Professor Alison Hutton

The number of natural disasters has increased globally as a result of climate change. Community nurses become frontline workers in disaster-struck areas, protecting their clients from harm and risk. The number of community-based healthcare providers in Japan has increased in recent years, along with the shift from cure-focused acute healthcare to home-based care settings. Many studies have investigated the preparedness and willingness to provide care in the aftermath of a disaster. However, there is still a dearth of knowledge on disaster preparedness among community-based healthcare professionals globally. This study investigated the preparedness of community nurses in Hiroshima, Japan, focusing on nurses providing home-based care. A mixed method design was employed, and data were collected through surveys and interviews. The survey results indicated a positive association between disaster experience and training, as well as training and the existence of a disaster plan. Further, participants reported that healthcare providers neglected the preparation of disaster plans due to time constraints and a lack of incentives; our results suggest that incentives may promote disaster preparedness.

Background: Child abuse and neglect need to be addressed through a public health approach that prioritises prevention and early intervention. Nurses and midwives are core to this public health response, yet little is known about how their roles are described in Australian policy. Aim: To explore how nurses¿ and midwives¿ roles in a public health response to child abuse and neglect are described in Australian policies about child protection, health, welfare, or development. Methods: This policy review used Internet searching to identify Australian policy documents relating to child protection, health, welfare, or development published from 2009 to 2021. Data were analysed using deductive coding and content analysis. Findings: Nurses¿ and midwives¿ contributions to a public health response to child abuse and neglect were either absent or described in scant detail within Australian policy. The information that was available represented only a portion of nursing and midwifery practices from a limited range of practice contexts. Discussion: A lack of visibility and clarity of nurses¿ and midwives¿ roles in policy raises many challenges. This includes a lack of guidance for interdisciplinary collaboration, educational preparation of nurses and midwives, and appropriate resourcing for their interventions. Further research is urgently needed to guide future best-practice policy and practices for nurses¿ and midwives¿ contributions to a public health response to child abuse and neglect. Conclusion: An enhanced representation of nurses¿ and midwives¿ roles in Australian policy is required to guide a public health approach that promotes better outcomes for all children.

Child abuse and neglect is an important public health issue in Australia and internationally. There is an increasing focus on preventing child abuse by addressing health, social and economic factors that make child abuse and neglect more likely. Given the complexity of factors contributing to child abuse, effective collaboration and a shared vision across all organisations, sectors and disciplines working with children is required. This review explored how responses to child abuse and neglect are conceptualised in Australian government policy. The main finding was a lack of consistent conceptualisations across policy documents and a shared language of child abuse and neglect, which presents barriers to multi-disciplinary and intersectoral collaboration. Clarification of health professionals¿ roles and how they should work together is urgently required in future policy. Furthermore, although policies relating to children's health and safety acknowledged the role of the social determinants of health in child abuse and neglect, this needs to be complemented with a coherent equity agenda across broader health, social and economic policy. Promoting equity is especially important for Australia's First Nations communities who are disproportionately impacted by health, social and economic conditions contributing to child abuse and neglect.

Objectives: To improve health and safety outcomes at mass gathering events (MGEs) for young attendees, it is essential to understand the psychosocial factors that may influence behaviour so that the implementation of support strategies before, during and after MGEs can be developed to enhance outcomes. This review identifies the psychosocial outcomes that may occur at MGEs, including social connection, substance use, risky behaviours and psychological distress and examines what interventions have been implemented to target these outcomes. Study design: Scoping review. Methods: This study examined MGE psychosocial interventions with predominantly youth attendees was conducted using the Preferred Reporting Items of Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Papers were collected from the databases CINAHL, MEDLINE, Embase and PsycINFO. Titles and abstracts were scanned for relevance, followed by a full-text screening. Information relevant to the research question was extracted from papers meeting the inclusion criteria. Results: Twenty-six papers met the inclusion criteria. The psychosocial factors that were most studied included social influence, social interactions and psychological stressors, which lead to behaviours such as excessive alcohol consumption, drug taking, risky casual sex and risk taking amongst psychological factors of young attendees. Effective interventions implemented before or during MGEs, such as alcohol-free zones, antidrinking campaigns, psychoeducation and disapproval from parents with regard to drinking alcohol, showed promise in reducing harms. Conclusion: Psychosocial interventions have the potential to reduce harms and enhance well-being for young people attending MGEs. This review has identified gaps and opportunities in the current literature with regard to psychosocial interventions and strategies to support young people at MGEs and makes recommendations to support the development and refinement of evidence-based interventions aimed at young MGE attendees.

Background: When a disaster occurs, a health response must adapt to meet the needs of the community. Nursing students may be able to assist in supporting the nursing workforce to meet the community's health needs during and/or following a disaster. However, there is a paucity of literature regarding the educational needs of nursing students regarding disaster preparedness. Further, the disaster-related content that is important to be included in undergraduate nursing curricula is poorly understood. Methods: This study used a modified three-round Delphi design guided by the principles of the Guidance on Conducting and REporting DElphi Studies. Data was collected from Australian clinical and academic nurses via online surveys. Analysis was undertaken using descriptive statistics including means of central tendency, with disaster content topic areas and statements considered a priority if they obtained a mean score of four out of five, or greater. Results: A total of 38 nurses participated in this study. Across the three rounds, eight topic areas and 37 different statements were included. High priority statements for topic inclusions in undergraduate curricula were ¿disaster knowledge,¿ ¿assessment and triage,¿ ¿critical thinking,¿ and ¿technical skills.¿ Additionally, statements relating to ¿mental wellbeing¿ and ¿teamwork in stressful situations¿ were ranked as the highest. Conclusions: Disaster-related content should be included in undergraduate nursing curricula. This content could be embedded within existing units of study and/or delivered as a standalone unit of study. The educational method for delivering disaster content could vary from a didactic approach to simulation exercises depending on the content and local context.

