semi-structured interview guide. Transcripts underwent inductive content analysis. ResultsParticipants all identified as female, lived in one of 5 Australian states, included representation from regional locations (n=9, 33%), and mostly identified as Australian or mixed Australian ethnicity (n=25, 93%). The major theme, “Foundational support resource for nurses”, described how participants require a resource to support the delivery of gynaecological cancer nursing care. Participants articulated their goals for the resource through four subthemes: reducing variation in care; acknowledging diversity of nursing roles; addressing barriers; supporting development. ConclusionThe development of a guidance resource for gynaecological cancer nursing is supported by Australian gynaecological cancer nurses and people with cancer lived experience. It is expected its implementation will assist to improve cancer outcomes, equitable access to quality care and support the development and sustainability of the gynaecological cancer nursing workforce.

Australian rural emergency nurses' care of paediatric patients: A qualitative study

BackgroundRural emergency nurses (RENs) are expected to provide care to paediatric patients presenting to their facilities however, as generalist nurses, they experience challenges and feelings that are unique to the rural context. Design and methodsAn exploratory qualitative study of 13 RENs via semi structured interviews of perceptions and experiences of caring for paediatrics and self-determination of autonomous practice, motivations and connectedness in care was the approach used. FindingsInductive thematic analysis of data identified four themes with sub-themes identified within each theme. The four themes were: Caring for Children, Professional Roles, Professional Care and Connection and Professional Development. ConclusionRENs describe feeling fear, stress and anxiety when caring for sick children, particularly when known to the patient and family in their community yet will self-determine autonomous practice and use gatekeeping in certain situations of paediatric care. RENs are motivated to increase their paediatric knowledge and skills, seeking paediatric education opportunities but face barriers in attendance such as travel and costs. RENs rely on connectedness with other rural nurses, seeking paediatric nursing guidance or telehealth support, particularly when performing multiple roles or in the absence of a doctor in the ED. Practice implicationsProvision of opportunities for RENs to lead education in paediatric nursing, that is contextually appropriate and co-designed with paediatric experts is preferred. This would yield greater REN engagement and participation in paediatric education for knowledge and skill proficiency, would increase rural nurse professional development and reduce feelings of fear and anxiety when caring for paediatrics.

The Australian nursing and midwifery academic workforce: A cross-sectional study

AimTo explore the demographics, employment characteristics, job satisfaction and career intentions of the Australian nursing and midwifery academic workforce. BackgroundThe academic workforce is crucial in preparing the next generation of nurses and midwives. Thus, understanding current satisfaction, challenges, opportunities and intentions is important for recruitment and succession planning. DesignCross-sectional online Australian academic nursing and midwifery survey. MethodRespondents were invited to complete an online survey via social media platforms, advertisements on professional websites and circulation via professional associations. Descriptive and inferential statistics were used to analyse the data. ResultsOf the 250 respondents, most were Registered Nurses (n=212), female (n=222), held tenured teaching and research positions (n=126) and were over the age of 50 (n=130). Almost half of respondents held a PhD (n=98), with 55 (43.7%) of those without a Doctoral qualification indicating no intention in undertaking doctoral studies. Over 85% (n=213) of respondents indicated working regular unpaid hours. Female respondents had a significantly higher mean annual teaching allocation compared with males who had higher research workload allocations (p=0.033). Job satisfaction and intention to leave academia were linked with workload and perceived value. Job satisfaction was significantly higher among teaching-only and research-only academics (p=0.005). ConclusionThe sustainability of the Australian nursing and midwifery workforce is at risk due to an ageing workforce and some academics' lack of intention in pursuing doctoral studies. Gender inequities emerged as a finding in this study. Workforce strategies are required to address gender disparities and workload imbalances that have an impact on job satisfaction.

What Enables Implementation of Pain Management Interventions in Intensive Care Units and Why: A Realist Evaluation to Refine Program Theory.

