Associate Professor Ashley Kable

© 2016 Elsevier Ltd.International guidelines recommend a collaborative approach to the care of pregnant women with asthma. Midwives, as the primary health care provider for childbearing women should be viewed as collaborative partners in the provision of antenatal asthma management. However, the role of the midwife in providing antenatal asthma management has not been widely reported.Method: Australian midwives' perceived role in antenatal asthma management was studied using a qualitative descriptive method. Semi-structured in-depth interviews were conducted with 13 midwives working in a regional tertiary hospital. Morse and Field's four-stage process was used to analyse the data.Findings: the perceived role of the midwife in antenatal asthma management varied among participants. Some midwives stated their role was to refer women on to other health professionals. Other midwives stated that they should provide education to the women regarding their asthma management during their pregnancy.Conclusion: participants were uncertain about their role and lacked confidence in antenatal asthma management. The midwifery context in which they worked and the resources available to them at this health care facility appeared to influence the perception of their role.

© 2016 John Wiley & Sons Ltd.Aim: To determine how nurses recognize and respond to unsafe practice. Background: Practice guidelines and standards outline safe practice. Nurses face challenges in recognizing and responding unsafe practice. Design: Whittemore and Knafl's revised framework for integrative reviews guided the analysis. Data sources: A comprehensive search of literature exploring the identification and response to unsafe practice, was undertaken in CINAHL, Medline, Embase and PsychoINFO databases for the period 2004-2014. Review methods: Nineteen articles from 15 studies were included in the review. A mixed method integrative approach was used to review data and draw conclusions. Results: Behaviours and cues that indicate unsafe practice are influenced by organizational and individual characteristics. Individual nurses responses are variable and there are professional and personal costs associated with being reported or reporting unsafe practice. Conclusion: The small number of studies reviewed limits the conclusions that can be drawn from the review but suggest that nurses can identify unsafe practice in their peers. Individual nurses' recognition and response to unsafe practice in their peers contributes to patient outcomes and safety. Nurses need awareness training and strategies to respond to unsafe practice and reporting systems that protect reporters from repercussions. Further research investigating organizational factors and individual factors that contribute to a shift in practice across safety boundaries is required.

© 2016 Elsevier Ltd.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.

© 2016 Informa UK Limited, trading as Taylor & Francis Group.Aim: To report nurses¿ attitudes towards older people in the emergency department (ED). Background: A nurse¿s attitude towards an older person can have an effect on nurses¿ work practices and interactions and can result in adverse outcomes for the older person. Design: A national cross-sectional survey using a previously validated instrument Older Person in Acute Care Survey (OPACS) was conducted to measure emergency nurses¿ attitudes towards older people in their care. Methods: Members of the College of Emergency Nursing Australasia (CENA) were invited to participate in the study. There were 371 (39%) completed surveys returned. Results: The OPACS survey identified that ED nurses have positive attitudes towards older people in the ED. Conclusion: The implications for practice are clinically significant because positive attitudes can result in prevention of discrimination and marginalisation of the older person in the ED.

© 2016 John Wiley & Sons LtdAim and objective: To report Australian nurses' practices caring for older people in the emergency department. Background: Unmet clinical needs of older patients in the emergency departments can have a negative impact on nurses and patients. Method and design: A national cross-sectional survey using a previously validated instrument, Older Person in Acute Care survey, was conducted to measure Australian emergency nurses' attitudes towards older people in their care. Members of the College of Emergency Nursing Australasia (CENA) were invited to participate in the study. There were 371 (39%) completed and valid surveys returned. Results: This study determined that Australian emergency department nurses report many positive practices used for older patients in their care. Conclusion: In this study, the Older Person in Acute Care survey has identified that, overall, emergency departments nurses have positive clinical practices towards their older patients in the emergency departments. The implications for clinical practice are significant as patient centred care in the Australian emergency departments will reduce adverse events for the older patient.