Background: Globally, families and communities are impacted by disasters every day. Nurses are integral to assisting in disasters, in the support and enablement of individuals and communities. However, some studies indicate that nurses feel ill-equipped to assist, partially because disaster content is not thoroughly addressed in the undergraduate curriculum. Therefore, nursing schools need to equip undergraduate nursing students with the knowledge and preparation required to assist effectively during and/or following a disaster. Aim: To explore priority disaster topic areas aimed at preparing Australian undergraduate nursing students to assist in caring for survivors in the aftermath of disasters. Method: This study used an integrative review methodology. Various databases and platforms were searched for literature published between 2000 and 2018 using Medical Subject Heading terms and keywords relating to the undergraduate nursing curriculum. A thematic analysis of the included papers was conducted. Results: A total of 10 articles were identified that meet the inclusion criteria. The reviewed studies highlighted that the areas of disaster knowledge, assessment and triage, critical thinking, teamwork, technical skills, mental wellbeing, legal and ethical consideration, and socio-cultural contexts, are relevant for the undergraduate curriculum. Discussion: This review highlights disaster education and training topic areas that could be considered for inclusion in Australian undergraduate nursing curricula. The content relating to disaster assistance must be incorporated into nursing schools¿ curriculum. Conclusion: The incorporation of disaster-related content in the undergraduate nursing curriculum may enhance the disaster preparedness of nursing students and the nursing workforce more broadly.

The present research aimed to investigate the relative effectiveness of three types of alcohol reduction intervention. Participants were 354 university students from an Australian university. After completing an initial survey, they were randomly assigned to either (a) follow national guidelines for alcohol consumption, (b) set their own personal alcohol consumption reduction goal, or (c) work with their peers to set a goal. Participants then recorded their alcohol consumption in a drinking diary over a period of four weeks. The results showed that participants in the personal goal condition reported significantly higher alcohol consumption than those in the national guidelines conditions, with participants in the group goal condition reporting mid-level alcohol consumption. This effect was moderated by binge drinking propensity. Personal goal setting was most likely to lead to higher alcohol consumption when participants scored relatively high on measures of binge drinking propensity. These findings highlight the point that different types of alcohol reduction interventions may be effective for different types of people. In particular, people who have a relatively high propensity for binge drinking should be encouraged to follow goals that have been set by authorities (e.g., national guidelines) rather than by themselves.

Background: The surgical count process is currently the recommended strategy for preventing unintentionally retained surgical items (RSIs) in Australia. Despite this, RSIs still occur and remain an internationally recognised issue and sentinel event associated with morbidity and mortality. There are numerous new and emerging strategies to prevent inadvertent RSIs, apart from the surgical count, and many involve the use of technology. These strategies are not currently specified in Standards for Perioperative Nursing in Australia (the ACORN Standards). Aim: To provide an integrative synthesis of the literature to identify current and emerging strategies for preventing RSIs during surgical procedures. Design: An integrative review process was undertaken. Method: The literature search was conducted in the CINAHL, ClinicalKey and Medline databases and included primary research papers of any design about RSIs and prevention strategies in humans that were published in English between 2008 and 2022. Data was extracted and developed into a table. Quality assessment was undertaken using the Mixed Method Assessment Tool (MMAT). Findings: Based on the inclusion and exclusion criteria, 186 articles were screened and 18 studies were included following quality assessment. Data were grouped into categories according to the prevention strategies of surgical count, radiography, radiofrequency technology, barcode technology and other technologies. Conclusions: RSIs occur despite the mandated use of the surgical count, a human-based process. The use of adjunct, technological prevention strategies is not yet feasible as more research is needed into efficacy and cost-effectiveness.

Purpose: To construct a conceptual model of comprehensive care for Indonesian children with Human Immunodeficiency Virus. Design and Methods: A qualitative constructivist grounded theory design. Purposive sampling was used to interview 12 children with Human Immunodeficiency Virus and 8 family members with the age of the children ranged from 9 to 18 years, and 23 health professionals, including general practitioners, paediatric specialists, nurses, midwife, and nutritionist from public health centres and provincial hospitals in East Java, Indonesia. Data was analysed using constant comparative coding methods, theoretical sensitivity, memo writing, and diagramming to facilitate the development of the substantive theory. Results: Exploring the perspectives of the participants has revealed the need to enhance the delivery of comprehensive care across the continuum, because HIV care and services for children was sub-optimal. Understanding children's needs and preferences forms the foundation of the development of a framework for the comprehensive care of children with HIV consisting of child-centred care and social support, delivered by integration and coordination of care through a healthcare service. Conclusions: The conceptual model provides new knowledge and has the capacity to bring together optimal care across the continuum addressing the challenges of fragmentation of care for children and their families. Practice implications: The model informs that children with HIV not only need pharmacotherapy, but also other care interventions depending on their individual needs, preferences, and age. Implementing the model may help to resolve such problems, to improve collaborative practice and enhance children's participation, thereby promoting children's health outcomes.