To uncover perspectives and refine 12 initial program theories concerning the implementation of pain management interventions in intensive care units. Contexts enabling implementation are delineated, and causal mechanisms within these contexts are described. A realist evaluation approach was employed. Fourteen purposively selected Australian nurses of variant roles were virtually and individually interviewed between July and September 2023. Participants were presented with initial program theory, and their perspectives were collated. Data were analysed using an integrated approach of context (C), mechanism (M), outcome (O) categorisation coding, CMO configurations connecting and pattern matching. Pain management interventions work if perceived to be beneficial, precise, comprehensive and fit for purpose. Nurses should be willing to change attitudes and update knowledge. Unit leaders should nurture the development of nurses' professional identity, access to learning, autonomy and self-determination. Organisations should change the infrastructure, provide resources, mitigate barriers, develop shared mental models, update evidence and institute quality assurance. Adherence to interventions is affected by the outcomes of implementation and intrinsic merits of interventions. In these contexts, confidence is boosted; feelings of empowerment, self-efficacy, reflective motivation, trust, awareness and autonomy are developed; and capacity is built. Furthermore, frustration from the variability of practices is reduced, accountability and ownership are augmented, yielding positive implementation outcomes. Findings have implications on nurses, team leaders and organisations concerned with implementation. The findings provided a fortified understanding of conditions favouring successful implementation of pain management interventions. Actions should be undertaken at an individual, unit and organisation level to ensure successful implementation. RAMESES II Reporting Standards for Realist Evaluations informed presentation of study. Intensive care nurses contributed insights to refine the program theory.

Graduate qualities for preservice health and welfare professionals for collaborative prevention and early intervention for child maltreatment: a qualitative study

AimThis study explored Australian nursing, midwifery and social work perspectives on needs within pre-service education to enable interprofessional public health responses to child maltreatment. BackgroundChild maltreatment is a global public health concern, but little is known about how well health and welfare professionals are equipped for interprofessional responses to child maltreatment during initial pre-service qualification. DesignQualitative, World Café approach with online roundtable discussions. MethodsTwenty-five participants attended one of three online roundtables in October 2023. Participants were nurses, midwives and social workers from Australia with expertise in tertiary education, professional regulation and/or child protection. Data were analysed through inductive thematic analysis. ResultsGraduates are not well-equipped during their pre-service education for collaborative responses to child maltreatment. Findings identified four core areas of focus so health and welfare professionals can effectively collaborate to respond to child maltreatment. Core areas are described as graduate qualities and encompass broad domains of knowledge, skills and values which are transferable across multiple areas of practice. ConclusionsOur study proposes core qualities which are essential for health and welfare professional pre-service education to equip graduates for collaborative responses to child maltreatment. Key barriers included lack of shared interprofessional language and priorities, meaning future work should establish consensus on essential knowledge, skills and values. A shared understanding which acknowledges disciplinary nuances is vital to inform curriculum that equips future professionals to collaboratively mitigate harms from child maltreatment.

Exploring the Knowledge and Use of Standardised Nursing Terminology Across Australia.

Standardised nursing terminologies (SNTs) support the visibility of nursing work and documentation, enabling data sharing and comparison. An online survey assessed the knowledge and use of SNTs and revealed barriers and enablers to their use by Australian nurses. Just over half of the respondents were familiar with SNTs before the survey, a quarter reported a reasonable understanding of SNTs, just under half reported previous use of a SNT, and less than 14% indicated a current use of a SNT in their workplace. Perceived benefits to SNTs identified by respondents included a reduction in variation and the ability to evaluate the effectiveness of nursing care by measuring outcomes. Both barriers and enablers to the use of SNTs included education and training, standardisation and contextualisation across Australia, and integration into any electronic medical record system. Nurses are poorly informed on what SNTs are and how they can be leveraged to support their work and documentation. There is a need for an Australia-wide strategic approach to ensure the future of nurses' work is visible, and SNTs are purposefully and correctly implemented across the country.

Domestic, family and sexual violence polyvictimisation and health experiences of Australian nurses, midwives and carers: a cross-sectional study

