Professor Ritin Fernandez

Purpose:The purpose of this systematic review was to investigate knowledge and attitudes toward eye donation and sources of eye donation information among the general population.Methods:A search was conducted using MEDLINE through Ovid and Scopus; CINAHL through EBSCOhost and ProQuest; and Embase through Ovid database entries from January 2010 to March 2021. Quantitative studies were selected if they included participants aged 16 years or older from the general population (nonhealthcare) and had a sample size of >200. Studies were included if they measured knowledge and attitudes toward eye donation and sources of eye donation information. Methodological quality was assessed using JBI criteria, and the data were analyzed using SUMARI software.Results:A total of 25 studies were included in this review. Pooled data from 6 studies demonstrated that 30.8% of participants [95% confidence interval (CI) = 11.0-55.4] had some knowledge of eye donation. Seventeen studies reported that 40.6% (95% CI = 39.8-41.3) were willing to donate their eyes, and 5 of these studies found that 7.3% (95% CI = 6.5-8.3) had already pledged their eyes. Eleven studies reported on the source of eye donation information, indicating 50.9% of participants (95% CI = 49.8-52.1) received information from mass media.Conclusions:The results of this review indicate that understanding eye donation knowledge and attitudes is crucial for developing interventions or tools to increase eye donation rates. Further studies in different populations are required.

Peripheral blood hematopoietic progenitor stem cells (HPSCs) are the most common source of stem cells for autologous and allogenic transplantation. Currently, systematic reviews comparing the collection efficiency of a continuous to an intermittent method are lacking despite the existence of primary studies. Therefore, the objective of this review was to synthesize the best available evidence to compare the efficiency of the continuous vs the intermittent method for the collection of hematopoietic progenitor stem cells required for HPC transplantation. A search using MEDLINE, CINAHL, EMBASE, Google scholar, and MedNar for both published and unpublished studies was conducted in December 2021. The systematic review was conducted in accordance with JBI methodology. A critical appraisal of the studies was undertaken by two independent reviewers using the JBI quasi-experimental critical appraisal checklist. A total of six studies were included in the review. The findings of this review demonstrated that there was no statistically significant difference in the collection efficiency, length of procedure time, and total blood volume processed between the continuous and intermittent programs. The evidence suggests that the continuous method is as safe and effective as the intermittent method to collect HPSCs. Until further evidence becomes available clinicians should be guided by the policies of their individual hospitals.

Aim: The purpose of this study was to investigate the cultural and linguistic appropriateness of the content, images and layout of the web-based breastfeeding educational resource for Saudi women using a consensus development approach. Background: Although the World Health Organization highly recommends exclusive breastfeeding, there is a decline in breastfeeding rates in Saudi Arabia, especially during hospital stay. The combining of health professional support with e-technology tools has been proposed as a method to increase exclusive breastfeeding. However, the cultural and linguistic appropriateness of an e-technology-based approach has not been explored in Saudi women. Methods: After developing a content draft of the web-based breastfeeding educational resource specific to Saudi culture, an online consensus development conference was organised with ten participants including two university researchers and eight health care providers to investigate the cultural and linguistic appropriateness of the educational content. The participants from Saudi Arabia were Saudi mothers who had breastfeeding experiences and were key maternity health professionals employed at the Maternity and Children Hospital of Dammam, Saudi Arabia. The SQUIRE checklist was used in the reporting of this study. Results: Feedback received prior to the meeting showed that 81% of the content was acceptable and minor changes were required. Changes were made to the content based on the suggestions and feedback received. The consensus group accepted all the changes and the content was finalised. Conclusions: The online consensus development conference was found to be a very convenient way to decide on the cultural and linguistic appropriateness of the content of the web-based breastfeeding educational resource allowing the participation of experts from different countries; this was considered a critical step in ensuring the successful implementation of the intervention.

What is known on the subject?: Arts-based research is an established and accepted research approach and systematic reviews have been published on this methodology. There are many possible data collection techniques and study designs within arts-based research, which have been implemented but not yet systematically reviewed. Rationales and challenges for arts-based research have covered participants¿ experiences of being in arts-based studies in health service research. What the paper adds to existing knowledge?: The main results of this systematic review are that mental health recovery concepts are effectively communicated by visual arts-based research and participation in these studies is progressive and connecting for mental health consumers. This paper adds new knowledge about participants¿ experiences specifically in visual arts-based studies, where the participants are mental health consumers. The results are significant because they support visual arts-based research in its development and popularity, both as a research approach and as an empowerment intervention. What are the implications for practice?: The results of this systematic review can enhance the fields of qualitative research methods and mental health nursing. Recommendations for professional development can be advanced from consumers¿ ideas and experiences of recovery reported in this review. Nurse scientists and consumer researchers can take into consideration visual arts-based data collection techniques for use as research and empowerment interventions with mental health consumer participants. Abstract: Introduction: Art creation has been found to be therapeutic to mental health consumers, making the prospect of art creation's conceivable benefits as a mental health research strategy worthy of consideration. Aim: This systematic review aims to explore experiences of recovery among adults with a mental illness using visual art methods. Method: Following a comprehensive database search, 14 suitable studies were identified. These involved adult participants with a formal mental health diagnosis, or who self-identify as having a mental illness. The studies employed arts-based methodologies with participant-created, visual art as their data. Articles underwent data extraction and quality appraisal with the JBI-QARI (Qualitative Assessment and Review Instrument). Results: Results were categorised and further aggregated into two synthesised findings according to Joanna Briggs Institute (JBI) guidelines. The synthesised findings are: (1) Creative artmaking enables the use of visual metaphors which can aid expression of feelings, externalisation of identity, and personal learning, and (2) Interpersonal and self-connectedness through inclusion in community, receiving support when needed, and progressing through loss, are beneficial for mental health recovery. Discussion: These findings are comparable to those already existing in the literature, and suggest that visual arts-based research methods are as dependable as other qualitative research methods. Additionally, this systematic review reveals that when conducting research studies, there are benefits for mental health consumer participants when visual arts-based methods are used. Implications for practice: A visual arts-based research intervention can be concluded to have the effect of an empowerment intervention, as well as being a credible research method.

Aims and objectives: To identify final-year undergraduate students and new graduate nurses¿ behavioural intentions towards medication safety across four countries. Background: Medication errors are a common and avoidable occurrence, being costly for not only patients but also for health systems and society. Design: A multi-site cross-sectional study. Methods: A self-administered survey was distributed to students and new graduate nurses in South Africa, India, Turkey and Australia. Descriptive statistics were calculated for all survey items. Multiple linear regressions were performed to predict behavioural intentions using the three Theory of Planned Behaviour constructs: attitudes, behavioural control and subjective norms. This study adheres to the STROBE guidelines. Results: Data were analysed for 432 students and 576 new graduate nurses. Across all countries, new graduate nurses reported significantly higher scores on all the TPB variables compared with student nurses. Attitudes towards medication management were found significantly and positively related to intention to practice safe medication management for both student and new graduate nurses. Total perceived behavioural control was significantly and negatively related to intention to practice safe medication management for students. Conclusion: Student and new graduate nurses showed favourable attitude, subjective norm, perceived behaviour control and intention in practising medication safety. However, differences in countries require further exploration on the factors influencing attitudes towards medication safety among student nurses and new nurse graduates. Relevance to clinical practice: Understanding student and new graduate nurses¿ medication administration practices is important to inform strategies aimed at improving patient safety. The findings of this study highlight the need for an internationally coordinated approach to ensure safe medication administration by student and new graduate nurses.

Aim: This study was conducted in three phases. Phase 1 aimed to adapt the Cancer Information Overload Scale and conduct content validity testing. Phase 2 aimed to conduct factorial validity testing of the scale. Phase 3 aimed to assess information overload and the sources of information used by nurses and midwives to keep up-to-date about COVID-19. Design: A cross-sectional survey of nurses and midwives working in a metropolitan Local Health District in Sydney, Australia, was conducted from May to June 2020. Methods: Adaptation of the Cancer Information Overload Scale and content validity of the modified scale (as the Pandemic Information Overload Scale) was undertaken by an expert panel comprising of senior nurses and researchers. Factorial validity and reliability of the Pandemic Information Overload Scale were evaluated using exploratory factor analyses using one subsample of the data. Using the second subsample of the data, information overload and sources of information used by nurses and midwives to keep up-to-date about COVID-19 were examined. Results: The Pandemic Information Overload Scale is a reliable and valid instrument for measuring information overload among nurses during a pandemic. Its internal consistency was high (a = 0.81, M = 3.84). Conclusion: The 8-item PIO scale is a brief, reliable and psychometrically sound instrument for measuring nurses' and midwives' perceptions of information overload during COVID-19. Mean scores across this study indicated that participants were experiencing above average information overload. Implementing strategies to reduce this overload would optimize clinical decision making and promote patient safety.

Objective: The objective of this review was to synthesize the best available research evidence regarding the effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections. Introduction: Pain associated with intramuscular injections continues to be a challenge for nurses. Various physical stimulation methods to alleviate pain and improve satisfaction for patients receiving intramuscular injections have been reported; however, the evidence surrounding the effectiveness of these methods remains inconclusive. Inclusion criteria: This systematic review considered randomized and quasi-experimental studies that used any physical stimulation strategies (eg, skin tapping, manual pressure, massage, pinch, traction) for adults aged 18 years and over receiving intramuscular injections. Studies that evaluated pain using validated instruments were considered for inclusion. Methods: A three-step search strategy was conducted. MEDLINE, Embase, CINAHL, the Cochrane Library (Cochrane CENTRAL), Google Scholar, Dissertation Abstracts International, ProQuest Dissertations and Theses, and MedNar were searched from inception until 2020. We restricted the inclusion of studies to trials published in English. Two independent reviewers conducted the critical appraisal of eligible studies using the JBI checklists for randomized controlled and quasi-experimental trials. Data were extracted using the JBI data extraction tool, and meta-analysis and subgroup analysis were undertaken, where appropriate. Results: Twenty-five studies were included with a total sample size of 1956 patients. Pooled results demonstrated that pain was significantly less with the use of the Helfer skin tap technique compared to no intervention (two studies; RR 0.73; 95% CI 0.66, 0.81; P<0.00001) or standard intervention (three studies; SMD -2.25; 95% CI -3.65, -0.85; P=0.002). Intervention with acupressure using standard treatment as control showed significant reduction in pain intensity (MD -4.78; 95% CI -5.32, -4.24; P<0.00001). Similarly, pain was significantly lower with manual pressure (two studies; SMD -0.42; 95% CI -0.69, 0.15; P=0.002) when compared to standard treatment. Pain scores were significantly lower in patients who received pinch technique, ShotBlocker, massage, or combination intervention (skin traction, pressure, and rapid muscle release) compared with no intervention, standard treatment, or placebo control. Conclusions: The evidence from this review demonstrates that physical stimulation - particularly the Helfer skin tap technique, acupressure, manual pressure, pinch technique, ShotBlocker, massage, and combination - can significantly lower intramuscular injection pain; however, this is based on low or very low certainty of evidence. Systematic review registration number: PROSPERO CRD42020168586.

Background: There is an urgent need to increase the research capability and capacity within the nursing and midwifery workforce, to underpin evidence-based care. Aim: To explore the perceptions of nursing service leaders and academics of the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) Nursing and Midwifery Clinician Researcher Career Pathway for acceptability and utility. Methods: Using a qualitative descriptive design, data were collected via an online focus group and one individual semi-structured interview. Content and thematic analyses were undertaken. Findings: Data from 22 participants were included in the analyses. Most participants were female (82%), employed within Local Health Districts (LHDs) (29%), universities (24%), and both LHD and university (47%). There was strong support for the SPHERE Nursing and Midwifery Clinician Researcher Career Pathway. Four major themes were identified: (¿) Current disintegration of the clinician researcher role, (¿) Implementation, (¿) Balancing a clinical and research role: need for protected time, and (¿) Reintegration of the clinician researcher role: growing and stabilising a generation of clinician researchers. Discussion: The SPHERE Nursing and Midwifery Clinician Researcher Career Pathway provides a unique opportunity to develop and sustain the future generation of clinician researchers. To succeed, changes to existing perceptions of clinicians, other health professionals, managers, and consumers are required. Leadership, appropriate language and messaging, and a shared vision is required from a unified professional voice. Protected research time remains the greatest challenge, requiring creative solutions that acknowledge diverse models of care. Conclusion: The SPHERE Nursing and Midwifery Clinician Researcher Pathway provides a vision for the reintegration of the role of clinician and researcher within Australian health services, which may take a generation to transform health service research culture.

Aim: The social and economic impacts that have occurred during the COVID-19 pandemic can disproportionally affect those already experiencing poverty or at risk of poverty. Therefore, this study sought to explore the relationship between well-being and social determinants of health among Australian adults during the pandemic. Subject and Methods: Semi-structured interviews were undertaken with 20 participants, aged 21¿65 years, from various socioeconomic areas. Results: Three main themes emerged from the analysis of the data: food security; housing outcomes; and psychological and emotional impact. Participants in low socioeconomic areas struggled with food security, having to access food banks, which was precipitated by employment loss during the pandemic. Some female participants experienced worsening inequalities and lack of financial and housing stability, affecting their overall well-being. Conclusion: This study identified that there was a clear social divide between adults living in low socioeconomic areas compared with those living in high socioeconomic areas, with participants in low socioeconomic areas faring worse in terms of exacerbated social determinants of health and consequent impacts on well-being.

