Dr Peter Sinclair

National and international guidelines recommend opportunistic screening for chronic kidney disease to allow for early detection and management. Despite these guidelines, screening for chronic kidney disease in general practice settings is often suboptimal. This paper reports the results of a study that evaluated: (a) the effect of an asynchronous web-based e-learning module on general practice nurses' knowledge about chronic kidney disease risk factors and screening practices and (b) general practice nurses' perceived satisfaction with the e-learning module. Changes in chronic kidney disease knowledge were assessed using a pre-test and post-test evaluative design, and satisfaction scores were measured on completion of the module. Participants' baseline knowledge scores were poor, with mean pre-test scores of 3.77 (s.d. 1.66) out of 10. Post-test scores revealed a significant improvement (mean difference 1.81, (95% CI: 1.53-2.09), P < 0.01) however, overall final scores remained inadequate. Participants highly rated their satisfaction with the design of the module. Our results suggest that an asynchronous web-based e-learning module can improve general practice nurses' knowledge about chronic kidney disease risk factors and screening practice. Efforts are required to increase practice nurses' access to educational opportunities designed to improve knowledge in this area with the aim of increasing opportunistic screening for chronic kidney disease in the general practice setting.

Background: The burden of Chronic Kidney Disease (CKD) on the Australian health system is growing. Efforts to reverse this trend have not been successful. This paper evaluates the effectiveness of a targeted asynchronous web based e-learning module on general practice nurses¿ behavioural intentions in relation to opportunistic screening practices for people at risk of CKD. Design: Double blinded pre-post interventional randomised control design. Methods: Participants were nurses working in general practice settings in Australia. Participants were randomised to a knowledge based active control or targeted behavioural based intervention which were delivered using asynchronous e-learning modules. The intervention was designed to influence the behavioural constructs of the theory of planned behaviour (TPB): attitude, subjective norm and perceived behavioural control (PBC). Results: Of the 420 participants, we analysed the primary and secondary outcomes for 212 (50.47%) who had complete follow up data. There were no significant differences (p 0.424, [d] 0.04) in behavioural intention between the intervention and control groups at follow-up, when controlling for baseline values. However, regression models assessing the relationship between the change in the TPB constructs and behavioural intention at follow-up for all participants, regardless of study arm, demonstrated a significant change in intention to initiate a kidney health check. Although these changes could not be attributed to the effect of the intervention. Attitude (r2 = 0.3525, p 0.0004) and PBC (r2 = 0.3510, p 0.0005) models accounted for approximately 35% of the explained variance in behavioural intentions and social norm (r2 = 0.3297, p 0.0171) accounted for approximately 33% of the variance. When all TPB constructs were included in the model, 37% of the variance in intention was explained. Conclusion: A targeted behavioural online intervention was no more effective than a knowledge based online program to improve primary health care nurses¿ intention to initiate a kidney health check in people at risk of chronic kidney disease. Relevance to clinical practice: Collaborative efforts are required by all staff working in general practice to develop models of care to improve screening practices for chronic kidney disease. Future research should focus on interventions that improve collaboration between health care professionals in the primary care setting and public health campaigns to increase awareness of risks of CKD and the importance of screening in the primary care setting.