The risk of alcohol related harm is experienced disproportionality by young people aged 15¿24¿years. Harmful use of alcohol has serious effects on individual physical and mental wellbeing and is considered by the World Health Organization to be one of the main risk factors for poor health globally. It is crucial to understand the factors that influence drinking behavior in young people in order to inform prevention strategies to prevent problematic drinking. This is particularly paramount during the transition into young adulthood (around 18¿25¿years), when risky health behaviors are likely to become embedded. This pilot study adopted a qualitative descriptive methodology that facilitates exploration of what young people say about their own experiences and behavior, as it relates to SNS use and alcohol consumption. Semi-structured interviews were conducted in Newcastle, NSW Australia. An inductive, semantic approach to thematic analysis was selected to analyze the data as this method supported the exploratory nature of the pilot study and ensured that the themes identified were strongly linked to the data. Four main organizing themes that arose from the collected data were: organizing friends; safety amongst friends, planning not to plan; and different event¿different plans. All of the participants stated they preferred to use Facebook Messenger¿ to connect and share in a group conversation with peers. Convenience, cost and accessibility emerged as the main reasons for using SNSs to plan nights out. Planning for a night out using SNSs allows young people to impulsively plan and change plans¿making planning fluid and asynchronous. To date, despite the global use of SNSs, the influence of SNSs in young adults¿ planning for events during which alcohol is served is relatively unknown. This pilot study gives us a some understanding of how young people use SNSs to plan and prepare for a night out where alcohol is served. Further research needs to be conducted to determine whether SNSs can be used effectively to promote health behavior change or be used as forums for advice seeking and support when attending events where alcohol is served, with the ultimate goal of lowering risky behaviors and thereby improving health outcomes for young people.

Introduction: There is a growing awareness among governments, communities, and health care agencies of the need to evaluate roles and competencies in disaster nursing. A validated instrument was developed to evaluate nurses¿ competencies for disaster response. Methods: A psychometric evaluation study was developed in 2 stages: 1) content and face validity, and 2) verification of feasibility and reliability with test-retest. Competencies were extracted from the Framework of Disaster Nursing Competencies published by the International Council of Nurses. The participants included 8 experts in emergencies and disasters who were nurses with a PhD and had more than 2 years of experience with education or clinical practice in emergencies or disasters, and 326 nurses from a mobile emergency care service in southern Brazil. The data analysis used a content validity index and intraclass correlation coefficients. The psychometric properties of the instrument included reliability assessed with Cronbach alpha, feasibility and test-retest reliability assessed with t tests and intraclass correlation coefficients, and factor analysis. Results: The overall evaluation of the instrument yielded an intraclass correlation coefficient of 0.92 (SD = 0.04), and the mean content validity index was acceptable at 0.88 (SD = 0.12). Out of 51 items, 41 were validated and organized in 3 domains according to factor analysis: 1) care of the community; 2) care of the individual and family; and 3) psychological support and care of vulnerable populations. The instrument demonstrated good internal consistency (Cronbach a = 0.96) and adequate test-retest reliability (intraclass correlation coefficient >0.7). Discussion: The Nurses¿ Disaster Response Competencies Assessment Questionnaire showed good internal consistency, adequate reproducibility, and appropriate feasibility for use to evaluate nurses¿ competencies for disaster response.

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a ¿now window¿ of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

This qualitative research article explored the convergences and divergences of perceptions of adolescent romantic experience between a group of adolescents and parents in China. One-to-one, in-depth interviews were conducted with 38 adolescents (aged 15-18 years; 26 girls, 12 boys) and 27 parents (aged 40-52 years; 16 mothers, 11 fathers) from the urban areas of a northern Chinese city. Data analysis was conducted using thematic analysis and interpreted using a socio-ecological approach. Four major themes were identified: opportunities and risks, acceptable versus unacceptable sexual intimacy, generational difference, and girls¿ vulnerability and ¿self-respect.¿ In these themes, congruity and divergence of perceptions were found between the groups of adolescents and parents. These perceptions were largely influenced by traditional cultural beliefs of education, sexuality, gender, and family as well as the current socio-cultural context of modernization and globalization in China. The findings provide implications regarding how to support both adolescents and parents in managing adolescent romantic experience for adolescent health-promoting romantic and sexual behaviors.