Background:The impact of the COVID-19 pandemic forced global changes to how nurses practice. Nurse practitioners adjusted their scope, changed how they delivered their service, and worked with limited resources. For some services, patient access was also compromised.Objectives:To synthesize, combine, and present current evidence on the experiences of nurse practitioners working during the COVID-19 pandemic.Data sources:CINAHL, Embase, and MEDLINE electronic databases were used to perform a structured search strategy.Conclusion:During the COVID-19 pandemic, health care services had to leverage their workforce skills to accelerate COVID-19 identification, treatment, and care. Nurse practitioners rapidly found themselves at the forefront and were concerned about infecting others. They also identified the need for support and were able to adapt to the changing environment. Nurse practitioners also recognized the impact on their well-being. Having insight into nurse practitioner's experiences during the pandemic is valuable for future health care workforce planning. Understanding how they coped will help with critical preparedness and response actions to other health care crises.Implications for practice:Having insight into nurse practitioner's experiences during the pandemic is valuable for future health care workforce planning because, as we know, the nurse practitioner workforce is one of the most rapidly growing professions in primary health care. Any future work in this space will help inform future nurse practitioner education and also help by informing critical preparedness and response actions to future health care crises, whether global or local or clinical or nonclinical.

Aims: To validate the ¿safe and effective staffing tool¿ and explore the impact of COVID-19 on the quality of Australian primary health care (PHC). Design: A national survey was conducted from October to December 2020. Methods: The online survey was distributed via social media and professional organisations to PHC nurses. Results: Three-hundred fifty-nine PHC nurses participated. A two-factor solution was found with factors named; ¿Perception of quality of care provided¿ and ¿Personal satisfaction with care delivered¿. Cronbach's alpha demonstrated good internal consistency for the total scale (a¿=.915) and each subscale (a¿=.879/a¿=.864). Nearly three-quarters of participants (71.3%) were satisfied with the quality of care they delivered. Participants working in general practice, and those with more nursing experience had significantly higher scores in the factor ¿perceptions of quality of care provided¿ and the total ¿quality and satisfaction with care¿. A lack of time, inadequate supervision and support, and performing non-nursing duties were reported to be impacting care quality. Most participants (80.5%) reported that COVID-19¿had impacted negatively on the detection and management of non-COVID related health conditions. Conclusion: The ¿safe and effective staffing tool¿ is a valid and reliable measure of perceived quality of care and satisfaction with care delivered. Many PHC nurses perceive that there has been an overall reduction in the quality of care delivered due to COVID-19 and feel that there is a lack of adequate supervision and workplace support. Given the limited baseline data, further research is required to understand the extent that COVID-19 impacts these findings. However, this study demonstrates that strategies need to be implemented to support PHC nurses to provide high-quality care to optimise health outcomes and maintain nurse satisfaction. Impact: This is the first attempt to evaluate care quality in Australian PHC. Policymaking requires this evidence to drive changes to better support PHC nurses.

To evaluate the impact of general practice nurse-led interventions for blood pressure control and cardiovascular disease risk factor reduction in patients with hypertension. Systematic review and meta-analysis of randomized control trials. CINAHL, Medline and Scopus databases were searched to identify peer-reviewed studies published between 2000 and 2021. A systematic review of randomized control trials was conducted using a structured search strategy. The Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to appraise study quality. Meta-analysis and narrative synthesis were performed to determine the effectiveness of the included interventions. Eleven trials comprising of 4454 participants were included in the review. Meta-analysis showed significant reductions in both systolic and diastolic blood pressure in trials with 6¿months or less follow-up. Improvements were also demonstrated in reducing blood lipids, physical activity, general lifestyle measures and medication adherence. Evidence for dietary improvements and reduction in alcohol and smoking rates was inconclusive. Nurse-led interventions for patients with hypertension are heterogeneous in terms of the nature of the intervention and outcomes measured. However, nurse-led interventions in general practice demonstrate significant potential to improve blood pressure and support cardiovascular disease risk factor reduction. Future research should be directed towards elucidating the successful elements of these interventions, evaluating cost-effectiveness and exploring translation into usual care. This review provides evidence that nurses in general practice could enhance current hypertension management through nurse-led interventions.

Objective: The aim of this study is to explore the association between economic wellbeing and ethnicity, socioeconomic status, and remoteness during the COVID-19 pandemic. Design: A cross-sectional study via SurveyMonkey was conducted in Australia between August 2020 and October 2020. Descriptive and inferential statistics were used to analyze the data. Results: A total of 1211 individuals responded to the survey. Income loss was significantly associated with those from low socioeconomic status (OR = 1.65; 95% CI 1.01¿2.68). Access of superannuation was significantly associated with those in outer regional (OR = 3.61; 95% CI 0.81¿16.03) and low socioeconomic status (OR = 2.72; 95% CI 1.34¿5.53). Financial inability to pay for services was significantly associated with living in remote areas (OR = 2.26; 95% CI 0.88¿5.80). Conclusions: The economic wellbeing of people who identify as Aboriginal and Torres Strait Islander, live in regional or remote areas, and reside in low socioeconomic areas have been substantially impacted during the pandemic. Findings call for policies to address the underlying social determinants of health.

Aim: The aim of this study was to understand the challenges that nurses and midwives face when seeking to practice social distancing within the various clinical settings in a hospital work environment during COVID-19. Background: COVID-19 has had a significant impact on nurses and midwives internationally. With the ease of transmission of COVID-19 and the limitations in pharmaceutical interventions, other measures had to be implemented across communities and in healthcare settings. These public health measures were enacted in various ways throughout the world. A key measure employed globally was social distancing. Australia was no different, initiating community wide interventions to apply social distancing principles and action, in an effort to reduce transmission. Whilst at their places of work, nurses and midwives were also encouraged to practice social distancing. Design and methods: Using convenience sampling, 579 nurses and midwives employed within one local health district in NSW, Australia completed an online questionnaire during the COVID-19 pandemic. Subsequently, a thematic analysis was undertaken as a way of categorising data from the 216 (37%) qualitative responses with regards to social distancing. This study adhered to The Standards for Reporting Qualitative Research (SRQR) guidelines. Results: Overwhelmingly, responses indicated that participants found it challenging to practice social distancing in their workplaces across various clinical settings within the hospital. The two major themes identified were: 1) challenges relating to social distancing with patients and 2) challenges related to social distancing with colleagues. Several sub themes were also identified. Conclusion: The COVID-19 pandemic has highlighted a number of challenges for healthcare professionals, social distancing being a key challenge. Social distancing is argued to be almost impossible in various clinical settings within a hospital where patient contact and provision of care in a team environment occurs.

Introduction: The objective of this review is to synthesise and present the best available evidence on the prevalence, predictors and information needs about sexual health among female Arab cancer survivors. Methods: The databases searched included MEDLINE, Embase and CINAHL from inception of the database until March 2020. The review was undertaken according to the JBI guidelines. Proportional meta-analysis using a random effects model was used for statistical pooling through JBI SUMARI. Results: Seven studies involving female Arab cancer survivors were included in the review. The overall prevalence of sexual dysfunction ranged from 16.7 to 67% (pooled estimate 51%, 95% CIs 21.7% to 80.2%). Dyspareunia and erectile dysfunction were the two main types of sexual dysfunction reported after diagnosis, and the overall prevalence ranged from 42.5% to 65% and 38% to 61%, respectively. The prevalence of vaginal dryness was ranged from 19.8% to 54.2%, and dyspareunia ranged from 22.2% to 65%. The lack of sexuality information and communication with health care providers (HCPs) was also reported in the included studies. Conclusion: Cancer and its treatment may result in significant difficulties with sexual activity and sexual functioning among cancer survivor. Communication between the health care professionals and cancer survivors is essential to overcome this problem and improve the quality of life of female Arab cancer survivors.

The social determinants of health affect an individual's capacity to cope during a crisis such as the COVID-19 pandemic which could potentially impact their well-being. The aim of this study was to examine the relationship between well-being and the social determinants of health among Australian adults during the COVID-19 pandemic. A cross-sectional study of adults residing in Australia was conducted using SurveyMonkey between 20 August and 14 October 2020. Participants were recruited via social media. Well-being was measured using the 10-item Multicultural Quality of Life Index and social determinants of health were measured using validated tools and investigator developed questions. Data were analysed using SPSS version 25. Inferential statistics, including independent t-test and one-way ANOVA, were undertaken. Multiple regression analysis was used to investigate the predictors of well-being. In total, 1211 responses were received. Females accounted for 80.7% of the responses, men 16.7% and transgender/non-binary 2.6%. The mean age of the respondents was 43 years (SD 14.2). The mean score for total well-being was 62.58 (SD 21.22). The significant predictors of higher well-being were housing security (p¿=¿0.000), food security (p¿=¿0.000), social support (p¿=¿0.000) and access to healthcare (p¿=¿0.000). This study demonstrates that those with poor social support, difficulty accessing healthcare, insecure housing and food insecurity had significantly poorer well-being during the COVID-19 pandemic. It shows that the COVID-19 pandemic has exacerbated social vulnerabilities and highlights the need for action to address the social determinants of health and inequalities.

Aim: The aim of this study is to explore primary health care nurses' mental health, concerns and perceived safety and supports during COVID-19. Background: Respiratory pandemics have negative impacts on nurses' wellbeing. While literature is replete with hospital nurses' experiences, there is less exploration of COVID-19 impacts on primary health care nurses. Given the importance of primary health care nurses in the health system, understanding their experiences is vital. Methods: Three hundred and fifty nine primary health care nurses responded to an online cross-sectional survey. The Depression Anxiety Stress Scales (DASS-21) was used to measure emotional state. Data were analysed using descriptive and inferential statistics. Results: DASS-21 scores indicated that 39.6% of participants were experiencing symptoms of depression, anxiety or stress. Of those, 41.8% were experiencing symptoms on one scale, 26.9% were experiencing symptoms on two scales and 31.2% were experiencing symptoms across all three scales. Most participants identified that their feelings were related to COVID-19. Conclusions: COVID-19 is having a significant impact on primary health care nurses' mental health. Nurse managers need to develop strategies to effectively address nurses' concerns and effectively support them to sustain the workforce during and after the pandemic. Implications for Nursing Management: Findings from this study can inform the design of effective nurse support programmes to reduce mental health impacts and promote staff wellbeing during the pandemic.

Introduction: Cardiovascular disease (CVD) accounts for 25% to 45% of deaths among Arab people. The purpose of this review was to investigate the level, predictors, motivators, and barriers to adherence to lifestyle recommendations among Arab patients with CVD. Method: A systematic search of the literature was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMCARE, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched. Studies that explored adherence to a healthy lifestyle among Arab adult patients with CVD were included. Results: Twelve studies were included. Quantitative results showed low adherence among Arab people with CVD. Qualitative synthesized results revealed that internal motivators, personal desire as well as structural drivers impact the patient¿s ability to adhere to a healthy lifestyle. Discussion: Multidimensional solutions that consider religion and culture and include active involvement of families are required to improve adherence.

Background: Cardiovascular disease (CVD) is one of the most common chronic illnesses in the Eastern Mediterranean. There have been few studies on medication adherence in Arab patients with CVD. Aim: To investigate the rates and the reasons for medication adherence in Arab patients with CVD. Methodology: The Joanna Briggs Institute methodology for prevalence systematic reviews was used. MEDLINE, EMCARE, CINAHL, Scopus, Science Direct, PsychINFO, and the Cochrane Central Register of Controlled Trials were searched. Results: Thirteen quantitative studies on medication adherence in Arab adult CVD patients were included. Pooled data from nine studies demonstrated that 53.2% (95% confidence interval = [51.2%, 55.1%]) of patients were adherent to their medications. Reasons for nonadherence to medication include personal factors, understanding, and complexity of treatment regimes, medication knowledge and structural barriers. Conclusion: Medication adherence appears to have a social gradient, and families should be actively involved in future strategies to increase medication adherence.

Objective: With longer life expectancies, cardiovascular diseases are increasingly common among older adults, which also leads to functional changes that severely impact their quality of life. This study aimed to identify the predictors of health-related quality of life (HRQOL) among older New Zealanders with cardiovascular health problems. Methods: A cross-sectional data analysis of the 2015/16¿New Zealand Health Survey was performed. In total, 2203 older New Zealanders with cardiovascular health problems were identified and included in the final analyses. The association between demographics, physical activity, health measurements, and HRQOL was examined using a multiple linear regression model. Results: Significant differences in HRQOL were identified between the demographics and cardiovascular risk factors. Predictors of higher HRQOL among older New Zealanders with cardiovascular conditions were increased physical activity (ß¿=¿0.218), age (ß¿=¿-0.067), employed (ß¿=¿0.137), lower waist circumference (ß¿=¿-0.261), male (ß¿=¿0.127), and being without a history of diabetes (ß¿=¿-0.071). Conclusions: Physical activity is the strongest predictor of HRQOL in older adults with cardiovascular problems. Older female New Zealanders with cardiovascular health problems have lower perceptions of their health status. These predictors should be considered while designing and developing intervention and health education that aims to improve the HRQOL of older adults.