Aims and objectives: This study aimed to identify and describe the experience of parents of children diagnosed with early onset scoliosis living in Australia. Background: Chronic childhood disease has a major impact on health-related quality of life. Caring for a child with a chronic illness is well documented but the specific experiences of parents who care for children with early onset scoliosis, a rare but devastating illness, has not been explored. Numerous studies have described the interrelated psychological, financial, social, physical and logistical factors that impact the experience of the caregiver role with various diseases, but in the case of early onset scoliosis, limited studies have been conducted about the parental experience. Methods: A qualitative descriptive design was used. A snowball sampling technique assisted in the recruitment. Parents invited to the study included mothers, fathers and guardians. Data were collected through semistructured interviews and transcribed verbatim. Transcripts were analysed thematically. Data collection complied with the Consolidated criteria for reporting qualitative research guidelines. Findings: Twelve mothers of children with early onset scoliosis were interviewed, as only mothers consented to participate. Four major themes emerged: emotional rollercoaster ride, a lack of resources, money talks and pervasive burden. Factors that impacted on the participants¿ ability to confront, manage and endure caring for a child with early onset scoliosis emerged from the data. Conclusion: The findings suggest there are multiple factors that influence the experience of mothers¿ caring for a child with early onset scoliosis. The recognition and appropriate management of these factors by healthcare professionals have the potential to improve the quality of life of parents who care for a child with early onset scoliosis. Relevance to clinical practice: Healthcare professionals have first-line contact with parents of children with early onset scoliosis and are well placed to provide parents with evidence-based education and increased support.

Aim The aim of this review was to explore factors which facilitate or inhibit undergraduate nursing students¿ willingness to demonstrate moral courage when confronted by poor patient care. Methods Included papers were those that met the criteria of being qualitative research that explored undergraduate nursing students¿ depictions of situations where moral courage was or was not demonstrated during clinical placements, with a particular focus on situations that impacted or had the potential to impact the quality of patient care. Papers were reviewed using the Critical Appraisal Skills Programme Qualitative Research Checklist. The 15 papers included in the review were then thematically analysed. Findings The literature reports, despite feeling a moral obligation to act, most nursing students lack the moral courage to intervene or speak up when faced with poor practice. While students may subsequently report the behaviour, at the time of the event, they often remain passive spectators and sometimes even active participants. The major themes identified in the literature were: just a student, don't rock the boat, fear of consequences, mentor¿student relationship, and patient advocate identity. The literature also identified that nursing students suffer ongoing moral distress when they do not have the courage to confront poor practice. Conclusion There is a need for further research to explore positive examples of how nursing students demonstrate moral courage when undertaking clinical placements. These narratives have the potential to influence future students¿ attitudes, values and behaviours by providing stimulus materials for teaching.

E-learning involves the transfer of skills and knowledge via technology so that learners can access meaningful and authentic educational materials. While learner engagement is important, in the context of healthcare education, pedagogy must not be sacrificed for edu-tainment style instructional design. Consequently, health professional educators need to be competent in the use of current web-based educational technologies so that learners are able to access relevant and engaging e-learning materials without restriction. The increasing popularity of asynchronous e-learning programs developed for use outside of formal education institutions has made this need more relevant. In these contexts, educators must balance design and functionality to deliver relevant, cost-effective, sustainable, and accessible programs that overcome scheduling and geographic barriers for learners. This paper presents 10 guiding design principles and their application in the development of an e-learning program for general practice nurses focused on behavior change. Consideration of these principles will assist educators to develop high quality, pedagogically sound, engaging, and interactive e-learning resources.

Aim: This paper profiles a qualitative study that examined how undergraduate nursing students demonstrate moral courage when confronted with clinical situations that negatively impact the quality of patient care and/or patient experience and the factors that encouraged or inhibited their willingness to speak up when they identified poor practice. Background: Clinical placements are an essential component of nursing programmes. However, placements are a reported source of stress for students, with many witnessing, or feeling compelled to participate in, poor practice. In these instances, nursing students require the moral courage to raise concerns in order to protect patient safety and dignity. Methods: This was a qualitative descriptive study. Nine nursing students and one nursing graduate from one semi-metropolitan university in Australia were interviewed and the data were thematically analysed. Findings: Four key themes emerged: (1) patient advocate identity, which had two sub-themes of knowing one's own moral code and previous life experiences; (2) consequences to the patient and to the participant; (3) the impact of key individuals; and (4) picking your battles. Conclusion: This study demonstrates the importance of undergraduate nursing students identifying as patient advocates, the multitude of consequences students face when questioning the practice of a registered nurse, and the influence supervising nurses and clinical facilitators have on a student's decisions to intervene to protect patient safety. Further research is required to examine the factors, both intrinsic and extrinsic, that influence nursing students' moral courage and their decisions to intervene when poor practice is witnessed.