BackgroundDomestic, family and sexual violence is a prevalent health and social issue. Nurses may be exposed to higher rates of this violence in their personal lives compared to the community, but little is known about their polyvictimisation experiences or health and well-being impacts.MethodsAn online descriptive, cross-sectional survey of women nurses, midwives and carer members of the Australian Nursing and Midwifery Federation (ANMF) (Victorian Branch) (response rate: 15.2% of nurses sent an invitation email/28.4% opened the email). Violence survey measures included: intimate partner violence (Composite Abuse Scale); child abuse and sexual violence (Australian Bureau of Statistics Personal Safety Survey items). Health measures included: Short Form-12; Fast Alcohol Screening Test; Patient Health Questionnaire-4; Short Screening for DSM-IV Posttraumatic Stress Disorder; well-being measures included: Connor-Davidson Resilience Scale, social support, and financial stress. Proportions were used to describe the prevalence of violence by sociodemographic characteristics and health and well-being issues; logistic regression predicted the odds of experiencing overlapping types of violence and of experiencing health and well-being outcomes.Results5,982 participants (from a parent study of 10,674 nurses, midwives and carers) had experienced at least one type of lifetime violence; half (50.1%) had experienced two or three types (polyvictimisation). Survivors of child abuse were three times more likely to experience both intimate partner violence and non-partner adult sexual assault. Any violence was associated with poorer health and well-being, and the proportion of affected participants increased as the types of violence they had experienced increased. Violence in the last 12-months was associated with the poorest health and well-being.ConclusionsFindings suggest a cumulative, temporal and injurious life course effect of domestic, family and sexual violence. The polyvictimisation experiences and health and well-being associations reported by survivor nurses, midwives and carers underscores the need for more accessible and effective workplace interventions to prevent and mitigate psychosocial ill health, especially in the recent aftermath of violence.

Cancer Nurses’ Voices and Recommendations to Address Workforce Challenges: A Qualitative Analysis

ObjectivesAmidst the fulfilment of making a positive impact on patients’ lives, cancer nurses also contend with high workloads, limited resources, and barriers to career advancement. Understanding the perceptions of cancer nurses is essential in addressing these challenges and fostering an environment that promotes both professional satisfaction and optimal patient care.Our aim was to explore Australian cancer nurses' experiences and perspectives of workforce challenges and their proposed solutions to address them. MethodsThe Cancer Nurses Society Australia workforce cross-sectional survey was distributed online in 2022 through professional networks and social media. Free text responses to open-ended questions were analyzed using qualitative content analysis and inductive processes. ResultsResponses from 601 cancer nurses highlight the intricate interplay between rewards and obstacles experienced by the profession and identify key areas for improvement. Positive and negative quotes highlight the passion of cancer nurses which were summarized into themes and subthemes:1) Finding fulfilment while struggling against the tide. While feeling undervalued and facing workload pressures, burnout and limited opportunities for career progression, nurses express love for their jobs, finding it rewarding yet emotionally challenging.2) Grassroots solutions versus organizational inertia. Proposed solutions included addressing nurse-to-patient ratios, proactive succession planning, more specific education, dedicated time for learning, and mentorship and career development programs. Perceived barriers to initiatives included lethargic management and resistance to change. Networking opportunities, appropriate remuneration, and interdisciplinary teamwork with an appreciation of individual expertise are desired. ConclusionsOur findings give a voice to the cancer nurses of Australia. Nurses identified a range of solutions to address workforce challenges. Implications for nursing practiceAddressing the systemic issues that contribute to high workload and impede nurses’ well-being and their recognition, and promoting policies to support professional growth will increase satisfaction, enhance patient care outcomes, and contribute to a sustainable workforce.

Assessing genomics confidence and learning needs in Australian nurses and midwives: an educational program evaluation.

Introduction: The mainstreaming of genomics across healthcare specialties necessitates that all nurses and midwives have a high literacy in genomics. Methods: We aimed to design, develop, implement and evaluate a genomics education workshop for nurses and midwives using action research principles. Results: Registered nurses and midwives completed an online survey regarding genomics confidence and learning needs (n = 274). The results of this survey were used to develop the genomics education workshop. The workshop was run three times (n = 105) with evaluation data being collected both before and after each workshop. Significant improvements in confidence across all learning domains was found following the workshops (p < 0.001). A desire for more education across all learning domains except for genetics knowledge was also identified (p < 0.001). Discussion: Genomics education workshops were found to increase the confidence of nurses and midwives across a range of specialties. Nurses and midwives also expressed a desire for further education in genomics.

Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices: A descriptive survey study.

To explore Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices. A cross-sectional survey design. An online survey was sent to Australian and New Zealand nursing and midwifery educators across the 45 Schools of Nursing and Midwifery between July and September 2023. The online survey consisted of 29 open- and closed-ended questions about nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices. There was a total of 127 responses to the first open-ended question. A total of 97 nursing and midwifery educators then completed the remaining questions. While educators had mostly positive views about integrating planetary health into their teaching, they lacked the knowledge and/or confidence to do so effectively. Australian and New Zealand nursing and midwifery educators acknowledge that planetary health should be included in nursing and midwifery curricula, but most reported a deficit in knowledge and/or confidence to integrate these complex concepts into their teaching. When considering planetary health, most educators focussed on climate change, which demonstrates their limited understanding of the concept of planetary health. All nurses and midwives need to understand how the health of the planet and human civilization are interconnected and be prepared to address complex global health challenges now and in the future. Across the world, key healthcare organizations have called upon nursing and midwifery educators to prepare the healthcare workforce to practice in a more sustainable way, including supporting decarbonization of healthcare. However, our study has demonstrated that nursing and midwifery educators do not feel ready to respond due to a lack of required knowledge and/or confidence. We used the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). No patient or public contribution.