Background: Although various solutions have been recommended for cleansing wounds, normal saline is favoured as it is an isotonic solution and is not thought to interfere with the normal healing process. Tap water is commonly used in community settings for cleansing wounds because it is easily accessible, efficient and cost-effective; however, there is an unresolved debate about its use. Objectives: To assess the effects of water for wound cleansing. Search methods: For this fifth update, in May 2021 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. Selection criteria: We included all randomised controlled trials (RCTs) that assessed wound cleansing using different types of water (e.g. tap water, distilled, boiled) compared with no cleansing or with other solutions (e.g. normal saline). For this update, we excluded quasi-RCTs, thereby removing some studies which had been included in the previous version of the review. Data collection and analysis: Two review authors independently carried out trial selection, data extraction and GRADE assessment of the certainty of evidence. Main results: We included 13 trials in this update including a total of 2504 participants ranging in age from two to 95 years. Participants in the trials experienced open fractures, surgical wounds, traumatic wounds, anal fissures and chronic wounds. The trials were conducted in six different countries with the majority conducted in India and the USA. Three trials involving 148 participants compared cleansing with tap water with no cleansing. Eight trials involving 2204 participants assessed¿cleansing with tap water compared with cleansing with normal saline.¿Two trials¿involving 152 participants¿assessed cleansing with distilled water compared with cleansing with normal saline. One trial involving 51 participants also assessed cleansing with¿cooled boiled water compared with cleansing with normal saline, and cleansing with¿distilled water compared with cleansing with cooled boiled water. Wound infection: no trials reported on wound infection for the comparison cleansing with tap water versus no cleansing. For all wounds, eight trials found the effect of cleansing with tap water compared with normal saline is uncertain (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.59 to 1.19); very low-certainty evidence. Two trials¿comparing the use of distilled water with normal saline for cleansing open fractures found that the effect on the number of fractures that were infected is uncertain (RR 0.70, 95% CI 0.45 to 1.09); very low-certainty evidence. One trial compared the use of cooled boiled water with normal saline for cleansing open fractures and found that the effect on the number of fractures infected is uncertain (RR 0.83, 95% CI 0.37 to 1.87); very low-certainty evidence. This trial also compared the use of distilled water with cooled boiled water and found that the effect on the number of fractures infected is uncertain (RR 0.59, 95% CI 0.24 to 1.47); very low-certainty evidence. Wound healing: results from three trials comparing the use of tap water with no wound cleansing demonstrated there may be little or no difference in the number of wounds that did not heal between the groups (RR 1.04, 95% CI 0.95 to 1.14); low-certainty evidence. The effect of tap water compared with normal saline is uncertain; two trials were pooled (RR 0.57, 95% CI 0.30 to 1.07) but the certainty of the evidence is very low.¿Results from one study comparing the use of distilled water with normal saline for cleansing open fractures found that...

Aim: To synthesize the best available research evidence regarding the effectiveness of spiritual intelligence educational interventions on spiritual intelligence and professional outcomes in nurses and nursing students. Background: Spiritual intelligence is a form of intelligence with which individuals can deal with a crisis, alter situations, solve problems and achieve goals through a set of capacities and abilities. Possessing spiritual intelligence contributes to professional practice and competence in the workplace and has been seen to be beneficial for nurses and nursing students. Nursing interventions to teach and increase understanding of spiritual intelligence have been explored in the literature, but the effectiveness of spiritual intelligence training for nurses and nursing students remains uncertain. Design: A systematic review and meta-analysis. Data sources: A three-step systematized search of sixteen electronic English and Persian databases was conducted to identify randomized and non-randomized trials published in English and Persian from January 2000 to November 2021. Methods: The methodological quality of eligible studies was undertaken by two independent reviewers using the Medical Education Research Study Quality Instrument. Meta-analyses were undertaken where appropriate using STATA v16. Results: Seven studies involving 512 participants were included. Pooled results demonstrated that those who received the educational intervention had significantly higher spiritual intelligence scores at 2 weeks (MD 13.38, 95 % CI: 5.76, 20.99) and one month follow up (MD 20.03, 95% CI: 6.61, 33.45) compared with those who did not. No difference in spiritual intelligence scores was observed among those who received spiritual intelligence education or life skills training (MD 7.52, 95 % CI -1.78, 16.82). Significantly higher communication skills (MD 5.41, 95 % CI: 2.16, 8.66), job satisfaction (MD; 11.30, 95 % CI: 8.63, 13.97) and spiritual care competence (MD; 28.55, 95 % CI: 26.08, 31.02) and decrease in overall stress (MD; 10.30, 95 % CI: 6.84, 13.76) among those who received the educational interventions were reported at the one-month follow-up. Significantly higher job satisfaction levels were also reported at 2-month follow-up among those who received the educational interventions (MD; 16, 95 % CI: 11.06, 20.94). Conclusions: The evidence from this review demonstrates that spiritual intelligence educational interventions have a positive effect on spiritual intelligence and professional outcomes in nurses and nursing students. We noted that the outcomes in the studies included were mostly measured at one-month follow-up and with subjective measures. Longer trials with objective measures are required to provide higher levels of evidence. The results of this review are largely based on single trials and were limited in terms of the number of outcomes. Conducting further trials is warranted to identify the influence of such education on various professional outcomes in nursing practice. Tweetable Abstract: Systematic review and meta-analysis shows spiritual intelligence educational interventions have a positive effect on nurses' and nursing students¿ spiritual intelligence, work-related stress and professional practice.

Aim: To explore the coping strategies used by Australian preregistration nursing students during the COVID-19 pandemic ¿lockdown¿ period. Background: COVID-19 has had a significant impact on preregistration nursing students, both physically and psychologically. As campuses closed and online learning commenced, clinical placement access was reduced, with heightened concern about personal and family safety. As such, nursing students were forced to adopt coping strategies to manage their self and the environment. Design: A descriptive qualitative study. Methods: One hundred and fifty-five preregistration nursing students enrolled at a regional Australian university completed a self-administered online survey. Results: Overwhelmingly, student responses revealed that staying connected was the key coping strategy to ensure emotional and mental health wellbeing. Heightened vigilance in infection control measures was also evident, personally and for others. Routines, including exercise, facilitated physical and mental wellbeing. Overall, coping strategies identified by nursing students demonstrated applied resilience during the isolation period. Conclusions: Understanding the adaptive coping strategies used by nursing students can enable nurse academics to understand how to best provide support. This study emphasises the importance of recognising that not all students are able to adapt and ¿cope¿ without supports in place. Future studies should investigate the longer-term impact of COVID-19 within the broader preregistration nursing experience and how this might impact nursing students¿ future careers.

Background: Research about skin-to-skin care (SSC) experiences in early period after birth has focused on mothers and infants. Purpose: The purpose of this study was to determine the outcomes of paternal skin-to-skin care (P-SSC) in both fathers and infants. Methods: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, Embase, CINAHL, PsycInfo, Airiti Library, and Google Scholar were searched for randomized controlled trials (RCTs) that reported outcomes of P-SSC in both fathers and infants. We calculated pooled mean differences (MDs) and 95% confidence intervals (CIs) using RevMan 5.3 for the meta-analysis [PROSPERO: CRD42018106790]. Results: Seven RCTs including a total of 552 participants were eligible for inclusion. Compared to the maternal skin-to-skin care (M-SSC), fathers in the P-SSC exhibited no significant differences in salivary oxytocin levels (MD: -0.35 pg/mL; 95% CI: -0.75, 0.05), salivary cortisol levels (MD: 0.25 µg/dL; 95% CI: -0.82, 1.33), or anxiety scores (MD: -0.17; 95% CI: -0.57, 0.22) during the period of SSC. Similarly, there were no significant differences in the salivary cortisol levels (MD: -0.11 µg/dL; 95% CI: -0.05, 0.28) among preterm infants between the 2 groups. However, the crying time was less among full-term infants in the P-SSC group compared with infants in the incubator care or cot care groups. Implications for Practice and Research: P-SSC had similar effects as M-SSC on stress-related outcomes during and after SSC among fathers and infants in the early stages after birth. We recommend that P-SSC be implemented in the early stages after birth. Further RCTs with a longitudinal design and large samples are needed to better understand the long-term effects of P-SSC on fathers and infants.

BACKGROUND Rapid alterations to study environments during COVID-19 raised concerns for nursing students about their academic progression. AIM The study aim was to investigate the psychometric properties of the Altered Student Study Environment Tool (ASSET) and the relationship between students' concerns, demographics, COVID-19-related knowledge, and communication received from the university. METHOD The 11-item ASSET and investigator-developed questions were administered to prelicensure nursing students using an anonymous online survey. RESULTS Responses were obtained from 234 students. Exploratory factor analysis supported a three-factor structure, namely, attending clinical placement, completion of clinical placement, and grade attainment. Students with higher scores on knowledge had significantly lower concerns for the subscale attending clinical placement. Full-Time students had significantly higher concerns for the subscale completion of clinical placement. CONCLUSION The ASSET is a valid and reliable instrument that can be used to measure concerns relating to the effects of altered study environments on academic progression.

Objectives The aim of this study was to examine the strength of improvement recommendations proposed after investigation of fall incidents in health care facilities that result in major injuries. Methods This study was conducted using a retrospective multi-incident analysis design. The study setting was 4 tertiary teaching hospitals, 1 subacute rehabilitation facility, and a residential aged care facility in a metropolitan health district in New South Wales, Australia. Ninety-eight injurious fall incidents during a 2-year period (2015-2016) were investigated. Recommendations were grouped into 3 categories: strong (including environmental modifications, equipment, workflow or process redesign), medium (including changes in communication or documentation processes, staffing numbers and/or skill mix, education to address identified knowledge deficits), and weak (including alerts/warning/labels or expected practice without any associated policy or procedure). Results The majority of the incidents (34.7%; n = 34) occurred between 1300 and 1859 hours, 65.3% (n = 64) occurred in the patient's room, and 79.4% (n = 81) of the injuries were fractures. There were 224 recommendations made for 79 incidents, and 19 incidents did not have any recommendations. The average number of improvement recommendations proposed per incident investigation was 2.3 (SD, 2.1; range, 0-9). Nineteen (8.5%), 80 (35.7%), and 125 (55.8%) recommendations were classified as strong, medium, and weak, respectively. Half of the investigative teams included representatives from more than one professional group. There were a significantly greater number of medium recommendations made by multi-disciplinary teams compared with single-disciplinary teams (odds ratio, 1.83; 95% confidence interval, 1.05-3.21). There was no significant difference in the number of strong and weak recommendations made between the 2 teams. Conclusions This study found that only 8.5% of recommendations were classified as strong. This suggests that a major challenge lies in formulating robust recommendations; hence, efforts should focus on enhancing the strength of improvement recommendations.

Background: COVID-19 has created global disruption, with governments across the world taking rapid action to limit the spread of the virus. Physical distancing and lockdowns abruptly changed living conditions for many, posing specific challenges of social isolation and lack of connectedness due to being physically and socially isolated from family and friends. Social capital is the bonding of individuals within a society that facilitates and shapes social interactions. The aim of this study was to qualitatively explore the impact that existing social capital has on Australians¿ experience of lockdowns during the COVID-19 pandemic and the effect this has had on their wellbeing and quality of life. Methods: Participants from various socioeconomic areas within Australia were purposively selected to participate in semi-structured interviews conducted via videoconferencing or telephone. Inductive thematic analysis of the data was undertaken. Results: A total of 20 participants were interviewed ranging in age from 21 to 65 years, including 50% (n = 10) females, 40% (n = 8) males, 5% (n = 1) non-binary and 5% (n = 1) transgender. Three main themes emerged from the analysis of the data: No person is an island; Social engagement; and Loneliness and isolation. Individuals who resided in low socioeconomic areas, those who lived alone and had reduced social support expressed feelings of poorer wellbeing. Conclusions: This study describes the lived-experiences of the influence of the COVID-19 pandemic on Australians¿ social capital and wellbeing. The findings highlight the need for interventions to increase social support, social cohesion, and social connectedness, especially among Australians from low socioeconomic areas, to enhance their overall wellbeing.

Background Patients with type 2 diabetes mellitus (T2DM) have been shown to have thiamine deficiency. Dietary supplementation is an economic strategy to control blood glucose. Objective: To evaluate effectiveness of thiamine supplementation on glycaemic outcomes in patients with T2DM. Methods Eligibility criteria: Studies that assessed effect of thiamine supplementation in adults with T2DM which measured glycaemic outcomes - HbA1c, fasting blood glucose (FBG) and/or postprandial blood glucose (PPG) were included. Information sources: PUBMED, Tripdatabase, the Cochrane Central Register, National Institute of Health Clinical Database and Google Scholar were searched until December 2021 for RCTs. Risk of bias: It was assessed using standardised critical appraisal instruments from the Joanna Briggs Institute for RCTs. Synthesis of results: Where possible, studies were pooled in a meta-analysis. Results were presented in a narrative format if statistical pooling was not possible. Results Included studies: Six trials involving 364 participants. Synthesis of results: No significant beneficial effects were observed on glycaemic outcomes with 100-900 mg/day of thiamine or benfotiamine for up to 3 months (HbA1c: MD, -0.02%, 95% CI: -0.35 to 0.31; FBG: MD,-0.20 mmol/L; 95% CI: -0.69 to 0.29; PPG: MD, - 0.20 mmol/L, 95% CI: -2.05 to 1.65 (mean difference, MD)). There was a significant increase in high-density lipoprotein (HDL) (MD, 0.10; 95% CI: 0.10 to 0.20) at 3-month follow-up. Benfotiamine reduced triglyceride level (MD, -1.10; 95% CI: -1.90 to -0.30) in 120 mg/day dose as compared with placebo 150 mg/day, however this was not demonstrated in higher doses. Discussion Limitations of evidence: Inclusion of single-centre trials published only in English, small sample sizes of included studies, lack of trials investigating outcomes for same comparisons and varying follow-up periods. Interpretation: Thiamine supplementation does not affect glycaemic outcomes, however reduces triglycerides while increasing HDL. Multicentre well-designed RCT with higher doses of thiamine and a follow-up period of 1-2 years will provide better evidence. PROSPERO registration number CRD42020170520.