Background: The contemporary health workforce has a professional responsibility to maintain competency in practice. However, some difficulties exist with access to ongoing professional development opportunities, particularly for staff in rural and remote areas and those not enrolled in a formal programme of study. E-learning is at the nexus of overcoming these challenges. The benefits of e-learning have been reported in terms of increased accessibility to education, improved self-efficacy, knowledge generation, cost effectiveness, learner flexibility and interactivity. What is less clear, is whether improved self-efficacy or knowledge gained through e-learning influences healthcare professional behaviour or skill development, whether these changes are sustained, and whether these changes improve patient outcomes. Objective: To identify, appraise and synthesise the best available evidence for the effectiveness of e-learning programmes on health care professional behaviour and patient outcomes. Design: A systematic review of randomised controlled trials was conducted to assess the effectiveness of e-learning programmes on clinician behaviour and patient outcomes. Electronic databases including CINAHL, Embase, ERIC, MEDLINE, Mosby's Index, Scopus and Cochrane - CENTRAL were searched in July 2014 and again in July 2015. Quality assessment and data extraction: Studies were reviewed and data extracted by two independent reviewers using the Joanna Briggs Institute standardised critical appraisal and data extraction instruments. Data synthesis: Seven trials met the inclusion criteria for the analysis. Due to substantial instructional design, subject matter, study population, and methodological variation between the identified studies, statistical pooling was not possible and a meta-analysis could not be performed. Consequently, the findings of this systematic review are presented as a narrative review. Results: The results suggest that e-learning was at least as effective as traditional learning approaches, and superior to no instruction at all in improving health care professional behaviour. There was variation in behavioural outcomes depending on the skill being taught, and the learning approach utilised. No papers were identified that reported the effectiveness of an e-learning programme on patient outcomes. Conclusion: This review found insufficient evidence regarding the effectiveness of e-learning on healthcare professional behaviour or patient outcomes, consequently further research in this area is warranted. Future randomised controlled trials should adhere to the CONSORT reporting guidelines in order to improve the quality of reporting, to allow evaluation of the effectiveness of e-learning programmes on healthcare professional behaviour and patient outcomes.

SUMMARY: Background: Simulation is a well-established and proven teaching method, yet its use in renal education is not widely reported. Criticisms of simulation-based teaching include limited realism and a lack of authentic patient interaction. Method: This paper discusses the benefits and challenges of high-fidelity simulation and suggests hybrid simulation as a complementary model to existing simulation programmes. Conclusion: Through the use of a simulated patient, hybrid simulation can improve the authenticity of renal simulation-based education while simultaneously teaching and assessing technologically enframed caring.

Learning outcomes: On completion of this continuing professional development (CPD) activity, participants will be able to: ¿ identify strategies to support undergraduate students and new staff working in a supernumerary role; ¿ define the roles and responsibilities of the mentor and mentee; ¿ identify key attributes of successful mentors; ¿ discuss the stages of the mentor-mentee relationship and the key elements of each; ¿ describe a suitable strategy for engaging mentees and developing a mutually beneficial mentor-mentee partnership; ¿ enable staff to reflect on their current approaches to providing feedback to mentees and identify areas that may require change; and ¿ identify barriers to a successful mentor-mentee relationship;.

Learning outcomes: On completion of this continuing professional development activity, participants will be able to: 1. List the relative and absolute contraindications for peritoneal dialysis. 2. Discuss the main issues related to the assessment of people considering peritoneal dialysis. 3. Identify assessment tools that can be utilised to assess people's capability to perform peritoneal dialysis safely.