Problem: The prevalence of prediabetes and type 2 diabetes (T2D) is increasing in adolescents worldwide. Most studies have focused on the clinical features, treatment, and complications for adolescents and so the need to generate insight into the risk factors and prevalence of undiagnosed prediabetes and T2D in adolescents across the globe remains. Eligibility criteria: Relevant articles that were published from 2007 up to and including January 2017 were identified through electronic searches of CINAHL, Cochrane, Medline, PsycInfo, PubMed, Scopus, Web of Science, and Sociological Abstracts (Proquest). Four independent researchers examined the articles for eligibility. Sample: Sixteen studies were included that investigated the risk and prevalence of undiagnosed prediabetes and T2D in adolescents aged 12¿19. Results: The most commonly measured risk factors included obesity/overweight, family history, and ethnicity. Other studies measured risk factors associated with insulin resistance, including hypertension, acanthosis nigricans, and dyslipidemia. Prevalence of undiagnosed prediabetes and T2D varied among regions globally with rates ranging from 3.3 to 14.3% and 0.1 to 2.2%, respectively. Conclusions: Undiagnosed prediabetes and T2D and the associated risk factors are prevalent in many regions in countries worldwide, significantly impacting adolescents and their families. Implications: Future research is required to inform interventions aimed at preventative measures for early screening and detection of prediabetes and T2D in adolescents, as well as the development of multi-disciplinary teams that include pediatric nurses and the specialized care they provide.

Aim: This review discusses the need for consistency in mass-gathering research and evaluation from a psychosocial perspective.Background: Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to determine required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A standardized approach to data collection is important to identify a consistent reporting standard for the psychosocial domain.Method: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing minimum data set as a framework.Results: In total, 31 manuscripts met the inclusion criteria. The main variables identified were use of alcohol or drugs, crowd behavior, crowd mood, rationale, and length of stay.Conclusion: Upon interrogating the literature, the authors have determined that the variables fall under the categories of alcohol or drugs; maladaptive and adaptive behaviors; crowd behavior, crowd culture, and crowd mood; reason for attending event (motivation); duration; and crowd demographics. In collecting psychosocial data from mass gatherings, an agreed-upon set of variables that can be used to collect de-identified psychosocial variables for the purpose of making comparisons across societies for mass-gathering events (MGEs) would be invaluable to researchers and event clinicians.

Nurses who work with children have the opportunity to make a difference by identifying and responding to child abuse and neglect. Little is known about the ways that nurses define, assess and respond to child abuse and neglect and how this subsequently affects children. This paper reports one of four themes identified through inductive analysis of a qualitative study exploring nurses¿ perceptions and experiences of keeping children safe from abuse and neglect. The aim of this paper was to report on how nurses understand and interpret child abuse, is found to be shaped by their own sociocultural contexts. A qualitative research design underpinned by social constructionism framed the study. Data were collected in 2016 and 2017 through 21 in-depth, semi-structured interviews with nurses who work with children in Australia. Key findings showed that nurses working with children had difficulty defining child abuse and drew upon multiple sources to construct a working definition. In addition to drawing from official legislation and guidelines, nurses compared and contrasted the level of abuse with their own personal and professional experiences of parenting. Nurses described the challenges of making assessments when faced with cultural practices different from their own. Nurses¿ descriptions of how they defined abuse showed that their assessments of child abuse and neglect were inextricably linked to their personal values and beliefs. As such, nurses were often working from their own value systems rather than consistently taking a child-focussed approach. There was an absence of consistent and explicit critical reflection on ways that values and beliefs might shape practice at individual and system levels. We propose this is a missing aspect of child safe practice. Reflection on how personal and professional values and beliefs interact with the implementation of evidence-informed approaches will increase nurses¿ capacity to maintain a child-focus.

Introduction Mass gatherings such as marathons are increasingly frequent. During mass gatherings, the provision of timely access to health care services is required for the mass-gathering population, as well as for the local community. However, the nature and impact of health care provision during sporting mass gatherings is not well-understood.Purpose The aim of this study was to describe the structures and processes developed for an emergency health team to operate an in-event, acute health care facility during one of the largest mass-sporting participation events in the southern hemisphere, the Gold Coast Marathon (Queensland, Australia).Methods A pragmatic, qualitative methodology was used to describe the structures and processes required to operate an in-event, acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with emergency department (ED) clinical staff working during the two-day event was undertaken in 2016.Findings Important structural elements of the in-event health care facility included: physical spaces, such as the clinical zones in the marathon health tent and surrounding area, and access and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms (ECGs) and intravenous fluids. Process elements of the in-event health care facility included clear communication pathways, as well as inter-professional care coordination and engagement involving shared knowledge of and access to resources, and distinct but overlapping clinical scope between nurses and doctors. This was seen to be critical for timely care provision and appropriate case management. Staff reported many perceived benefits and opportunities of in-event health care delivery, including ED avoidance and disaster training.Conclusions This in-event model of emergency care delivery, established in an out-of-hospital location, enabled the delivery of acute health care that could be clearly described and defined. Staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider. JohnstonANB, WadhamJ, Polong-BrownJ, AitkenM, RanseJ, HuttonA, RichardsB, CrillyJ.