Background: The concept of spiritual intelligence was developed in 1997 based on philosophical theories and neurological evidence and introduced as the ultimate intelligence. Spiritual intelligence has been considered as one of the skills required by professionals and has recently gained traction within nursing practice. Understanding the role of spiritual intelligence and its association with professional nursing practice is crucial to creating knowledge in this area of inquiry. Objective: To identify the best available evidence of the spiritual intelligence level and its correlation with professional practice among nurses. Design: A systematic review and meta-analysis of observational studies were reported according to the PRISMA and MOOSE guidelines. The protocol for this systematic review was registered with PROSPERO with the identification CRD42021254881. Data Sources: Ten electronic English and Persian databases [Cochrane Library, Web of Science, Scopus, PubMed, CINAHL, Science Direct, Wiley Online Library, Magiran, SID, IranDoc] were searched to identify eligible studies, published in the English and Persian languages from January 2000 to May 2020. Review Methods: A systematized search strategy was used to include eligible published and unpublished observational studies that examined the spiritual intelligence level and its correlation with professional practice among nurses. Screening, quality assessments, data extractions, and analysis were undertaken using Joanna Briggs Institute methodology and carried out by two independent reviewers. Results: Thirty-five studies, with a total of 7301 nurses, were included. The mean score for spiritual intelligence in 29 studies and 5853 nurses was 0.63 (95% CI: 0.57¿0.69, I2 = 99.97%). The Spiritual Intelligence Self-Report Inventory was the most frequently used instrument to measure spiritual intelligence. Most of the professional nursing outcomes represented a positive association with nurses' spiritual intelligence. The pooled positive correlation coefficients between spiritual intelligence and a professional nursing practice components including the art of nursing, competence, attributes of practice and, personal commitment were 0.34 (95% CI: 0.24, 0.43, I2 = 63.4%, 5 studies), 0.42 (95% CI: 0.25,0.56, I 2 = 62.2%, 2 studies), 0.32 (95% CI: 0.11, 0.50, I 2 = 92.2%, 5 studies) and 0.41 (95% CI: 0.34, 0.49, I 2 = 74.3%, 8 studies) respectively. Conclusions: The findings of this systematic review indicated a relatively high level of spiritual intelligence among nurses that was moderately associated with professional nursing practice. implementing strategies to promote spiritual intelligence levels among nurses is warranted.

Objective:The objective of this review was to synthesize the perceptions and practices of community members relating to trachoma in Africa.Introduction:Trachoma is the leading cause of blindness worldwide, and Africa is the worst-affected continent. Synthesized evidence relating to the disease has focused on various aspects including epidemiology, control, health education, facial cleanliness, interventions for trachomatous trichiasis, and the burden of trachoma on women. Currently, systematic reviews on perceptions and practices relating to trachoma are lacking despite the existence of primary studies. Filling this knowledge gap is critical for decision-making for effective community uptake of interventions.Inclusion criteria:Qualitative studies on the perceptions and practices relating to trachoma in both health care and community settings in Africa were considered for inclusion. Studies with participants 14 years or older were considered, regardless of gender, health status, religion, or ethnicity. Perceptions included beliefs, perspectives, views, knowledge, and thoughts relating to trachoma. Practices included regular actions relating to trachoma, such as treatment and prevention behaviors.Methods:A search for studies in English was conducted in MEDLINE, CINAHL, Embase, PsycINFO, Sociological Abstracts, BioMed Central, Current Contents, Cochrane Library, and Google Scholar in May 2019 and updated in October 2021. Unpublished studies were searched in MedNar, Index to Thesis, ProQuest Dissertations and Theses Global, World Health Organization, and individual governments' commissioned trachoma reports. Two independent reviewers were involved in study selection, critical appraisal, and data extraction using the JBI tools. Data were synthesized using the JBI meta-aggregative approach.Results:Seven studies were included in this review. Participants were people either with or without trachoma. A total of 90 findings were extracted, from which 10 categories were produced and three synthesized findings derived from the categories. The synthesized findings are: understanding and awareness of trachoma influences perceptions of treatment and preventive methods; beliefs and behaviors influence treatment options; economic constraints, socio-cultural beliefs, and risk perceptions influence prevention behaviors and practices.Conclusion:Various perceptions and practices relating to trachoma exist among community members in Africa. These perceptions and practices are influenced by knowledge, cultural beliefs, economic factors, and environmental factors. The findings suggest the need for decision-makers in policy and practice to consider and include these perceptions and practices when designing interventions to combat trachoma in endemic countries. However, due to the limited number of included studies and their methodological weaknesses, more high-quality studies are needed to have a deeper and broader view on these perceptions and practices.

Aim: To explore final year nursing students' perceptions of the general practice environment and their priorities when choosing a workplace. Design: Online survey, reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Methods: The validated Profession Scale from the Scale on Community Care Perceptions (SCOPE) tool was used to identify characteristics within the general practice environment and the importance of these in choosing a workplace. To explore the factor structure, exploratory factor analysis was undertaken which was used to revise the survey language and flow before widespread dissemination. Results: Three hundred and fifty-five responses were received. Factor analysis revealed three factors: Provision of care, Employment conditions and Nature of work. Respondents exposed to general practice in the Bachelor of Nursing program or who had a general practice clinical placement had significantly different perceptions across all factors. Although wages, advancement opportunities, work pressures and the physical nature of work were perceived as important in choosing a workplace, they were seen as only moderately present in general practice.

Background In Jordan, cancer is the second leading cause of death after cardiac disease. The impact of cancer on sexual relationships is a taboo subject and hence, such issues are underreported research among Jordanian people examining unmet needs. Aim To examine the experiences and preferences of Jordanian cancer survivors related to communication regarding their sexual needs. Methods Qualitative study conducted between May and June 2020 using semi-structured face-toface interviews using the snow-balling approach for recruitment. Participants were recruited until data saturation was obtained and data were analyzed using qualitative thematic analysis. Results Analysis of participants' interview data identified three main categories: 1) The psychological impact of cancer of sexual relationships; 2) Physician support; 3) Variations in sexual life and sexual experiences. Conclusion The study revealed that there is a substantial psychological impact of cancer on sexual relationships among Arab Jordanian cancer survivors. Feeling powerless, being labelled as 'sexually disabled', and lack of communication with physicians were emphasized by participants as a barrier to discuss sexual needs with their physicians. Lack of physicians support negatively impact Jordanian cancer survivors sexual experience and led to increased their sense of powerlessness and loss of control over sexual relationships. Implications for practice Overall, the study indicated a crucial need for physicians to encourage patients to disclose their sexual experience to help them maintain their sexual and mental health while in the fight against cancer. The physicians, nurses and allied health professionals should be engaged in the conversation with patients by taking an active role in the discussion. Additionally, the family and partners of the patients should also be approached and engaged by health professionals in the discussion to address their needs or sexual issues.

Abstract Background: There has been a rise in¿multimorbidity as people age and technology advances which is challenging for health systems. Multimorbidity prevalence varies globally due to various biological and social risk factors which can be accentuated or mitigated for populations in migration. This study investigated the prevalence and predictors of multimorbidity amongst a group of migrant Asian Indian women living in Australia. Methods: A cross-sectional descriptive study design using convenience sampling investigated the¿multimorbidity¿risk factors among first generation migrant Asian Indian women in Australia.¿¿This study was part of a larger study titled ¿Measuring Acculturation and Psychological Health of Senior Indian Women Living in Australia¿ that was conducted in Sydney, Australia. Data were collected using validated instruments as well as investigator developed questions. Women completed questionnaire surveys either by themselves or through the assistance of bilingual coordinators as English was not their first language. Results: 26% of the participants had one chronic condition and¿74% had multimorbidities. The¿prevalence of individual conditions¿included cardiovascular disease 67.0%, osteoarthritis 57.6%, depression 37.4%,¿diabetes¿31.5%,¿chronic respiratory conditions¿10.8%, cancer¿4.9%¿and nephrological problems 1.47%.¿In the¿unadjusted¿model,¿factors such as¿increasing age, education level, employment status,¿living¿arrangements,¿low¿physical activity,¿and elements of acculturative stress were significantly associated with multimorbidity. Multi-variable analysis identified the acculturative stress factor of threat to ethnic identity as a predictor of multimorbidity. Conclusion: ¿Identifying the key determinants of multimorbidity in older adults from a migrant community with pre-existing risk factors can assist with the development of culturally appropriate strategies to identify people at risk of health conditions and to mitigate the health effects of acculturative stress.

Background Reporting, investigating, and full disclosure of medication errors (MEs) is a fundamental component of patient safety. Therefore, determining nursing students' intention to report MEs is important. Purpose This study examined the factors related to nursing students' intention to report MEs and the use of the Turkish version of the Theory of Planned Behavior Medication Safety Questionnaire (TPB-MSQ-T). Methods A descriptive cross-sectional design was used with a sample of 227 undergraduate nursing students in Istanbul, Turkey. Students' intentions to report MEs were measured using an online TPB-MSQ-T. Quantitative analysis was conducted. Results Attitudes and perceived behavioral control (PBC) were significant predictors of intention to report MEs (P =.05 and P =.01, respectively), but subjective norms did not predict it (P =.11). The Cronbach's a of the questionnaire was 0.88. Conclusions Attitude and PBC are important determinants of nursing students' intention to report MEs. The TPB-MSQ-T can be used for identifying the main determinants of intention to report MEs.

Background: Attrition in pre-registration nursing degrees is a global issue. Students' perceptions of belonging is a factor that influences attrition. Objective: The objective of this study was to evaluate students' perception of belonging to a School of Nursing, as well as their intention to complete the pre-registration Bachelor of Nursing (BN) program following implementation of the Initiatives for Retention (IR) intervention. Design: A prospective cross-sectional survey of student nurses was undertaken using an online questionnaire. Setting: A large regional university in Australia. Participants: Pre-registration nursing students. Methods: Perceptions of Belonging were evaluated using the 24-item Belonging questionnaire comprising three subscales. Data were analysed using SPSS version 25. Pearson's correlation, Student's t-tests and one way ANOVA were used to assess associations and differences in belonging scores and student demographics, study status and participation in the Initiatives for Retention (IR) intervention. Results: A total of 201 students responded to the voluntary questionnaire. The mean score for overall Belonging was 70.5 (maximum obtainable 96), mean Scores for University affiliation, University support and acceptance, and staff relations with students were 34.7, 24.1 and 11.8 respectively. Female students, those who were studying at the university for less than a year and those who participated in the IR intervention activities reported significantly higher University Belonging scores compared to their contemporaries. Logistic regression revealed that students studying the BN course for more than 3 years (OR: 0.43 95% CI 0.20¿0.93, p = 0.031), and those employed (OR: 0.435, 95% CI 0.16¿0.16, p = 0.022) were significant predictors of not attending the IR sessions. There were no significant differences in overall University Belonging scores based on other demographic characteristics and, study status. The majority of the students (84%) stated that they plan to continue and complete the BN program. Conclusions: Measures designed to develop student involvement may positively contribute a successful relationship between the institution and the student, increasing the students' sense of belonging and decreasing attrition among student nurses. Practice implications: Initiatives for Retention (IR) facilitate a greater sense of belonging in nursing students hence Schools of Nursing should consider embedding such strategies.

Objective: To synthesize the best available qualitative evidence on the perceptions of Aboriginal and Torres Strait Islander Australians (hereafter, respectfully referred to as Indigenous Australians) toward participation in cardiovascular primary prevention programs. Background: In 2017, cardiovascular disease was the leading cause of premature mortality in Indigenous Australians, accounting for 11.5% of all deaths. Health risk behaviors such as smoking, physical inactivity, poor nutrition, and obesity largely contribute to this burden of disease. Methods: A search using MEDLINE, CINAHL, EMBASE, PubMed, Google Scholar, MedNar, ProQuest and Index to Theses for published and unpublished studies was conducted in January 2020. The methodological quality of the included studies was independently assessed by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tool. Data extraction and meta-aggregation were conducted in accordance with JBI methodology. Results: Eleven studies were included. Three synthesized findings were developed (a) social and community support affect participants¿ experiences of prevention programs; (b) structural drivers and social determinants influence Indigenous Australians experiences and participation in prevention programs and health risk behavioral change; and (c) a personal desire to change behaviors and participate in prevention programs requires development of knowledge regarding healthy lifestyles and creation of new social norms. Conclusions: Indigenous Australians participation in primary prevention for cardiovascular risk factors and adoption of a healthy lifestyle are influenced by social support, social determinants, and personal desire. Future programs need to tackle the structural drivers and facilitate a supportive environment to assist in health risk behavior change.