VTE prophylaxis for major abdominal surgery: A hospital audit and nurses' survey for quality improvement

Objective: The objective of this study is to assess and improve VTE prophylaxis practices in major abdominal surgery through a hospital audit and nurses' survey. Primary aims: Evaluate adherence to VTE prophylaxis guidelines in abdominal surgery, identify improvement opportunities in VTE prevention and assess the effectiveness of current prophylactic measures. Nurses’ survey: Evaluate surgical nurses' knowledge and implementation of VTE prophylaxis and identify educational gaps to improve VTE prevention. Secondary aims: Integrate audit and survey insights: Gain insight into VTE management practices, to develop quality improvement programs for better prophylaxis and outcomes. Background: Guidelines for the prevention of venous thromboembolism (VTE) in surgical patients involve risk assessment, followed by chemical and mechanical prophylaxis. Often, VTE risk assessments are not completed which leads to inappropriate or inadequate prophylaxis. The current guidelines suggest that a healthcare provider, such as a nurse or physician, should conduct the VTE risk assessment for each patient. Study design and methods: Initially, a prospective audit was conducted to examine VTE prophylaxis practices at a tertiary hospital. This VTE audit was conducted alongside a nurses' survey to assess current VTE prophylaxis practices. Both measures were taken to review the quality of care provided to surgical patients. Results: The practice of VTE prophylaxis shows high utilisation of all three prophylactic modalities but a lack of risk assessment documentation in the medical records. Nurses, although perceiving it as their responsibility, do not conduct assessments for venous thromboembolism risk. Conclusion: Based on the audit and survey results, the hospital has not fully adopted the guidelines for venous thromboembolism prophylaxis in major abdominal surgery cases. There is a lack of proper risk assessment documentation, and nurses are not consistently engaged in conducting these. Implications for research, policy, and practice: This paper presents valuable insights into the current prescribing practices for VTE prophylaxis after major abdominal surgery, as gleaned from a clinical audit and a survey of nurses. The hospital audit indicates that overall, all three are being used, instead of two. While this approach does not contravene current guidelines, the use of both stockings and compression devices is not needed, instead adding new risks, unnecessary nursing workload and financial cost to health services. Further, this approach may prolong recovery with patients unable to mobilise while wearing compression devices to take part in rehabilitation programs. What this paper adds: This paper adds to the existing literature by highlighting the gap between recommended guidelines and the actual implementation of VTE prophylaxis practices in the context of major abdominal surgery. These results provide meaningful clinical relevance about VTE prophylaxis practice for nurses and surgeons involved major abdominal surgery. The continuing education of Australian nurses should include an emphasis on VTE risk assessment and prevention.

Frequency of workplace incidents and injuries in veterinarians, veterinary nurses and veterinary students and measures to control these.

Veterinarians, veterinary nurses and veterinary students work and train in a variety of environments and are exposed to a wide range of hazards. (1) To compare the rate of health and safety incidents and injuries between veterinarians, veterinary nurses and veterinary students. (2) To investigate the health and safety hazard controls present in Australian veterinary workplaces. A cross-sectional study, using an online questionnaire. Anonymous links to the questionnaire were disseminated to Australian veterinarians, veterinary nurses and veterinary students. A total of 494 veterinarians, 484 veterinary nurses and 212 veterinary students completed the survey. Incidents and injuries were common, particularly sharps-related injuries and animal bites. Australian veterinary nurses and veterinarians experienced the studied incidents at similar rates to each other. Veterinary students experienced some incidents and injuries at rates higher than both veterinarians and veterinary nurses, including heatstroke, hypothermia, sunburn, electric shock, loss of consciousness, being rammed or pushed over by an animal and farm equipment injuries. Of the workplace hazard controls reported, first aid boxes were most commonly present, and safety meetings occurred least commonly. Veterinary nurses received Q fever and rabies vaccines much less frequently than veterinarians and veterinary students. This study demonstrated that improvements need to be made to the occupational health and safety standards in the Australian veterinary sector. Veterinarians and veterinary nurses had suboptimal rates of access to many of the required and critical workplace health and safety controls. Improvements to the standard of health and safety training of veterinary students are indicated, given their higher rates of certain incidents and injury.