Objective: The aim of this study was to describe the in-event, ambulance and ED impacts of patient presentations from an Australian mass gathering event (MGE) including patient demographics, provision of care, length of stay and discharge disposition. Methods: This research was set at one MGE in Australia. The MGE had one first aid post and one in-event health team staffed by doctors, nurses and paramedics. A retrospective analysis of patient care records from providers of in-event, ambulance and ED services was undertaken. Data analysis included descriptive and inferential statistics. Results: Of the 20 000 MGE participants, 197 (0.99% [95% CI 0.86¿1.13], 9.85/1000) presented for in-event first aid care, with 24/197 (12.2% [95% CI 8.33¿17.49], 1.2/1000) referred to in-event health professionals. Fifteen of the referred patients (62.5% [95% CI 42.71¿78.84]) returned to the MGE following administration of intravenous fluids (n = 13) and/or anti-emetics (n = 11). Seven (29.2% [95% CI 14.92¿49.17], 0.35/1000) were referred to ambulance paramedic care, requiring endotracheal intubation (n = 1) and airway adjuncts (n = 3) prior to transportation to ED; these patients had an ED median length of stay of 7 h (5.5¿12.5) receiving imaging and ventilator support. Five were discharged from ED, one required an operation and another required intensive care unit admission. Conclusions: There was an impact on in-event, ambulance and ED services from this MGE but the in-event model of care may have limited ambulance usage and ED visits. The ED length of stay was greater than the national median, perhaps reflecting the appropriateness of transport and nature of care requirements while in the ED.

Background: Immersive virtual reality is an advancing technology that has the potential to change the traditional pedagogical approaches to teaching tertiary nursing and midwifery students. The application of immersive virtual reality in nursing and midwifery education may be a novel, accessible method for information provision and skill acquisition, however little is known of the extent of immersive virtual reality technology integration into tertiary nursing and midwifery programs. Objectives: The purpose of this review is to identify the application and integration of immersive virtual reality within nursing and midwifery tertiary education programs. Design: A scoping review based on the Joanna Briggs Institute methodology for scoping reviews was undertaken. An a priori review protocol and eligibility criterion was developed with the protocol subject to review a posteriori following first round screening. An electronic search of ten databases was conducted in January 2018. Results: A total of n = 506 non-duplicate records were identified and subjected to level one and level two screening. The search strategy and screening process identified n = 2 articles that were quality checked and included for review. Conclusions: There is currently a paucity of quality published literature on the application and/or integration of immersive virtual reality into nursing and midwifery tertiary education. Immersive virtual reality has the potential to increase competence and confidence for students providing accessible and repeatable learning opportunities in a fail-safe environment. There is a need for educators to be involved in the conceptualisation, design, integration and research of immersive virtual reality technology into undergraduate nursing and midwifery programs.

Aim: This paper discusses the need for consistency in mass-gathering research and evaluation from an environmental reporting perspective.Background: Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to inform health services about the possible required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A minimum data set (MDS) has been proposed to standardize collection of biomedical data across various mass gatherings, and there is a need for an environmental component. The environmental domain includes factors such as the nature of the event, availability of drugs or alcohol, venue characteristics, and meteorological factors.Method: This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing MDS as a framework.Results: In total, 39 manuscripts were identified that met the inclusion criteria.Conclusion: In collecting environmental data from mass gatherings, there must be an agreed-upon MDS. A set of variables can be used to collect de-identified environmental variables for the purpose of making comparisons across societies for mass-gathering events (MGEs).

Objectives: To explore the extent of child protection work performed by nurses and identify which interventions hold the strongest evidence for future practice. Design: This scoping review was guided by Arksey and O'Malley's framework for scoping reviews. Data Sources: Electronic databases (CINAHL, Medline, Scopus, Web of Science) and grey literature were searched in August 2017. Further studies were identified through manual literature searching. Results: Forty-one studies from seven countries met the inclusion criteria. The studies showed nurses keep children safe primarily through the prevention of abuse (n = 32), but also through detection of abuse (n = 1) and interventions to mitigate the effects of abuse (n = 8). Nurses' specific interventions most frequently involved post-natal home visiting (n = 20), parent education (n = 10) and assessment and care of children or adolescents following sexual abuse (n = 4). The main findings showed that although nurses did have positive impacts upon some measures of abuse and neglect, results were not consistent across studies. In addition, some studies used indirect measures of abuse and neglect, which may not impact children's experiences of abuse. It is difficult to extrapolate these findings to the broader nursing profession as literature did not accurately represent the range of ways that nurses keep children safe from abuse and neglect. Conclusions: This review demonstrated nurses prevent, detect and respond to abuse and neglect in many ways. However, given mixed evidence and absence of some nurse interventions in the literature, further research is needed to represent the range of ways that nurses keep children safe and determine their effectiveness.

This report identifies what is known about audience motivations at three different massgathering events: outdoor music festivals, religious events, and sporting events. In light of these motivations, the paper discusses how these can be harnessed by the event organizer and Emergency Medical Services. Lastly, motivations tell what kinds of interventions can be used to achieve an understanding of audience characteristics and the opportunity to develop tailor-made programs to maximize safety and make long-lasting public health interventions to a particular "cohort" or event population. A lot of these will depend on what the risks/hazards are with the particular populations in order to "target" them with public health interventions. Audience motivations tell the event organizer and Emergency Medical Services about the types of behaviors they should expect from the audience and how this may affect their health while at the event. Through these understandings, health promotion and event safety messages can be developed for a particular type of massgathering event based on the likely composition of the audience in attendance. Health promotion and providing public information should be at the core of any mass-gathering event to minimize public health risk and to provide opportunities for the promotion of healthy behaviors in the local population. Audience motivations are a key element to identify and agree on what public health information is needed for the event audience. A more developed understanding of audience behavior provides critical information for event planners, event risk managers, and Emergency Medical Services personnel to better predict and plan to minimize risk and reduce patient presentations at events. Mass-gathering event organizers and designers intend their events to be positive experiences and to have meaning for those who attend. Therefore, continual vigilance to improve public health effectiveness and efficiency can become best practice at events. Through understanding the motivations of the audience, event planners and designers, event risk managers, and emergency medical personnel may be better able to understand the motivation of the audience and how this might impact on audience behavior at the event.