Objective: To synthesize the best available evidence on the relationship between the social determinants of health and health outcomes among adults during the COVID-19 pandemic. Introduction: COVID-19 has created widespread global transmission. Rapid increase in individuals infected with COVID-19 prompted significant public health responses from governments globally. However, the social and economic impact on communities may leave some individuals more susceptible to the detrimental effects. Methods: A three-step search strategy was used to find published and unpublished papers. Databases searched included:¿MEDLINE, CINAHL, EMBASE, and Google Scholar. All identified citations were uploaded into¿Endnote X9, with duplicates removed. Methodological quality of eligible papers was assessed by two reviewers, with meta-synthesis conducted in accordance with JBI methodology. Results: Fifteen papers were included. Three synthesized-conclusions were established (a) Vulnerable populations groups, particularly those from a racial minority and those with low incomes, are more susceptible and have been disproportionately affected by COVID-19 including mortality; (b) Gender inequalities and family violence have been exacerbated by COVID-19, leading to diminished wellbeing among women; and (c) COVID-19 is exacerbating existing social determinants of health through loss of employment/income, disparities in social class leading to lack of access to health care, housing instability, homelessness, and difficulties in physical distancing. Conclusion: Reflection on social and health policies implemented are necessary to ensure that the COVID-19 pandemic does not exacerbate health inequalities into the future.

Background Transradial cardiac catheterization is increasingly being used for the management of coronary artery disease given the low risk of procedural discomfort and complications with this approach. However, the evidence relating to preprocedural anxiety levels in these patients is scarce. Objective The aim of this study was to evaluate the anxiety levels and the predictors of anxiety in patients undergoing transradial cardiac catheterization procedures. Methods Data were collected using a self-administered survey. Anxiety was measured using the Spielberg's State-Trait Anxiety Inventory questionnaire. Multiple regression analysis was used to identify whether gender, age, family history of heart disease, smoking status, history of depression, and trait anxiety scores were predictors of preprocedural anxiety. Results A total of 198 patients participated in this study. More than half of the patients (53.5%) were classified as having a high state anxiety level. The mean (SD) preprocedural trait and state anxiety scores were 35.34 (9.8) and 36.43 (11.4), respectively. Female patients, those younger than 65 years, current smokers, and those with a family history of heart disease, a history of depression, and a history of anxiety had significantly higher anxiety scores. Having high trait anxiety scores was the only predictor of preprocedural anxiety. Conclusion Although the transradial approach has a low procedural risk and causes less discomfort to the patient, anxiety persists in more than 50% of patients, with trait anxiety being the best predictor. Nurses should therefore try to decrease anxiety levels in the preprocedural phase to minimize postprocedural adverse outcomes in this group of patients.

Purpose: Mastectomy in women is perceived as losing feminine identity and reducing sexual attraction. The aim of this review is to explore the perception and impacts of mastectomy on Iranian women with breast cancer on their sexuality and body image. Methods: The review used a systematic literature search that followed the guidelines of the Joanna Briggs Institute (JBI). The data sources PubMed, Scopus, Web of Science, Google Scholar, SID, ProQuest, MEDLINE, and CINAHL (via the EBSCOhost) were systematically searched. Quality appraisal, data extraction, and findings from the included studies were pooled using meta-aggregation with the Qualitative Assessment and Review Instrument (JBI-QARI). Results: Eight studies involving 163 women aged from 31 to 65 years, who had mastectomy, were included. A total of 31 findings were extracted and were aggregated into 4 categories and then further grouped into two synthesized findings: (1) fear of losing spouse¿s sexual monopoly and (2) overcoming the challenges of losing femininity. Conclusions: This review found even in Muslim countries such as Iran women¿s breasts are perceived as sexually attractive, and changes in body shape can lead to subsequent challenges in marital relationships.

Objective: Sex and intimacy are basic needs and important aspects of quality of life among humans. This focus of this review was to synthesise and present the best available qualitative evidence on the sexual life experiences and needs of Chinese adults living with cancer. Moreover, the first-hand experience, meaning and perspective about the sexual life changes and support needs during the survival and extended treatment period were synthesised in this study. Methods: A systematic review of qualitative studies was undertaken using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI). A comprehensive search of five databases: CINAHL, MEDLINE, PubMed, Scopus and Google Scholar were undertaken from 2010 until February 2020 using defined criteria. Methodological quality and data extraction were undertaken using JBI-SUMARI. Results: Eight studies were included in the review. A total of 39 findings were extracted and aggregated into eight categories based on similarity of meaning. Three synthesised themes were generated: (i) misconceptions and lack of education or information regarding sexual activity exists for patients with cancer, (ii) concerns for overall health and well-being as well as physical and psychological changes can alter sexual desire and behaviours in patients with cancer and (iii) lack of sexual activity and intimacy can create relationship problems. Conclusions: Sexual relationships are intimate, personal and private in Chinese culture and beliefs. Chinese adults living with cancer report many neglected issues on sexual well-being in various domains. Adequate and consistent education about sexual intimacy issues from health care providers was identified as an important need. Unaddressed needs might affect adults' coping strategies in managing their sexual relations during various stages of cancer treatment and beyond. It must be noted that there are many Chinese ethnic minorities living with cancer outside the Greater China region. The evidence provides valuable recommendations to health care providers globally to consider the specific sexual needs and initiate culturally sensitive sexuality education and care support for Chinese adults living with cancer.

Aims and Objectives: To compare knowledge, anxiety, academic concerns and preventative behaviours between undergraduate nursing students in Australia and India during the COVID-19 pandemic. Background: Based on the World Health Organization's direction for containment of the novel coronavirus (COVID-19), countries implemented varying levels of restrictions including closure of university campuses and providing on line undergraduate education. Methods: Students in NSW, Australia and Kerala, India completed an online survey assessing their (a) knowledge and source of information about COVID-19; (b) anxiety; and coping strategies; (c) academic concerns; and (d) preventative behaviours. Descriptive and inferential statistics were used to summarise the data. Results: Data from 99 Australian and 113 Indian undergraduate nurses were analysed. Greater number of Indian students indicated having sufficient knowledge of COVID-19 (OR 0.22; 95% CI 0.08, 0.63), getting information about COVID-19 from social media (OR 0.03; 95% CI 0.01, 0.07) and being concerned about ¿attending clinical placement¿ (MD-1.08; 95% CI -1.94, -0.23). Australian students reported significantly higher levels of anxiety (MD 1.99 95% CI 1.21, 2.78), difficulty sleeping (OR 18.00; 95% CI 6.76, 47.96), concentrating (OR 33.22; 95% CI 13.85, 79.67) and eating (OR 14.05; 95% CI 3.19, 61.84). Greater number of Australian students indicated that they would go to the University if they needed to meet with other students (OR 9.21; 95% CI 3.08, 27.55), had to access the library (OR 7.20; 95% CI 3.26, 15.90) or had a group assignment (OR 2.93; 95% CI 1.26, 6.77). Conclusions: Wide variations were present in knowledge, anxiety, academic concerns and preventative behaviours among undergraduate nursing students in two countries. Relevance to clinical practice: Undergraduate students may benefit from additional support from the University and staff in the clinical setting with online learning and resources in order to adjust to the ¿new normal¿ and enable them to achieve academic success.

Background: The COVID-19 pandemic posed and continues to pose challenges for health care systems globally, particularly to Intensive Care Units (ICU). At the forefront of the ICU are highly trained nurses with a professional obligation to care for patients with COVID-19 despite the potential to become infected. The aim of this study was to explore ICU nurses¿ willingness to care during the COVID-19 pandemic. Methods: A prospective cross-sectional study to explore ICU nurses¿ willingness to provide care during the COVID-19 pandemic was undertaken between 25 March and 3 April 2020 at a large principal and referral teaching hospital in Sydney, NSW Australia. Results: A total of 83 ICU nurses completed the survey. Approximately 60% reported receiving sufficient information from managers regarding COVID-19 and about caring for a patient with COVID-19. Ninety percent of nurses were concerned about spreading COVID-19 to their family. Sixty one percent of the nurses indicated that they were willing to care for patients with COVID-19. Receiving timely communication from managers was the only predictor of willingness to care among ICU nurses. Conclusions: Effective communication is a vital component during a public health emergency in order to promote nurses¿ willingness to care for patients in the ICU.

Background: Decentralised nursing stations (DCNs) have gained popularity in new hospital designs owing to their positive impact on patient safety. However, the impact on the nurses' working environment and on continuity and quality of patient care is limited. Objectives: The objective of this study was to describe nurses' perceptions and experiences of the working environment and of patient care in a decentralised intensive care unit (ICU). Methods: Twelve months after the establishment of the new decentralised ICU in a tertiary teaching hospital in Sydney, Australia, a prospective cross-sectional survey of registered nurses working in the unit was undertaken. Nurses' perceptions and experiences of the working environment and patient care were evaluated using a 56-item questionnaire comprising nine domains and optional open-ended comments. Quantitative data were analysed using SPSS, version 25. Qualitative data were used to enhance the quantitative data. Results: A total of 128 nurses responded to the questionnaire. The mean scores for overall job satisfaction, nursing teamwork, social cohesion, continuity of patient care, and quality of patient care were 3.02 (±0.91), 2.78 (±1.05), 2.68 (1.02), 2.60 (±1.01), and 3.48 (±0.88), respectively, for a maximum obtainable score of 5. Overall mean scores for teamwork, social cohesion, and continuity of patient care were explained by nurses to be a direct result of the physical layout of the new DCN ICU. Nurses believed this influenced their ability to interact with other staff and impacted teamwork and social cohesion and in turn reflected in their current job satisfaction. Conclusions: Implementation of a new model of nursing care, whereby staff members are rostered together in a pod for a period of time, along with team-building exercises, is recommended to improve the social cohesion and teamwork within the DCN ICU. Further research on nurses' experiences within a DCN ICU is required to produce robust evidence and generalisability.

Background: Many nursing programmes have had to swiftly move online in response to COVID-19. Nursing students are often a heterogenous group that traverses generational boundaries. Exploring generational differences may assist in developing support systems for specific groups. This study sought to examine psychological wellbeing and preventative behaviours among nursing students from the iGeneration in comparison to older generations. Method: A prospective cross-sectional study was undertaken using a convenience sample of pre-registration nursing students studying at two Australian Universities, one regional and one metropolitan. About 631 pre-registration nursing students completed an online survey. Results: An independent samples t-test revealed that students from the iGeneration possess higher anxiety compared to nursing students from older generations (p =.000). Compared to iGeneration participants, older generation participants had significantly higher scores for knowledge of COVID-19 (p =.015). iGeneration participants utilised social media to source information about COVID-19 far more than older generations (p =.008). iGeneration participants were significantly more concerned than older generations about the impact of COVID-19 on completing their clinical placement (p =.014). Older generations tended to have higher academic preventative behaviours, with significant mean scores for not attending university if they or others they knew had symptoms of COVID-19. Conclusion: Given the differences between generation groups with regard to psychological wellbeing, knowledge about COVID-19, and concerns about studying in an altered study environment, strategies should be targeted to generational groups. Anxiety negatively impacts the quality of life, educational performance and clinical practice and is experienced more frequently in the iGeneration. Therefore it is crucial for nursing educators to reflect on how they engage this generation in the online space to provide support, stability and a sense of connection. This will contribute towards ensuring a well-prepared future nursing workforce who may encounter other pandemics and isolating events. Impact statement: Compared with other generations, iGeneration students have a greater likelihood to experience mental health issues, isolation and insecurity. Nursing leaders and educators must be sensitive to such intergenerational differences, to ensure they are developing a skilled and productive workforce.

Background: COVID-19 has caused significant disruption. This has been particularly evident within the university student population where their traditional ways of learning were abruptly reorganised and support structures removed. Objective: This paper aims to explore undergraduate student nurses¿ perceptions of the support required from the university during COVID-19 using the Achievement Goal Theory framework. Design: Data were collected via an online survey of undergraduate student nurses from an Australian university. This paper is reporting the data from a single open-ended item asking participants about their support needs from the University. Data were analysed using thematic analysis. Results: Of the 178 students who responded 206 individual statements were provided about the support they would like from the university. Four primary themes emerged, Support beyond academia, Academic support, Online learning readiness and Clinical practice units and clinical placement. The students identified that their needs during this pandemic include financial needs, social isolation, needs for more communication and unpreparedness for online teaching. Conclusion: Several factors were identified by participants about the additional support required from the university during COVID-19. Understanding and addressing these factors have the potential to improve student support during COVID-19 and support students in future crises. Impact statement: Understanding what support students perceive they require from the university during significant disruption will assist in future crisis management planning.

Social support can play a crucial role in psycho-social well-being of people with chronic conditions. There is limited information about the experiences, barriers and sources of social support of Arab people affected by chronic conditions. The purpose of this review is to explore the experiences, barriers and sources of social support of Arab people affected by chronic conditions. A scoping review of the literature, based on Preferred Reporting Items for Scoping Reviews and Meta-Analyses (PRISMA) guidelines. Articles (n = 13) were identified for appraisal based on a group of inclusion and exclusion criteria. Eight articles were included in the final analysis. Three broad themes were identified: (a) Social support benefits¿physical, emotional and financial benefits; (b) Source of social support¿family and friends support, and (c) Support services utilization¿cultural barrier, Arab migrants language and unfamiliarity with the health system barriers. Appropriate future support programs should be tailored based on Arab cultural beliefs and the inherent responsibility of the family together inside the Arab community.