Learning outcomes: On completion of this continuing professional development activity, participants will be able to: ¿ Discuss basic ultrasound principles; ¿ Define the roles and responsibilities of the nurse in point of care ultrasound; ¿ Identify strategies to utilise ultrasound to provide quality cannulation practice; ¿ Identify anatomic structures on an ultrasound picture; ¿ Identify anomalies in the anatomy such as thrombus, stenosis, aneurysm and pseudoaneurysm; ¿ Describe the advantages and disadvantages of using ultrasound for assessment and cannulation; ¿ Enable staff to reflect on their current approaches to assessment and cannulation.

Medication calculation and administration are commonly performed nursing tasks. A consequence of this frequency is the potential for a higher incidence of medication-related errors. One strategy to assess proficiency in medication calculation is an annual medication calculation competency quiz. Traditionally, these quizzes are done in paper form at an institutional level and require educators or managers to administer and mark the quiz manually by hand. This paper discusses the rationale, challenges and peer-review process associated with the development of an e-learning programme designed to assess proficiency in medication calculation and the quality use of renal medicines.

Aim There has been a global decline in the uptake of home-based dialysis therapies in the past 20 years. The ability to provide appropriate information to potential patients in this area may be confounded by a lack of knowledge of home dialysis options. The aim of this study was to develop a web-based education package for health professionals to increase knowledge and positive perceptions of home-based dialysis options. Methods A three-module e-learning package concerning home dialysis was developed under the auspices of the home dialysis first project. These modules were tested on 88 undergraduate health professionals. Changes in attitudes and knowledge of home dialysis were measured using custom designed surveys administered electronically to students who completed the modules. Matched pre and post responses to the survey items were compared using Wilcoxon signed rank tests. Results The pre survey indicated clear deficits in existing knowledge of home dialysis options. In particular, when asked if haemodialysis could be performed at home, 22% of participants responded 'definitely no' and a further 24% responded 'probably no'. Upon completion of the e-learning, post survey responses indicated statistically significant improvements (P < 0.001) in eight of the nine items. When asked if the e-learning had increased their knowledge about home dialysis, 99% of participants responded 'definitely yes'. Conclusion A suite of web-based education modules can successfully deliver significant improvements in awareness and knowledge around home dialysis therapies. © 2014 Asian Pacific Society of Nephrology.

SUMMARY: Background: It has previously been shown that nurses can learn clinical nursing skills by e-learning (online), and that many variables will influence how well nurses adopt learned clinical skills using distance education. Objectives: This study aimed to identify and measure the strength of those factors which would simultaneously influence registered nurses' (RNs') beliefs about their own learning about buttonhole cannulation, using e-learning. Design: An online Likert style survey consisting of a list of statements related to knowledge and skill domains considered crucial in the area of buttonhole cannulation was distributed to 101 RNs before and after completing an e-learning programme. Participants were required to identify their current level of self-confidence in relationship to each of the statements. Measurements: Measures of RNs' self-rated abilities to assess and implement buttonhole cannulation after completing a related e-learning program were tested using a Partial Least Squares Analysis (PLS-PATH) programme. Results: The study's results strongly identify that the nurses' ability to meet both clinical and educational outcomes of the renal e-learning module can be predicted by six variables, none of which are directly related to the participants' demographic or clinical backgrounds. Conclusion: These findings support the use of e-learning to teach clinical skills to RNs, and demonstrate the value of Partial Least Squares Analysis in determining influential learning factors. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Australian and New Zealand nurses are required to make statutory disclosures as part of their nursing registration renewal. One area of self-disclosure relates to maintaining competence to practise. Nurses are required to develop and maintain a portfolio that demonstrates their assessment of practice, continuing professional development (CPD) and recency of practice in order to meet their registering bodies' required standards. One of the obstacles for nurses is a clear understanding of what constitutes a professional portfolio as well as what is required of them to demonstrate continuing competence. This paper discusses, from both the Australian and New Zealand regulation authorities' perspectives, the maintenance of competency, the requirements for demonstrating CPD, and how a professional portfolio assists in providing this evidence.