Background There is a growing body of literature relating to mass-gathering events. A common thread amongst this literature, particularly the literature relating to music festivals, is the incidence of patients presenting with substance and/or alcohol intoxication. However, the impact of alcohol and/or drugs on the provision of in-event health care services has not been explored in detail.Aim The goal of this review was to develop an understanding of the impact of alcohol and/or drugs on in-event health care services at mass-gathering events.Method This paper used integrative review as a methodology. The articles included in this literature review were sourced by searching databases inclusive of Medline (Ovid; US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), Scopus (Elsevier; Amsterdam, Netherlands), PsycINFO (Ovid; American Psychological Association; Washington DC, USA), and Pub Med (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA). Identified manuscripts that met the inclusion criteria were thematically analyzed.Results In total, 12 manuscripts met the inclusion criteria for this review. A thematic analysis of these manuscripts identified three main themes: (i) predictive factors, (ii) patient presentation rates, and (iii) levels of care.Conclusion: Substance use and/or intoxication can place a strain on in-event medical services at mass-gathering events. Of the various types of mass-gathering events, music festivals appear to be the most affected by substance use and intoxication. BullockM, RanseJ, HuttonA.

There is a dearth of research in Indonesia regarding pain management in children. Previous studies have identified that although a variety of research and clinical studies on all aspects of pain have been conducted in many countries, children continue to experience moderate to severe pain during hospitalization. Greater research efforts are needed to identify and explore the factors that impede effective pain management in children. To address this gap, the researchers conducted an exploratory descriptive qualitative study to capture Indonesian nurses¿ perceptions of barriers to paediatric pain management in two hospitals. Using purposive sampling, data were collected from 37 nurses through semi-structured, in-depth interviews. Findings indicated that nurses working in Indonesian paediatric wards felt that they were not able to provide effective pain care to hospitalized children. Nurses identified several organizational structural and cultural factors that were thought to hinder their provision of effective pain care to paediatric patients. These factors are embedded in nurses¿ clinical practice. The study findings can assist to inform relevant initiatives and strategies to improve clinical nurses¿ performance and competency in providing effective pain care to paediatric patients.

This paper reviews the literature around the Schoolies experience and concern that parents may have with adolescents undertaking risk-taking behaviour at this event. A systematic search of Ovid, Medline, Pub Med, Pro Quest and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were undertaken. Keywords in these searches included: Schoolies, school leavers, adolescents and parental attitudes. Four major themes identified were: substance use at Schoolies; expectations, previous experience and peers' influence on behaviour, and parental influences. Reducing harm in this cohort as a result of risk-taking behaviours could have far-reaching impacts: reducing alcohol and drug-related injury at these events could have an impact on health care as the burden on the country's health care system and resources may be reduced. In 2010 there were a reported 214,542 students undertaking Year 12 and it is estimated that in total 60,000 young people (36%) attend an organised Schoolies event, highlighting the importance of gaining insight into this topic.

This paper reports on the findings from a qualitative research study that explored how young people prepared to minimise and/or avoid alcohol-related harm while attending a Schoolies Festival (SF). SFs are mass gatherings at which young people (schoolies) celebrate their graduation from high school. The attendance of schoolies, in various Australian communities, ranges between 10000 and 30000 individuals during the event. The literature suggests that schoolies are at higher than normal risk of harm at SF from misuse of alcohol, unsafe sex, aggressive behaviour, and other risk-taking factors. As a result of these concerns, SF organisers developed an infrastructure that treats alcohol-related harm, and provides on-site care (first aid stations) by St John Ambulance staff. This study used focus groups to identify strategies used by schoolies to avoid alcohol-related harm during SFs. Data revealed that schoolies did not actively seek health information before attending the event and did not display an interest in doing so. It is important to note that schoolies planned to use alcohol to celebrate and have a good time. Therefore a harm minimisation approach with a focus on providing the necessary infrastructure at SFs to minimise the dangers associated with excess alcohol use is important. Schoolies indicated that they had no desire for information about the hazards of alcohol ingestion. If any health messages were to be used by health authorities, it would be far more appropriate to promote the message of 'take care of your mate', to contribute to building a supportive environment at the event. This may be of more benefit to minimise harm at SFs than funding other health messages.

Outdoor music festivals are unique events given that they are, for the most part, bounded and ticketed, and alcohol is served. They frequently have a higher incidence of patient presentations when compared with similar types of mass gatherings. Often, however, single events are reported in the literature, making it difficult to generalize the findings across multiple events and limiting the understanding of the typical patient presentations at these mass gatherings. The aim of this paper was to understand the characteristics of young people who have presented as patients to on-site health care at outdoor music festivals in Australia, and the relative proportion and type of injury and illness presentations at these events. This research used a nonexperimental design, utilizing a retrospective review of patient report forms from outdoor music festivals. Data were collected from 26 outdoor music festivals across four States of Australia during the year 2010. Females presented at greater numbers than males, and over two-thirds presented with minor illnesses, such as headaches. Males presented with injuries, in particular lacerations to their face and their hands, and alcohol and substance use made up 15% of all presentations.