Background: The emergence of COVID-19 has substantially impacted frontline health care workers, including nurse managers. To date, no studies have been conducted to examine the impact COVID-19 has had on Nurse Managers¿ mental health, coping strategies and organisational commitment. Aim: To investigate the mental health, coping behaviours, and organisational commitment among Nurse Managers during the COVID-19 pandemic. Methods: Cross-sectional study involving 59 Nursing Managers from one Local Health District in Sydney Australia during the first wave of the COVID-19 pandemic. Data were collected relating to demographics, anxiety, coping strategies and organisational commitment. Results: Overall, approximately three quarters of the Nurse Managers had high anxiety scores. Managers who had worked longer as a nurse had higher scores for adaptive coping strategies and 41% of Nurse Managers considered leaving their jobs. Conclusions: Strategies to minimise anxiety and enable coping as part of organisational disaster, emergency or crisis planning for Nurse Managers may result in decreased anxiety and stress levels, increased use of adaptive coping strategies and lower intent to leave the organisation and the nursing profession.

Introduction: Mobile Applications (apps) are commonly used in the health care settings to improve the quality of care, however prior to the release of the app it is vital to evaluate its usability. Therefore, the aim of this study is to adapt the mobile Health App Usability Questionnaire (MAUQ) and measure the usability of the Eye donor Aust App using the modified instrument (m-MAUQ). Methods: The study was undertaken using a convenience sample of 94 patients and their carers attending three eye clinics and one outpatient department in a large hospital in Sydney Australia. The study was conducted in two phases. Phase 1 involved the adaptation of the MAUQ, and validity testing of the modified version. Phase 2 included the usability evaluation of the Eye donor Aust App using the modified MAUQ (m-MAUQ). Results: The m-MAUQ comprised of 15 items and the content validity of the instrument was considered satisfactory. Exploratory factor analysis supported a three-factor structure namely: ease of use and satisfaction (nine items), usefulness in obtaining information (three items), and system information arrangement (three items). The internal consistency for the subscales and the total scale was high with Cronbach's alpha values greater than 0.90. The usability score for the Eye donor Aust App was high (mean 5.99; SD 0.74). The construct validity was supported as there were no differences in usability scores among males and females. Older people found the app less useful for obtaining information about eye donation. Conclusions: The results support the use of the m-MAUQ as a valid instrument to measure the usability of the Eye Donor Aust App. This instrument requires further testing in other groups of people. Usability testing of the Eye Donor Aust app demonstrated that the participants were satisfied with the content and functionality of the app stating that it was well organised, visually appealing and user friendly. This result could translate into more people using the app and thereby increasing their knowledge and attitude towards eye donation as well as registering to become a donor.

Breast cancer conservative treatment software (BCCT.core) has the potential to provide objective results using digital photographs, thus increasing the reliability, limiting the subjective interpretation and standardising the evaluation of breast cosmesis in patients. The aim of this systematic review was to summarise the empirical evidence regarding the agreement between the BCCT.core and other methods used by health professionals and patients to assess breast cosmesis. The Ovid MEDLINE, Embase, CINAHL, PsycINFO and Scopus databases were systematically searched for studies comparing the agreement between BCCT.core and other methods used to assess breast cosmesis. A total of 14 studies involving 2703 patients were included in the review. In studies where patients undertook self-assessment, the percentage agreement ranged from 69.2% to 74.8% and the kappa values ranged from slight (k¿=¿0.12) to fair agreement. There was a low correlation between the BCCT.core and the Harvard scale when patients assessed cosmetic outcomes using photographs of their breasts (r¿=¿0.165). A 75% and 42.8% agreement was reported in studies where clinicians assessed breast cosmesis by directly visualising the patients¿ breasts and photographs, respectively. Assessment of breast cosmesis by the expert panel using patient photographs reported a percentage agreement ranging from 25% to 83%. The results of this systematic review demonstrated an overall agreement of fair to moderate between the BCCT.core and the subjective scales used to assess breast cosmesis. However, clinician experience and patient values should be considered in clinical decision-making.

Objective: The objective of this systematic review was to synthesize the best available evidence on the effect of various radiation protection strategies on radiation dose received by proceduralists performing cardiac catheterization procedures involving fluoroscopy. Introduction: Cardiac catheterization procedures under fluoroscopy are the gold standard diagnostic and treatment method for patients with coronary artery disease. The growing demand of procedures means that proceduralists are being exposed to increasing amounts of radiation, resulting in an increased risk of deterministic and stochastic effects. Standard protective strategies and equipment such as lead garments reduce radiation exposure; however, the evidence surrounding additional equipment is contradictory. Inclusion criteria: Randomized controlled trials that compared the use of an additional radiation protection strategy with conventional radiation protection methods were considered for inclusion. The primary outcome of interest was the radiation dose received by the proceduralist during cardiac catheterization procedures. Methods: A three-step search was conducted in MEDLINE, CINAHL, Embase, and the Cochrane Library (CENTRAL). Trials published in the English language with adult participants were included. Trials published from database inception until July 2019 were eligible for inclusion. The methodological quality of the included studies was assessed using the JBI critical appraisal checklist for randomized controlled trials. Quantitative data were extracted from the included papers using the JBI data extraction tool. Results that could not be pooled in meta-analysis were reported in a narrative form. Results: Fifteen randomized controlled trials were included in the review. Six radiation protection strategies were assessed: Leaded and unleaded pelvic or arm drapes, transradial protection board, remotely controlled mechanical contrast injector, extension tubing for contrast injection, real-time radiation monitor, and a reduction in frame rate to 7.5 frames per second. Pooled data from two trials demonstrated a statistically significant decrease in the mean radiation dose (P<0.00001) received by proceduralists performing transfemoral cardiac catheterization on patients who received a leaded pelvic drape compared to standard protection. One trial that compared the use of unleaded pelvic drapes placed on patients compared to standard protection reported a statistically significant decrease (P=0.004) in the mean radiation dose received by proceduralists. Compared to standard protection, two trials that used unleaded arm drapes for patients, one trial that used a remotely controlled mechanical contrast injector, and one trial that used a transradial protection board demonstrated a statistically significant reduction in the radiation dose received by proceduralists. Similarly, using a frame rate of 7.5 versus 15 frames per second and monitoring radiation dose in real-time radiation significantly lowered the radiation dose received by the proceduralist. One trial demonstrated no statistically significant difference in proceduralist radiation dose among those who used the extension tubing compared to standard protection (P=1). Conclusions: This reviewprovides evidence to support the use of leaded pelvic drapes for patients as an additional radiation protection strategy for proceduralists performing transradial or transfemoral cardiac catheterization. Further studies on the effectiveness of using a lower fluoroscopy framerate, real-timeradiationmonitor, and transradial protection board are needed.

Objective:The objective of this systematic review was to synthesize the best available evidence relating to the measurement properties of the multidimensional pain assessment tools used to assess postoperative pain in adults.Introduction:Pain is a common and poorly managed occurrence in patients during the postoperative period. Currently, postoperative pain is usually evaluated with assessment tools that measure one dimension of pain, namely pain intensity, resulting in inadequate management of postoperative pain. It is important to understand the complex nature of pain by considering all dimensions for optimal postoperative pain management. Systematic, robust evidence is lacking regarding the most psychometrically reliable and valid multidimensional pain assessment tool for adult postoperative patients.Inclusion criteria:This systematic review considered all study types for inclusion. Studies were considered if they assessed the measurement properties of a multidimensional pain assessment tool in adult postoperative patients within two weeks post-surgery. The outcomes included measurement of at least one of the psychometric properties, including reliability, validity, and responsiveness.Methods:A three-step search strategy was undertaken, including a search of the MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases performed in October 2019. We also searched Dissertation Abstracts International, ProQuest Dissertations and Theses, MedNar, and ClinicalTrials.gov to identify unpublished studies. The title and abstracts of the studies were reviewed by two independent reviewers against the inclusion/exclusion criteria. The methodological quality of the potential studies was assessed independently by three reviewers using the COSMIN checklist.Results:Seventeen studies involving five multidimensional postoperative pain assessment tools were included in the review: American Pain Society Pain Outcomes Questionnaire-Revised; Brief Pain Inventory; Houston Pain Outcome Instrument; McGill Pain Questionnaire; and the Quality Improvement in Postoperative Pain Management Postoperative Pain Questionnaire. The two most commonly used tools were the Brief Pain Inventory and the American Pain Society Pain Outcomes Questionnaire-Revised, which were assessed in six studies each. The included studies mainly reported internal consistency reliability, with four of the five identified tools demonstrating high Cronbach's alpha values ranging from 0.72 to 0.92. However, the Houston Pain Outcome Instrument demonstrated mixed findings, with eight of the nine subscales having moderate to high reliability while the expectations about pain subscale had poor reliability (a=0.003).Conclusions:This review provides much needed information about the current tools used in many clinical, educational, and research settings. Of the five tools included in this review, the Brief Pain Inventory demonstrated strong evidence of psychometric validity and is recommended for use in assessing postoperative pain. Further psychometric validation of multidimensional postoperative pain assessment tools with emphasis on responsiveness and measurement error is required in order to accurately assess the minimal clinically important difference in postoperative pain outcomes.

Objective:The objective of this review was to synthesize the best available research evidence regarding the effectiveness of tree nuts on glycemic outcomes in adults with type 2 diabetes mellitus.Introduction:There has been an increase in the use of complementary therapy, particularly botanical products, for management of type 2 diabetes mellitus. It has been reported that increasing mono- and polyunsaturated fatty acids in diet effectively lowers the risk of development of type 2 diabetes mellitus. Hence, it was hypothesized that consumption of nuts, which are high in polyunsaturated fatty acids and mono-unsaturated fatty acids, may aid in preventing diabetes and reducing levels of blood glucose by reducing glycemic load by displacing dietary carbohydrates present in diet.Inclusion criteria:This systematic review included randomized controlled trials that compared the consumption of any type and form of tree nut with a placebo or any other intervention in adults with type 2 diabetes mellitus. Trials were included if they measured fasting blood glucose, postprandial blood glucose, and/or glycated hemoglobin. Trials that assessed triglyceride levels and weight postintervention were also considered for inclusion. Trials were restricted to the English language.Methods:A three step search of PubMed, CINAHL, Embase, Trip database, and Cochrane Central Register of Controlled Trials (CENTRAL) was done in July 2019. To find unpublished studies, ClinicalTrials.gov and Google Scholar were searched. Studies from the search were reviewed against the inclusion criteria by two reviewers. The JBI critical appraisal checklist for randomized controlled trials was used to assess the potential studies for methodological quality. A meta-analysis and subgroup analysis was conducted among trials with the same type of intervention and outcome measures. Results are presented in a narrative format where statistical pooling was not possible.Results:Fifteen trials were included with a total sample size of 667. Consumption of pistachios demonstrated a significant reduction in triglyceride levels (mmol/L) at three month or earlier follow-up (mean difference [MD] -0.28; confidence interval -0.33, -0.23; P¿<0.00001). The meta-analysis including all tree nuts combined showed reduction in both fasting blood glucose and glycated hemoglobin (MD -0.26¿mmol/L and -0.11% respectively) at three month or earlier follow-up. The subgroup analysis demonstrated MD of -0.45, -0.16, and -0.90¿mmol/L in fasting blood glucose following ingestion of walnuts, almonds, and hazelnuts, respectively, and -0.17% in glycated hemoglobin following ingestion of walnuts at three month or earlier follow-up. Although not clinically significant, these figures give an indication that further research with larger sample sizes and longer follow-up may show encouraging results.Conclusions:The authors found that pistachio consumption for three months or less significantly reduced triglyceride levels. Other tree nuts (walnuts, almonds, and hazelnuts) reduced fasting blood glucose and glycated hemoglobin levels by varying degrees. Further robust randomized controlled trials with power calculation-based sample size, comparing same type, dose, and method of nut intervention, will provide more evidence. For now, clinical decisions should be based on standard practice local guidelines.Systematic review registration number:PROSPERO CRD42019133558.

Objectives To summarise the evidence relating to the prevalence of anxiety and depression among healthcare workers (HCWs) during the COVID-19 pandemic. Design An umbrella review of systematic reviews was undertaken using the Joanna Briggs Institute (JBI) methods. Data sources The Cochrane database of systematic reviews, JBI Evidence Synthesis, MEDLINE, Web of Science, PsycINFO, Embase and CINAHL were searched in March 2021 for reviews published in English. Eligibility criteria Systematic reviews reporting the prevalence of anxiety and depression among HCWs during the COVID-19 pandemic. Two researchers screened each abstract and independently reviewed full text articles. Study quality was assessed using the JBI critical appraisal tool for systematic reviews, and the degree of overlap in primary studies was calculated. Results Ten systematic reviews (100 unique studies), including 169 157 HCWs from 35 countries were included. The prevalence of anxiety among all HCWs ranged from 22.2% (95% CI 21.3% to 23.1%) to 33.0% (95% CI 31.9% to 34.1%). The prevalence of anxiety among physicians (n=5820) was reported to be between 17% and 19.8% and for nurses (n=14 938) between 22.8% and 27%. The prevalence of depression among all HCWs ranged from 17.9% (95% CI 17.1% to 18.8%) to 36% (95% CI 34.9% to 37.1%). The prevalence of depression among physicians (n=643) and nurses (n=8063) was reported to be 40.4% and 28%, respectively. Conclusions There is wide variation evident in the presence of anxiety and depression among HCWs. In particular, the prevalence of depression among physicians was high. Strategies to reduce the incidence of anxiety and depression are urgently required. PROSPERO registration number CRD42021238960.