Nurturing Australian Nurse Practitioners: A 24-Year Odyssey Toward Independence and Recognition

Nurturing Australian Nurse Practitioners: A 24-Year Odyssey Toward Independence and Recognition

Australian Nurse Engagement in Eye Care: A National Survey.

An estimated 13 million Australians live with one or more chronic eye conditions, with prevalence increasing. Eye care services today and in the future rely on effective workforces, in which nurses play a pivotal role. Despite nurse involvement in eye care, there is no information describing their engagement, deployment, training, and opinion. This paper offers the first review of nurse engagement in eye care in Australia. We conducted an e-survey on Australian nurse engagement in eye care. Quantitative questions were analysed by descriptive, chi-square and bivariate correlation coefficients with assumed power of 0.80, and significance of p=0.05. Grounded theory, sentiment and saturation analysis extracted key themes, meaning and opinion from the qualitative questions. There were n=238 Australian nurse participants. Results indicated they were satisfied with their role, engaged in a wide range of healthcare and eye care setting and organisations, and adapted to their employer. Task-shifting "to" and "from" nurses was not universally supported but recognised by participants as necessary. Of concern, the results suggested that 68.6% of our participants would exit eye care over the next ten years, with insufficient entry pathways into the field for graduate and early-career nurses. For Australia to meet and sustain eye care services for its population, steps must be taken to improve exposure and entry to the field for students, graduates, and early-career nurses. Strategies to train and prepare nurses for task-shifting are urgently required and the eye care nursing sector must professionalise to achieve positive change.

Nurses' Use of mHealth Apps for Chronic Conditions: Cross-Sectional Survey.

Mobile health (mHealth) is increasingly used to support public health practice, as it has positive benefits such as enhancing self-efficacy and facilitating chronic disease management. Yet, relatively few studies have explored the use of mHealth apps among nurses, despite their important role in caring for patients with and at risk of chronic conditions. The aim of the study is to explore nurses' use of mHealth apps to support adults with or at risk of chronic conditions and understand the factors that influence technology adoption. A web-based cross-sectional survey was conducted between September 2022 and January 2023. The survey was shared via social media and professional nursing organizations to Australian nurses caring for adults with or at risk of chronic conditions. A total of 158 responses were included in the analysis. More than two-thirds (n=108, 68.4%) of respondents reported that they personally used at least 1 mHealth app. Over half (n=83, 52.5% to n=108, 68.4%) reported they use mHealth apps at least a few times a month for clinical purposes. Logistic regression demonstrated that performance expectancy (P=.04), facilitating condition (P=.05), and personal use of mHealth apps (P=.05) were significantly associated with mHealth app recommendation. In contrast, effort expectancy (P=.09) and social influence (P=.46) did not have a significant influence on whether respondents recommended mHealth apps to patients. The inability to identify the quality of mHealth apps and the lack of access to mobile devices or internet were the most common barriers to mHealth app recommendation. While nurses use mHealth apps personally, there is potential to increase their clinical application. Given the challenges reported in appraising and assessing mHealth apps, app regulation and upskilling nurses will help to integrate mHealth apps into usual patient care.

Building Career Pathways for Cancer Nurses: Ensuring Cancer Nursing's Future

Objectives: It is well established that cancer nurses and Advanced Practice Nurses (APN) are critical to the delivery of high-quality, accessible, safe and affordable cancer care globally. Specialised cancer nurses and APNs with a strong foundation in the pillars of nursing practice (clinical, leadership, education, and research) are essential to optimise patient outcomes, create increased cost-efficiencies through innovative models of care delivery, and can further leverage interprofessional collaboration in cancer care. To address the existing shortcomings in cancer control, Australian cancer nurses, including APNs, and cancer nurses and APNs globally, need an evidence-informed consensus drive framework to harmonize clinical, educational and career pathways leading to specialization, advanced practice, promotion, and equitable and accessible education. Methods: Critical perspective. Results: Scoping work has begun to build on the 2009 seminal Australian EdCaN framework, with ambitions to develop a contemporary practice and career framework for all cancer nurses which details clear pathways to specialised and APN roles inclusive of navigating to and through direct clinical care, research, academia, education and management or executive leadership. Conclusions: A revised framework that is cognisant of the changing landscape of contemporary cancer care, and the growing diversity of nursing roles is needed to address the imminent nursing workforce crisis. Implications for Nursing Practice: The revised framework may support the implementation of the newly released Australian Cancer Plan and provide a career pathway model that may be adopted internationally, including in low and middle income countries.