Background: Internationally there is an increasing amount of peer-reviewed literature pertaining to disaster nursing. The literature includes personal anecdotes, reflections, and accounts of single case studies. Furthermore, issues such as the willingness of nurses to assist in disasters, the role of nurses in disasters, leadership, competencies, and educational preparedness for nurses have been the focus of the literature. Aim: The aim of this research was to determine the international research priorities for disaster nursing. Method: This research used a three-round Delphi technique. The first round used a face-to-face workshop to generate research statements with nursing members of the World Association for Disaster and Emergency Medicine (WADEM). The second and third rounds included the ranking of statements on a 5-point Likert scale with nursing members of WADEM and the World Society of Disaster Nursing (WSDN). Statements that achieved a mean of four or greater were considered a priority and progressed. Results: Participants were from multiple countries. Research statements were generated in the areas of: education, training, and curriculum; psychosocial; strategy, relationship, and networking; and clinical practice. Psychosocial aspects of disaster nursing ranked the highest, with five statements appearing in the top ten research areas, followed by statements relating to: education, training, and curriculum; clinical practice; and finally, strategy, relationship, and networking. Conclusions: Future disaster nursing research should focus on the area of psychosocial aspects of disaster nursing, in particular, both the psychosocial needs of a disaster-affected community and the psychosocial wellbeing of nurses who assist in disaster health activities. Copyright © World Association for Disaster and Emergency Medicine 2014.

Introduction: In 2012, a minimum data set (MDS) was proposed to enable the standardized collection of biomedical data across various mass gatherings. However, the existing 2012 MDS could be enhanced to allow for its uptake and usability in the international context. The 2012 MDS is arguably Australian-centric and not substantially informed by the literature. As such, an MDS with contributions from the literature and application in the international settings is required.

Background The science underpinning the study of mass-gathering health (MGH) is developing rapidly. Current knowledge fails to adequately inform the understanding of the science of mass gatherings (MGs) because of the lack of theory development and adequate conceptual analysis. Defining populations of interest in the context of MGs is required to permit meaningful comparison and meta-analysis between events. Process A critique of existing definitions and descriptions of MGs was undertaken. Analyzing gaps in current knowledge, the authors sought to delineate the populations affected by MGs, employing a consensus approach to formulating a population model. The proposed conceptual model evolved through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings. Findings and Interpretation Reporting on the incidence of health conditions at specific MGs, and comparing those rates between and across events, requires a common understanding of the denominators, or the total populations in question. There are many, nested populations to consider within a MG, such as the population of patients, the population of medical services providers, the population of attendees/audience/participants, the crew, contractors, staff, and volunteers, as well as the population of the host community affected by, but not necessarily attending, the event. A pictorial representation of a basic population model was generated, followed by a more complex representation, capturing a global-health perspective, as well as academically- and operationally-relevant divisions in MG populations. Conclusions Consistent definitions of MG populations will support more rigorous data collection. This, in turn, will support meta-analysis and pooling of data sources internationally, creating a foundation for risk assessment as well as illness and injury prediction modeling. Ultimately, more rigorous data collection will support methodology for evaluating health promotion, harm reduction, and clinical-response interventions at MGs. Delineating MG populations progresses the current body of knowledge of MGs and informs the understanding of the full scope of their health effects.

Background Current knowledge about mass-gathering health (MGH) fails to adequately inform the understanding of mass gatherings (MGs) because of a relative lack of theory development and adequate conceptual analysis. This report describes the development of a series of event lenses that serve as a beginning MG event model, complimenting the MG population model reported elsewhere. Methods Existing descriptions of MGs were considered. Analyzing gaps in current knowledge, the authors sought to delineate the population of events being reported. Employing a consensus approach, the authors strove to capture the diversity, range, and scope of MG events, identifying common variables that might assist researchers in determining when events are similar and might be compared. Through face-to-face group meetings, structured breakout sessions, asynchronous collaboration, and virtual international meetings, a conceptual approach to classifying and describing events evolved in an iterative fashion. Findings Embedded within existing literature are a variety of approaches to event classification and description. Arising from these approaches, the authors discuss the interplay between event demographics, event dynamics, and event design. Specifically, the report details current understandings about event types, geography, scale, temporality, crowd dynamics, medical support, protective factors, and special hazards. A series of tables are presented to model the different analytic lenses that might be employed in understanding the context of MG events. Interpretation The development of an event model addresses a gap in the current body of knowledge vis a vis understanding and reporting the full scope of the health effects related to MGs. Consistent use of a consensus-based event model will support more rigorous data collection. This in turn will support meta-analysis, create a foundation for risk assessment, allow for the pooling of data for illness and injury prediction, and support methodology for evaluating health promotion, harm reduction, and clinical response interventions at MGs.