Background: There are a growing number of publications that report an absence of inflammatory based disease among populations that are endemic to parasitic worms (helminths) demonstrating the ability of these parasites to potentially regulate human immune responses. The aim of this systematic review and meta-analysis was to determine the impact of helminth infection on metabolic outcomes in human populations. Methods: Using PRISMA guidelines, six databases were searched for studies published up to August 2020. Random effects meta-analysis was performed to estimate pooled proportions with 95% confidence intervals using the Review Manager Software version 5.4.1. Results: Fourteen studies were included in the review. Fasting blood glucose was significantly lower in persons with infection (MD -0.22, 95% CI -0.40- -0.04, P=0.02), HbA1c levels were lower, although not significantly, and prevalence of the metabolic syndrome (P=0.001) and type 2 diabetes was lower (OR 1.03, 95% CI 0.34-3.09, P<0.0001). Infection was negatively associated with type 2 diabetes when comparing person with diabetes to the group without diabetes (OR 0.44, 95% CI 0.29-0.67, P=0.0001). Conclusions: While infection with helminths was generally associated with improved metabolic function, there were notable differences in efficacy between parasite species. Based on the data assessed, live infection with S. mansoni resulted in the most significant positive changes to metabolic outcomes. Systematic Review Registration: Website: PROSPERO Identified: CRD42021227619.

Background: With improved accessibility to social media globally, health researchers are capitalizing on social media platforms to recruit participants for research studies. This has particularly been the case during the COVID-19 pandemic, when researchers were not able to use traditional methods of recruitment. Nevertheless, there is limited evidence on the feasibility of social media for recruiting a national sample. Objective: This paper describes the use of social media as a tool for recruiting a national sample of adults to a web-based survey during the COVID-19 pandemic. Methods: Between August and October 2020, participants were recruited through Facebook via two advertisement campaigns (paid option and no-cost option) into a web-based survey exploring the relationship between social determinants of health and well-being of adults during the COVID-19 pandemic. Data were analyzed using SPSS software and Facebook metrics that were autogenerated by Facebook Ads Manager. Poststratification weights were calculated to match the Australian population on the basis of gender, age, and state or territory based on the 2016 Australian census data. Results: In total, 9594 people were reached nationally with the paid option and potentially 902,000 people were reached through the no-cost option, resulting in a total of 1211 survey responses. The total cost of the advertisement campaign was Aus $649.66 (US $489.23), resulting in an overall cost per click of Aus $0.25 (US $0.19). Conclusions: Facebook is a feasible and cost-effective method of recruiting participants for a web-based survey, enabling recruitment of population groups that are considered hard to reach or marginalized. Recruitment through Facebook facilitated diversity, with participants varying in socioeconomic status, geographical location, educational attainment, and age.

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.

Background: Pandemics and epidemics are public health emergencies that can result in substantial deaths and socio-economic disruption. Nurses play a key role in the public health response to such crises, delivering direct patient care and reducing the risk of exposure to the infectious disease. The experience of providing nursing care in this context has the potential to have significant short and long term consequences for individual nurses, society and the nursing profession. Objectives: To synthesize and present the best available evidence on the experiences of nurses working in acute hospital settings during a pandemic. Design: This review was conducted using the Joanna Briggs Institute methodology for systematic reviews. Data sources: A structured search using CINAHL, MEDLINE, EMBASE, PubMed, Google Scholar, Cochrane Library, MedNar, ProQuest and Index to Theses was conducted. Review methods: All studies describing nurses¿ experiences were included regardless of methodology. Themes and narrative statements were extracted from included papers using the SUMARI data extraction tool from Joanna Briggs Institute. Results: Thirteen qualitative studies were included in the review. The experiences of 348 nurses generated a total of 116 findings, which formed seven categories based on similarity of meaning. Three synthesized findings were generated from the categories: (i) Supportive nursing teams providing quality care; (ii) Acknowledging the physical and emotional impact; and (iii) Responsiveness of systematised organizational reaction. Conclusions: Nurses are pivotal to the health care response to infectious disease pandemics and epidemics. This systematic review emphasises that nurses¿ require Governments, policy makers and nursing groups to actively engage in supporting nurses, both during and following a pandemic or epidemic. Without this, nurses are likely to experience substantial psychological issues that can lead to burnout and loss from the nursing workforce.

Background: Central venous access devices (CVADs) are used widely in acute clinical settings for the infusion of parenteral nutrition (PN) in patients who are unable to meet their nutrition requirements via the oral or enteral routes. The aim of this study was to characterize the frequency and nature of CVAD complications in patients receiving PN in general ward settings. Methods: A retrospective analysis of CVAD-related outcomes for adult patients who received PN from January 2014 to December 2016 was conducted. Results: A total of 629 CVADs were placed in 475 patients for parenteral administration in general ward settings during the 3-year study period. A total 104 (16.53%) episodes of CVAD-associated complications were reported during this period, including suspected line infection, leak at site, catheter blockage, and generalized patient sepsis. Overall, 13 CVAD catheter-related bloodstream infections (CRBSIs) were diagnosed in the patient cohort over 8695 PN feeding days, giving an incidence of 1.49 CVAD infections per 1000 PN feeding days. Conclusion: The results showed that patients receiving PN through CVADs within general ward settings experience CRBSI at rates no different from those reported within critical care settings. These findings demonstrate that with appropriate nursing care, CVADs appear safe when used for the administration of PN in general ward settings.

Objective: To synthesize the evidence from systematic reviews of clinical trials investigating the effectiveness of pharmacological therapies approved by the Australian Therapeutic Goods Administration and the US Food and Drug Administration for the management of obesity in adults. Data Sources: A 3-step literature search of the MEDLINE, EMBASE, CINAHL, and PubMed databases was conducted between March and May 2019. The key terms used were obesity, pharmacological therapy, antiobesity agent, antiobesity medication, weight loss, and systematic review. Study Selection and Data Extraction: Systematic reviews that evaluated the effectiveness of pharmacological therapies for the management of obesity in patients with a body mass index of or greater than 25 kg/m2. Data Synthesis: Nine systematic reviews involving three pharmacotherapies, liraglutide, orlistat, and naltrexone-bupropion were identified. The results indicate that the pharmacotherapies reduced weight when compared with placebo. Orlistat was effective in significantly reducing fasting blood glucose, HbA1c, total cholesterol, triglycerides, and systolic and diastolic blood pressure. All reviews discussed the presence or risk of gastrointestinal adverse effects including diarrhea, vomiting, and nausea related to orlistat and liraglutide. Relevance to Patient Care and Clinical Practice: This umbrella review compares the efficacy and safety of antiobesity medications for reducing weight and a discussion on their weight loss and metabolic control to guide clinicians when prescribing medications for obesity. Conclusions: All pharmacological therapies included in this review are superior to placebo in reducing weight. Clinicians should consider patient comorbidities and risk of adverse events when recommending medications for weight loss.

Background: Emotional wellbeing is essential for mental and physical health. Although all university students are vulnerable to psychological distress, nursing students are particularly susceptible, and recognised at higher risk due to the stressful nature of the nursing program. Aim: The aim of this cross-sectional study was to compare the demographic characteristics and emotional wellbeing with regard to levels of anxiety, depression, behavioural control, positive affect and general distress of preregistration nursing students in Australia, Saudi Arabia and South Africa. Design: Cross-sectional design. Methods: A total of 1381 pre-registration nursing students from two universities in Saudi Arabia and one university in both Australia and South Africa completed the self-report measurement tool, the Mental Health Inventory. A one-way analysis of variance was used to compare well-being among pre-registration nursing students in these three countries. Findings: The results revealed that when compared to the Australian and South African cohorts, the Saudi Arabian cohort had significantly higher anxiety (Australia M = 26.79, SD = 8.15; Saudi Arabia M = 33.12, SD = 8.24; South Africa M = 29.48, SD = 7.54), depression, (Australia M = 10.15, SD = 3.65; Saudi Arabia M = 13.10, SD = 4.49; South Africa M = 11.83, SD = 3.72), and lower scores in the Mental Health Inventory (Australia M = 152.44, SD = 28.60; Saudi Arabia M = 138.11, SD = 30.09; South Africa M = 145.67, SD = 26.32). Conclusion: There were statistically significant differences in overall psychological distress and well-being among students in the three countries. Strategies to improve emotional wellbeing and reduce the negative aspects of mental health such as anxiety and depression of preregistration nursing students are needed.

Background: Cardiovascular nursing has emerged as a vital specialty area in Australia with coronary artery disease having a significant impact on the health care system. Coronary catheterisation and interventions are currently the gold standard for the diagnosis and management of patients with coronary artery disease and has been conducted globally for the past 80 years. Aim: This review details the events that led to the historical development of coronary artery catheterisation along with highlights and developments that occurred in Australia and how this has influenced the development of cardiovascular nursing in Australia and potential future directions for expansion. Method: Historical methods using both primary and secondary sources were used. Initially secondary sources were accessed to create a timeline of potential archive locations to access. Primary sources of documentation in relation to nursing development in this area were scarce or otherwise included minimal information. Findings and discussion: The history of coronary angiography extends to over five decades in Australia. It was first performed in Australia in 1962 by Dr Benness at St Vincent's Hospital in Sydney. Since then as a result of continuing research, technological and medication-related advancements, there have been numerous changes in technique, materials used and indications for the procedure. These advances in technology have resulted in reduced complication rates, increased patient satisfaction and patient safety. Conclusion: Developments started slowly and were clouded in ridicule for the pioneers in this area, these international developments have had a significant impact on the Australian population and evolution of treatment for cardiovascular disease in Australia. Associated advancements afforded developments in nursing practice and allowed nurses to work at extended scopes of practice and saw the new roles for nursing

Purpose: The COVID-19 pandemic has presented an international health crisis of a scope not seen in our lifetime. While much attention has been paid to health workers in critical care and acute areas, nurses working outside of hospitals are also significantly affected. This study sought to investigate the experience of nurses working in Australian primary healthcare during the COVID-19 pandemic. In particular, it sought to understand the implications on their employment status, role, and access to personal protective equipment. Design and Methods: Nurses employed in primary healthcare across Australia were invited to participate in a cross-sectional online survey through social media and professional organizations. The survey tool was composed of demographics, and of questions about the nurses¿ employment, work role, and access to personal protective equipment. Findings: Of the 637 responses received, nearly half (43.7%) reported a decrease in hours and threatened or actual loss of employment. While most respondents felt that they had sufficient knowledge about COVID-19, they expressed concern about work-related risks to themselves and their family. Most respondents described never or only sometimes having sufficient personal protective equipment in their workplace. Just over half of respondents (54.8%) felt well supported by their employer. A third of respondents (34%) perceived that care provided in their workplace was significantly or slightly worse than before the pandemic. Conclusions: This is the first study of primary healthcare nurses¿ experiences during the COVID-19 pandemic. The study findings highlighted a concerning level of insecurity around primary healthcare nursing employment, as well as issues with the availability of personal protective equipment for these nurses. The perception that the pandemic has resulted in reduced quality of care needs further exploration to ensure that those with chronic conditions are supported to maintain and promote health. Clinical Relevance: Understanding the implications of COVID-19 on the primary healthcare nursing workforce is vital to ensure staff retention and care quality. Ensuring that the community remains healthy and supported at home is vital to both reduce the burden on the health system and reduce secondary mortality.

Objective The aim of this study was to determine the similarities and differences in elements of nursing care that are commonly rationed in the critical care, medical, and surgical specialties within an acute hospital environment. Methods Registered nurses who provide bedside nursing care within the medical, surgical, and critical specialties at a single center were invited to anonymously complete the self-administered MISSCARE questionnaire. The frequency of rationing for each individual care element within the 4 broader care groups (assessment, intervention - individual needs, intervention - basic care, and planning) of the MISSCARE questionnaire was determined. A mean score for each care group was also determined, and multiple regression analysis was undertaken to determine the demographic predictors of care rationing. Results Interventions related to basic care was the most frequently rationed care group in the critical care/emergency specialty (missed care mean of 50.1%), whereas planning was the most frequently rationed care group among both the medical (missed care mean of 43.6%) and surgical (missed care mean of 44.8%) specialties. Assessment was the least frequently rationed care group among all 3 specialties (missed care mean of 19.7%-26.7%). Length of time practicing as a registered nurse was an independent predictor of care rationing in the critical care/emergency specialty, and age older than 50 was an independent predictor in the medical specialty. Conclusions There are numerous similarities and differences in care rationing between critical care, surgical, and medical nurses. The development and implementation of specialty-based strategies should be undertaken to reduce the incidence of nursing care rationing.