© 2015 Kable et al.Background: Healthcare professionals engage in discharge planning of people with dementia during hospitalisation, however plans for transitioning the person into community services can be patchy and ineffective. The aim of this study was to report acute, community and residential care health professionals' (HP) perspectives on the discharge process and transitional care arrangements for people with dementia and their carers. Methods: A qualitative descriptive study design and purposive sampling was used to recruit HPs from four groups: Nurses and allied health practitioners involved in discharge planning in the acute setting, junior medical officers in acute care, general practitioners (GPs) and Residential Aged Care Facility (RACF) staff in a regional area in NSW, Australia. Focus group discussions were conducted using a semi-structured schedule. Content analysis was used to understand the discharge process and transitional care arrangements for people with dementia (PWD) and their carers. Results: There were 33 participants in four focus groups, who described discharge planning and transitional care as a complex process with multiple contributors and components. Two main themes with belonging sub-themes derived from the analysis were: Barriers to effective discharge planning for PWD and their carers - the acute care perspective: managing PWD in the acute care setting, demand for post discharge services exceeds availability of services, pressure to discharge patients and incomplete discharge documentation. Transitional care process failures and associated outcomes for PWD - the community HP perspective: failures in delivery of services to PWD; inadequate discharge notification and negative patient outcomes; discharge-related adverse events, readmission and carer stress; and issues with medication discharge orders and outcomes for PWD. Conclusions: Although acute care HPs do engage in required discharge planning for people with dementia, participants identified critical issues: pressure on acute care health professionals to discharge PWD early, the requirement for JMOs to complete discharge summaries, the demand for post discharge services for PWD exceeding supply, the need to modify post discharge medication prescriptions for PWD, the need for improved coordination with RACF, and the need for routine provision of medication dose decision aids and home medicine reviews post discharge for PWD and their carers.

© 2015 MA Healthcare Ltd.International guidelines indicate that management of asthma during pregnancy should be multidisciplinary; however, the role of midwives has not been researched. Method: A qualitative descriptive study exploring Australian midwives' current knowledge about asthma in pregnancy and their perceived role in antenatal asthma management was conducted, involving individual semi-structured in-depth interviews with 13 midwives in a tertiary referral hospital. Data were analysed using Morse and Field's four-stage process. Findings: Midwives identified barriers preventing them from providing antenatal asthma management, including: lack of knowledge about asthma in pregnancy; time constraints; women's knowledge about asthma in pregnancy; lack of a clear referral pathway; and lack of accessible asthma management equipment. Barriers were influenced by the institutional context in which the midwives worked. Conclusion: While participants identified barriers preventing them from providing recommended antenatal asthma management, they also suggested that improving their knowledge about asthma in pregnancy and developing a clear referral pathway may be beneficial.

© 2015 AJA Inc.Aim: To examine the literature on the impact of the discharge experience of patients with dementia and their continuity of care. Methods: Peer-reviewed and grey literature published in the English language between 1995 and 2014 were systematically searched using Medline, CINAHL, PubMed, PsycINFO and Cochrane library databases, using a combination of the search terms Dementia, Caregivers, Integrated Health Care Systems, Managed Care, Patient Discharge. Also reviewed were Department of Health and Ageing and Alzheimer's Australia research reports between 2000 and 2014. Results: The review found a wide range of studies that raise concerns in relation to the quality of care provided to people with dementia during hospital discharge and in transitional care. Conclusion: Discharge planning and transitional care for patients with dementia are not adequate and are likely to lead to readmission and other poor health outcomes.

© 2014 Dietitians Association of Australia.Aim: The aim of this analysis is to establish if dietitians have the knowledge, skills and attitude to provide support to other health professional (HP) groups in the provision of weight management advice to overweight/obese patients. Methods: A secondary data analysis of a cross-sectional survey of HPs was undertaken to perform a gap analysis with regard to practices, knowledge, confidence and attitudes in the provision of weight management advice. Survey responses and additional measures (practice, knowledge, confidence and attitude scores) were compared between dietitians and other HPs. Descriptive statistics were undertaken, and differences between group ¿² tests were performed for nominal data and the Wilcoxon rank sum test for ordinal and non-parametric data. Results: About 100% of dietitians had received initial weight management training and 85% had participated in professional development training, compared with 18 and 19% of HPs, respectively, although 70% believed it was within their scope of practice to provide evidence-based advice. Dietitian respondents achieved a higher median score (maximum 10) in the following areas (practice = 6.5, knowledge = 8.0, confidence = 8.3) when compared with HP respondents (practice = 4.2, knowledge = 7.0, confidence = 5.4). The median attitude score for both groups was 6.0. Conclusions: HPs are receptive to providing evidence-based weight loss messages to overweight/obese clients in their current practice. However, weight management training is required to enhance HPs' knowledge and skills in order to increase confidence and improve practice skills. Dietitians can assist HPs to ensure that clear, consistent, evidence-based messages are delivered to overweight clients throughout the health-care system.