Objective To review literature from Australia, New Zealand, Canada and the United Kingdom to: gain insight into the adolescent perception of the general practice environment; identify areas of concern that prevent adolescents accessing health care services; and to establish which factors have a negative effect on their general practice experience. Method A thematic analysis was the method selected for this literature review. The articles were read and similar concepts combined to form 18 common themes. These 18 themes were then condensed down to three focal themes: personal, organisational, and external factors. Results Principal areas of concern for adolescents accessing health services and the general practice were confidentiality, privacy and trust. These concerning factors were voiced by adolescents of all ages, both genders and across studies from all four countries. Conclusion A review of the literature has revealed that not all adolescents face problems when using general practice facilities, or have concerns regarding accessing services, but for those that do confidentiality, privacy and trust are the main areas of concern.

Introduction The purpose of this critical review is to look at the current literature regarding mass gatherings and to create further understanding of this area with a particular focus on what the audience brings with them to the event, particularly in a planned event with a cultural theme or focus. Through an understanding of these predispositions and consequent effects on audience behavior in a mass-gathering setting, a more complete understanding of motivation factors of crowds and audiences can also be found. Methods A critical review of mass-gathering literature was undertaken by searching various online academic databases. Peer-reviewed scholarly articles relevant to the cultural aspects associated with religious, sporting and music mass gatherings were also analyzed. Results Results from the review show that the word culture is often used to explain what happens at the event without reflecting how the motivations or behaviors of audiences at an event are influenced by the cultural predispositions of the audience. Conclusions By understanding the cultural predispositions of the audience, event planners and designers, event risk managers and event safety personnel are able to better understand the motivation of the audience and how this might impact on audience behavior at the event. Further work needs to be done, however, to investigate the broader range of predispositions. The ultimate aim of developing this understanding is to better inform the health promotion and public health messages that can be developed for a particular type of event based on the likely composition of the audience in attendance.

Schools leavers festivals (SLFs) are common across Australia. The SLF is an organised event where young people go to celebrate the end of their schooling. Past research has shown that school leavers often drink alcohol as a form of celebration during this time. This paper presents the findings from a study undertaken to explore the way in which young people prepared to minimise and/or be free from alcohol-related harm at the Adelaide SLF, in South Australia. Data was generated through the retrospective accounts of 38 young people during seven separate focus groups. Our study demonstrated that young people did not access health information to minimise alcohol-related harm. However, the data gained showed that young people plan what type of alcohol they intend to drink and who they are going to drink alcohol with to celebrate the SLF. This study highlights the great length that participants went to planning and budgeting for their purchase of alcohol. For participants in this study peers were people that they could trust. As well as valuing peers, on-site volunteers, mainly made up of other young people, were also valued in supporting their health care needs at the SLF.

Purpose ¿ The purpose of this paper is to explore recent technological and methodological developments in the evaluation of audience behaviour at planned events and discuss the implications for researchers in this field, particularly the advantages of evaluating in real-time. The creation and staging of the event experience ¿ the realm of event design ¿ is predicated on an understanding of the psychosocial domain of the audience. By understanding the motivations, the behaviours and the predispositions that the audience brings to the event, and how event design principles and techniques can be applied to influence audience behaviour in real time, the event designer is able to more successfully create and stage the event experience to meet the aims and objectives of the event. Design/methodology/approach ¿ The paper discusses international developments in the evaluation of the psychosocial domain of audiences at planned events and the range of research methodologies being used from a practitioner academic perspective. The paper will look at current research being undertaken in Sweden, Austria and Australia and identify trends internationally in this nascent field of research. Findings ¿ The paper argues that real time data collection of audiences provides insights into the effective design and management of planned events, particularly from the event risk management perspective. Practical implications ¿ Drawing on work being undertaken in the mass gatherings, tourism and service fields, the paper examines and synthesises these into a proposed model for the effective evaluation of the event audience. Originality/value ¿ This paper argues for an increase in ¿ and a model for ¿ research on audience behaviour, specifically in the real time capture and analysis of data of audiences at events as a means of developing and understanding of the effects of event design techniques applied at planned events. © 2013, Emerald Group Publishing Limited

Background To explore what was known about the experiences of bystanders both at the scene, and following a motor vehicle accident (MVA). Understanding these experiences will further elucidate the knowledge underpinning bystander's action and their needs at the scene and in the hours, days, weeks and months following this event. Methods A search of Cumulative Index to Nursing and Allied Health Literature (CINAHL), MedLine (OVID) and Informit was undertaken using a combination of the keywords: bystander, first aid, motor vehicle accidents, car crash, car collision, lay people and witness. Thirteen articles met the selection criteria and were included in the analysis. The World Wide Web (web) was subsequently searched in response to a gap in current research on bystanders' experiences at and following a MVA. Systematic thematic coding was used in the extraction of patterns regarding bystander experiences during and after witnessing a MVA. Results In the exploration of bystanders' experiences during and after attending a MVA this review confirmed the presence of physical, emotional, cognitive and situational factors associated with bystander responses. Bystanders demonstrated that their response behaviours were determined by the nature of the emergency and the severity of perceived injury. In addition, bystanders weighed up the costs of helping and many felt morally responsible to offer assistance. Although there were no studies of long-term negative consequences exemplars from the web provided insight into ongoing psychological affects for bystanders. Conclusion This thematic literature analysis demonstrated the need for further research into the experiences of bystanders both during and following an MVA. Understanding bystander assistance in emergencies will allow health policy decision-makers to address the needs of both potential bystanders and those of actual bystanders during and post event. © 2013.