General practice nurse perceptions of barriers and facilitators to implementation of best-practice dementia care recommendations—a qualitative interview study

IntroductionWith an aging population and a growing prevalence of people living with dementia, the demand for best-practice dementia care in general practice increases. There is an opportunity to better utilise the nurse role within the primary care team to meet this increasing demand in the provision of care for people living with dementia. However, general practice nurses have limited knowledge in the provision of best-practice care for people living with dementia and their carer(s). A number of best-practice dementia care recommendations contained in the Australian Clinical Practice Guidelines and Principles of Care for People with Dementia have been identified as highly relevant to the role of the general practice nurse.AimsTo explore general practice nurses’ perspectives on published best-practice dementia care recommendations relevant to their role and identify barriers and facilitators to their implementation into clinical practice.MethodsThirteen Australian general practice nurses took part in this qualitative interview study. The research questions for this study were addressed within a paradigmatic framework of social constructionism. Data were transcribed verbatim and thematically analysed.ResultsThere was a high level of agreement between general practice nurses that the recommendations were important, reflected best-practice dementia care and were relevant to their role. However the recommendations were perceived as limited in their usefulness to nurses’ clinical practice due to being too vague and lacking direction. Four main themes were identified describing barriers and facilitators to operationalising best-practice dementia care.: creating a comfortable environment; changing approach to care; optimising the general practice nurse role and working collaboratively. Nine sub-themes were described: physical environment; social environment; complexity of care; care planning for the family; professional role and identity, funding better dementia care, education, networking and resources; different roles, one team; and interagency communication.ConclusionThis study identified several factors that need addressing to support general practice nurses to integrate best-practice dementia care recommendations into daily clinical practice. The development of interventions needs to include strategies to mitigate potential barriers and enhance facilitators that they perceive impact on their delivery of best-practice care for people living with dementia and their carer(s). The knowledge gained in this study could be used to develop multi-faceted interventions informed by theoretical implementation change models to enable the general practice nurse to operationalise best-practice dementia care recommendations.

Retaining Australian Nurses: An Analysis of Nurses' Wages and Exit Rates

AbstractThis study examines factors influencing Australian nurses' decisions to quit their jobs, the pathways they take after quitting, and estimates the average wage change associated with a nurse changing professions. Using data from the Household, Income, and Labour Dynamics in Australia Survey and panel data estimation methods, we find that a nurse's pre‐exit hourly wage is significantly associated with their exit decision when controlling for relevant exogenous factors. We also find that most nurses who change professions stay in the healthcare sector, which is characterised by significant increases in hourly wages and occupational prestige and suggests that these nurses change jobs for better opportunities. We conclude that while nurses' exit decisions are not associated with a loss of human capital in healthcare, higher wages would have to be paid if the policy objective is to increase nurse retention.

Transforming health care delivery: The role of primary health care nurses in rural and remote Australia.

This paper describes the policy context and approaches taken to improve access to primary health care in Australia by supporting nurses to deliver improved integrated care meeting community needs. In Primary Health Care (PHC), the nursing workforce are predominantly employed in the general practice sector. Despite evidence that nurse-led models of care can bridge traditional treatment silos in the provision of specialised and coordinated care, PHC nurses' scope of practice varies dramatically. Nurse-led models of care are imperative for rural and remote populations that experience workforce shortages and barriers to accessing health care. Existing barriers include policy constraints, limited organisational structures, education and financing models. The Australian Primary Health Care Nurses Association (APNA) received funding to implement nurse-led clinics as demonstration projects. The clinics enable PHC nurses to work to their full scope of practice, improve continuity of care and increase access to health care in under serviced locations. We reviewed a range of peer-reviewed literature, policy documents, grey literature and APNA provided sources, particularly those relevant to rural and remote populations. We argue more focus is needed on how to address variations in the scope of practice of the rural and remote PHC nursing workforce. Despite growing evidence for the effectiveness of nurse-led models of care, significant policy and financial barriers continue to inhibit PHC nurses working to their full scope of practice. If their potential to transform health care and increase access to health services is to be realised these barriers must be addressed.