© 2015 Wiley Publishing Asia Pty Ltd.A cross-sectional survey was conducted in a regional area in Australia to measure nurses' perceptions, practices, and knowledge in regard to providing healthy lifestyle advice to people who are overweight or obese. Responses were compared between geographic regions. Participation was voluntary and anonymous. Of the 79 nurse participants, 68% considered that provision of healthy lifestyle advice was within their scope of practice. Only 28% reported frequently estimating body mass index in the practice setting. Nurses often recommended increasing activity levels (44%), but recommended reducing daily caloric intake less often (25%). Nurses' knowledge about weight management was variable and the proportion of correct answers to knowledge items ranged from 33-99%. Nurses have many opportunities to deliver healthy lifestyle advice in a range of practice settings. The variation in practices and knowledge of nurses indicates a need for improved healthy lifestyle education for undergraduate and practicing nurses.

© 2016 Elsevier Ltd.Aims: The aims of the present study were to report and compare regional and metropolitan Australian ED nurses' knowledge and understanding of age related characteristics of the older person. Background: ED nurses, who have a duty of care to deliver best practices for managing the older person, can be challenged due to the complexities and co-morbidities associated with older person presentations in the ED. Nurses in regional areas may have limited access to continuing education programmes and limited opportunities to attend such programmes. Design: A cross-sectional survey using previously validated instruments (OPACS and Palmore's Facts of Ageing Quiz) was conducted to measure emergency nurses knowledge and perceptions of physical, physiologic, and age related characteristics of older people; and aspects of hospitalisation that affect older people. Methods: Members of the College of Emergency Nursing Australasia (CENA) were invited to participate in the present study. There were 371 (39%) completed and valid surveys returned. Results: The OPACS results indicate that 66% of ED nurses had a basic knowledge about physical aspects and hospitalisation issues that affect older people. There were 59% correct responses for the Palmore's Facts of Ageing Quiz items measuring knowledge of physiologic and age related characteristics of older people. There were few differences between regional and metropolitan nurses. Conclusion: Increased knowledge of ageing is required for emergency nurses to continue to provide adequate care to older patients presenting to the ED to avoid adverse outcomes for these people.

© 2014 - IOS Press and the authors. All rights reserved.BACKGROUND: There is little health specific literature on returning nurses with injuries to work despite the high incidence of injuries and the workforce shortages of these professionals. OBJECTIVE: To identify enabling factors and barriers to return-to-work for nurses with injuries from the perspective of return-to-work coordinators. PARTICIPANTS: Workplace return-to-workcoordinators employed in a health or disability facility who had worked on a rehabilitation case with a nurse with injuries in the past 12 months in New South Wales (NSW), Australia. METHOD: Five focus groups were conducted with 25 return-to-work coordinators from 14 different organisations, representing different health sectors (aged, disability, public and private hospital and community health) in metropolitan and rural areas of NSW, Australia. RESULTS: This study reports findings specifically relating to the provision of suitable duties for nurses with injuries. Four key themes were identified: suitable duties; supernumerary positions; nurse specialisation and tailoring of return-to-work plans. CONCLUSIONS: This study identified that return-to-work coordinators were resourceful and innovative in their approach to the provision of suitable duties for nurses with injuries and highlighted the importance of including clinical duties in any return-to-work program and of tailoring the return-to-work to the nurses' work and personal circumstances.

© 2014 AJA Inc.Objective: The purpose of this literature review was to determine nurses' knowledge and understanding of the ageing process and attitudes towards older people in emergency care settings. Methods: Primary research publications about emergency nurses' attitudes towards and knowledge about older people were sought in six databases and Google. Results: Sixteen articles were reviewed, including seven cross-sectional surveys, seven qualitative studies and two mixed-methods studies. Conclusion: Emergency department nurses' attitudes towards and knowledge about ageing processes may affect therapeutic interactions between nurses and their older patients. Issues such as managerial style, past experiences and the medical model used for health-care delivery were secondary factors shown to influence emergency nurses' negativity towards their older patients. Further research focused on nurses' attitudes to and awareness or knowledge of gerontological issues, in particular in the ED, is warranted and would contribute to achieving desired cultural change.

Background The aim of this paper is to determine factors associated with sharps-related injury rates in nurses by analysing the combined data from two state-wide cross-sectional studies of nurses and comparing rates between public and private sectors and between different nurse practice areas in NSW. Methods The data from two studies conducted in 2006 and 2007 were combined for 44 similar data items and for similar nurse participants (registered nurses, registered midwives and enrolled nurses). Both studies had recruited nurses from membership of the NSW Nurses' Association. Data for 256 and 1100 participants respectively were combined for this comparative analysis. Results The sharps-related annual injury rate was 7.2% (95% CI: 5.9, 8.7). It was significantly higher in operating theatres, renal, mental health and paediatric practice areas in private compared with public facilities (17.9% versus 5.2%). Positive aspects of sharps safety practices included: 90% of nurses reported their injuries, were aware of processes required for dealing with sharps injuries and found their managers to be approachable. Areas for improvement included the provision of information about persons responsible for follow-up (21% unsure), increased provision of safety-engineered medical devices (SEMDs) (50% not available), decreased provision of non-SEMDs (75% available) and a focus on the highly-resistant practice of recapping needles (35% report recapping non-SEMDs). Conclusions There are significant differences in sharps-related injuries between public and private facilities. Opportunities exist to improve safety practices across various nursing practice environments. © Australasian College for Infection Prevention and Control 2014.

Background/aim: Obesity affects more than half the Australian population and has become epidemic throughout the world. Little is known regarding occupational therapy interventions with clients who are overweight or obese. This study aimed to identify occupational therapy practice in relation to the provision of weight management. This was part of a larger study investigating health professional practice. Methods: A cross-sectional study design using a self-administered, purpose-designed survey was employed to identify the current practices of occupational therapists working in a regional area of New South Wales, Australia. Participants were recruited via email or mail as publically available. Results: Fifty-one occupational therapists anonymously completed the survey. Results revealed that 53% (n = 26) of respondents did not consider weight management to be within their scope of practice or their workplace role description. The most common intervention was the provision of physical activity advice (65.2%; n = 30). Dietary advice was provided by 20.8% (n = 10), while 77% (n = 32) referred onto dietitian services. During entry-level occupational therapy education, only 7.8% (n = 4) had received weight management advice education. Completion of postgraduate professional development training in this area was reported by 14% (n = 7) of respondents. Conclusion: This study provides insight into the current practices of Australian occupational therapists in relation to the provision of weight management advice. This research displays a need to acknowledge both a generic and a discipline-specific role for the provision of healthy lifestyle interventions. This may be achieved through better access to education during entry-level programmes and in the workplace. © 2013 Occupational Therapy Australia.

Simulation is widely used in nursing education. Previous studies have examined the impact of simulation on the acquisition of psychomotor skills, knowledge, critical thinking and non-technical skills such as teamwork.Challenges associated with the integration of simulation into nursing curricula have also been examined, however only limited research addresses the most effective simulation design and teaching strategies for quality educational outcomes.This paper reports a Delphi study that synthesises expert opinion on the pedagogical principles and teaching strategies that are indicative of quality in simulation based learning activities. The resultant set of Quality Indicator Statements is presented and opportunities for application and further research are discussed. © 2012 Elsevier Ltd.

Violence in healthcare is a significant issue and one that is increasing in prevalence globally. Nurses have been identified as the professional group at most risk, with patients the main source of this violence. The aim of this study was to describe the experiences of Australian ED nurses with episodes of patient-related violence from young adults (16-25. years of age) and the parents of paediatric patients. Data analysis of semi-structured interviews led to the identification of antecedents to episodes of violence and behaviours specific to these two groups of interest. These behaviours included: "performing" and attention-seeking behaviours and violent behaviours including both verbal and physical abuse. Antecedents discussed by participants included: parental emotions and alcohol and substance abuse. Overall the results speak to a working environment where participants regularly feel unsafe. Violence in the ED is perceived to occur frequently and to such an extent that participants have become resigned to expect and accept it as part of their job. The role played by distinct groups such as young adults and the parents of paediatric patients must be acknowledged and this knowledge used along with other known risk factors to help identify patients at risk of potential violence. © 2012 Elsevier Ltd.