Objective: The objective of this review was to identify, appraise, and synthesize the best available evidence related to participation in outdoor nature-based therapeutic recreation programs for adults with a mental illness living in the community. Introduction: Therapeutic recreation is posited to be beneficial for persons living with a mental illness. Research evidence indicates that therapeutic recreation programs can foster mental health recovery. It is important to understand the effectiveness of this from the perspective of persons living with mental illness how outdoor nature- based therapeutic recreation programs are meaningful and helpful for recovery. Inclusion criteria: This review considered studies that collected qualitative data on the experiences and perspectives of adults with a mental illness regarding their participation in outdoor nature-based therapeutic recreation programs. Methods: The databases PsycINFO, CINAHL, MEDLINE, Scopus, and Informit, as well as unpublished sources in gray literature (Google Scholar, OpenGrey), were searched and reference lists were checked to locate any additional studies. Studies published in English were considered, with a date range from inception to 2019. Three reviewers independently assessed the methodological quality of the studies that met the inclusion criteria using the JBI critical appraisal approach for qualitative research. Data were extracted by one reviewer using the standardized qualitative extraction tool and checked for accuracy by three other reviewers. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings, and a level of confidence was assigned to both synthesized findings. Results: Eighteen papers met the inclusion criteria and were included in the data extraction phase. A total of 84 findings were extracted and aggregated into six categories based on similarity of meaning and two synthesized findings. The methodological quality of the studies varied, and the overall level of confidence of the synthesized findings was determined to be moderate. Conclusions: This review identified that persons living with mental illness perceive outdoor nature-based therapeutic recreation as enjoyable and that therapeutic recreation makes a positive contribution to mental health. Congruent with the literature, therapeutic recreation offers a socially inclusive and psychologically safe environment. The intentionally structured social milieu enhances the formation of social relationships and meaningful connections for persons with mental illness. Elements linked with psychological well-being, such as intrinsic motivation, overcoming perceived challenges, and finding purpose and meaning, are enhanced through participation in therapeutic recreation in outdoor nature-based settings. Increased levels of physical activity, greater self-esteem, and enhanced sense of identity were some of the perceived positive changes. This review provides important insights into the subjective needs of persons with mental illness who undertake therapeutic recreation in outdoor nature- based settings. The qualitative findings can inform health care providers, or those interested in therapeutic recreation programming, to use alongside quantitative evidence of effectiveness to design nature-based therapeutic recreation activities that are meaningful for persons with mental illness. Limitations of the research were that papers published in languages other than English were not searched, and papers not located may have influenced the findings of this review.

Diabetic foot ulcers (DFUs) are a common complication of diabetes that impacts on the health-related quality of life (HRQOL). Foot care is an important factor in the self-care management of patients with DFUs. The objective of this study was to investigate the HRQOL and foot care management of people with DFUs. A cross-sectional study involving 41 people with DFUs was conducted at a large tertiary hospital in Northern Thailand. The Diabetic Foot Ulcer Scale-Short Form and the VA-Diabetes Foot Care Survey were used to assess the HRQOL and foot care management among people with DFUs. The majority of the participants were female (n = 24, 58.5%), and the mean age was 62.13 years. The scores for HRQOL in the six domains were as follows: leisure (66.95 ± 28.03), physical health (68.93 ± 28.51), dependence or daily life (80.08 ± 25.23), negative emotions (71.23 ± 29.48), worried about ulcers (62.20 ± 31.97), and bothered by ulcer care (69.36 ± 25.20). High scores indicate a high (good) HRQOL. Less than a third of the participants reported that they had received education about foot care management. Almost all participants reported that they washed their feet daily; however, a large proportion did not test the water temperature or use lubricants on their feet. Most of the participants did not have a mirror for checking under their feet (48.8%), and there was a lack of knowledge about how to use a mirror for foot inspections (51.2%). This study provides guidance for clinicians on the content and delivery of diabetes education programs for people with diabetes (and DFUs) in Northern Thailand. The findings provide guidance on existing knowledge and the need for programs to address barriers to foot self-care management both in terms of skills and attitudes.

Objective: The objective of this systematic review was to synthesize the best available research evidence on the effectiveness of flavonoid rich fruits in the treatment of hypertension. Introduction: Hypertension is a serious public health concern as it contributes to a significant burden of disease, attributable for millions of deaths globally. Complementary therapies including flavonoids have generated interest in assisting the treatment of hypertension. Flavonoids are a type of polyphenol abundant in fruits and a growing body of evidence suggests antihypertensive effects of the flavonoids due to its antioxidant properties. To date, no systematic review has been performed to collate the evidence on the effects of flavonoid rich fruits on hypertension in adults. Inclusion criteria: This systematic review included only randomized controlled trials (RCTs) that compared the administration of any type of flavonoid rich fruit or equivalent supplement with a placebo or other intervention in adults with hypertension. Trials that measured blood pressure using objective outcome measures such as a manual mercury sphygmomanometer were included. Studies that did not specify the flavonoid component of the fruit or fruit supplement were excluded in the review. Secondary outcomes, including change in weight, blood glucose level, triglycerides and total blood cholesterol levels were also assessed. Methods: A three-step search was undertaken, including a comprehensive search of the MEDLINE, Embase, Cochrane Trials (CENTRAL) and CINAHL databases, in September 2018. We also searched Dissertation Abstracts International, ProQuest Dissertations and Theses, MedNar and ClinicalTrials.gov to identify unpublished studies. The title and abstracts of the studies were reviewed by two independent reviewers against the inclusion/exclusion criteria. The methodological quality of the potential studies for inclusion were assessed using the critical appraisal checklist for randomized controlled trials as recommended by the Joanna Briggs Institute. Data were pooled in a statistical meta-analysis model. Subgroup-analysis according to type of intervention and length of intervention period was performed. Where statistical pooling was not possible, the findings have been presented in a narrative form. Results: Fifteen randomized controlled trials involving 572 participants were included in the review. The subclasses of flavonoids assessed included: anthocyanins, naringin, narirutin and flavan-3-ols. The overall methodological quality of the trials was high. Six trials investigated the effect of the flavonoid intervention on blood pressure within four weeks. Meta-analysis of five of the trials demonstrated evidence of no effect of flavonoids on systolic or diastolic blood pressure when compared to placebo (systolic mean difference =-1.02, 95% CI-3.12, 1.07; p = 0.34, I2 = 0%; diastolic mean difference =-0.90, 95% CI-2.10, 0.31; p = 0.15, I2 = 0%). Similarly, pooled results from two cross-over RCTs with two-timed dosed interventions in a 24-hour period demonstrated evidence of no effect on a reduction in diastolic blood pressure (p = 0.38) but did reveal evidence of a reduction in systolic blood pressure (p = 0). Six trials that assessed blood pressure following the flavonoid intervention at more than four weeks follow-up demonstrated evidence of no effect on either systolic (mean difference =-0.95, 95%CI-3.58, 1.68; p = 0.478, I2 = 0%) or diastolic blood pressure (mean difference = 0.86, 95%CI-1.11, 2.82; p = 0.393, I2 = 0%). Conclusions: The findings from this systematic review should be interpreted with caution, given that the results are obtained from single-center trials with small sample sizes. Given the results provided in this review, there is evidence of no effect of flavonoids on systolic and diastolic blood pressure. Further robust randomized controlled trials using sample sizes based on power calculations are needed to provide evidence for the use of...

Diabetic foot ulcers are a main cause of morbidity related to type 2 diabetes. Living with a diabetic foot ulcer has a significant impact on health-related quality of life and has a negative impact on daily living among people with the condition. The aim of this study was to explore the experiences of Thai adults living with diabetic foot ulcers using a descriptive qualitative design. Participants were recruited from the outpatient diabetes and foot clinic at a tertiary teaching hospital in Northern Thailand from January to April 2017. In-depth interviews were conducted with 13 participants using a semi-structured interview guide. Thematic analysis was used to identify the participants' experiences and two themes were identified: 1) living with a diabetic foot ulcer and 2) managing a diabetic foot ulcer. The findings enhance the knowledge of healthcare professionals and the public to understand the experience of having diabetic foot ulcers and contribute to understanding how to manage a diabetic foot ulcer based on the participant's experiences in the Thai context. Nurses must provide knowledge and self-care skills as part of routine care to improve health-related quality of life for people with diabetic foot ulcers.

Purpose: To develop a linguistically and psychometrically validated Thai version of the Simplified Diabetes Knowledge Scale (T-SDKS) for adults with Type 2 diabetes mellitus (T2DM). Design: A cross-sectional study was carried out among people with T2DM. Methods: Consecutive sampling was undertaken to recruit participants at the outpatient diabetes clinic of a hospital in Northern Thailand. Results: A total of 502 patients with T2DM were recruited. The mean age of the participants was 60.2 years, and 60.5% were female. The T-SDKS attained a reliability coefficient of.79. The item-total correlation value was greater than 0.20 for each item, and the inter-item correlation ranged between 0.03 and 0.49. Respondents attained a mean percentage knowledge score of 42.39% ± 15.45 on T-SDKS. Discussion/conclusions: The T-SDKS has demonstrated to be a brief and simple diabetes knowledge assessment tool to use in a busy clinical setting. Implication for practice: The findings can be used to improve health education interventions.

Objective: The aim of this study was to examine the psychometric properties of the Multidimensional Acculturative Stress Scale (MASS) when used to examine the stressors faced by senior Asian Indian women immigrants in Australia. Method: Data collected from a sample of Asian Indian women immigrants residing in Sydney, Australia, were used to examine the psychometric properties of the MASS using confirmatory factor analysis. Results: A total of 203 Indian women immigrants with an average age of 66.11 years [standard deviation (SD) ± 9.60; range 50¿90) participated in the study. The majority of the participants were born in India (n = 142; 70%) and their length of stay in Australia was between 1 month and 42 years. The original 24-item, five-factor MASS structure was confirmed, and the model showed a good fit to the data: comparative fit index = 0.93; root mean square error of approximation = 0.06; and standardised root mean square residual = 0.08. The Cronbach's alpha coefficients for the five subscales ranged from 0.80 to 0.93 and was 0.91 for the overall scale demonstrating high internal consistency. Conclusions: The findings confirm the factor structure and reliability of the MASS for assessing acculturative stress among female Asian Indian immigrants. However, scale development is an iterative process and further testing in other contexts is recommended.

Aims: To identify (a) determinants of glycated haemoglobin (HbA1c) at 18 and 30 months following transition in young people with Type 1 diabetes mellitus (T1DM) to a youth-specific diabetes service; and to (b) evaluate the impact of the service on acute admissions with diabetic ketoacidosis (DKA) over a 14-year period. Methods: An audit of records of youth with T1DM referred from paediatric services to the multidisciplinary transition service at Westmead Hospital, from 2001 to 2012, and followed-up to 2014. Results: Data from 439 adolescents and young adults (Median age: 18) were analysed. The recommended standard of glycaemic control, HbA1c < 7.5% (58 mmol/mol), was achieved by 23% at baseline, 22% at 18-months, and 20% at 30-month. After adjusting for lag time (>3 months) and diabetes duration (>7 years), glycaemic control at first visit predicted subsequent glycaemic control at 18-month and 30-month follow-up. From 2001 to 2014, only 8.6% were lost to follow-up; admissions and readmissions for DKA reduced from 72% (32/47) to 4% (14/340) (p < 0.001). Furthermore, mean length of stay (LOS) significantly decreased from 6.56 to 2.36 days (p < 0.001). Conclusions: Continuing engagement with the multidisciplinary transition service prevented deterioration in HbA1c following transition. Age-appropriate education and regular follow-up prevents DKA admissions and significantly reduced admission LOS.

Background: Clinical supervision of pre-registration nursing students has become an integral role of the registered nurse. The Clinical Supervision Self-assessment Tool relating to knowledge (CSAT¿Knowledge) and the individual's skills (CSAT-Skills) of clinical supervision and comprising of 30 items each originally is widely used for nurses in Australia. However, the psychometric properties of this tool have not been previously reported. Objective: To adapt the Clinical Supervision Self-Assessment Tool for nurses and to investigate the psychometric properties of the modified tool to measure registered nurses¿ knowledge and skills regarding supervising pre-registration nursing students. Design: Instrument adaptation and psychometric testing. Participants/Settings: A convenience sample of 229 registered nurses in a tertiary teaching hospital in Australia. Method: A two-phase prospective study was conducted. Phase 1 involved the modification of the Clinical supervision Self-Assessment Tool, content validity and pilot testing of the modified version. Phase 2 included the psychometric testing of the modified Clinical Supervision Self-Assessment Tool (mCSAT¿Knowledge; mCSAT-Skills). Results: The mCSAT¿Knowledge and mCSAT-Skills comprised of 30 items each. The content validity of the mCSAT was considered satisfactory based on the feedback from the expert panel. Results of the exploratory factor analysis supported a three-factor structure identified as: evaluating clinical learning; facilitating clinical learning and problem solving. The internal consistency was high with a Cronbach's alpha values >0.90. The construct validity was supported as nurses who had undertaken clinical supervision training demonstrated significantly higher clinical supervision knowledge and skills scores than those had no training. Conclusions: The findings provide empirical support for the modified Clinical Supervision Self-Assessment Tool as a valid measure of registered nurses¿ knowledge and skills regarding the clinical supervision of pre-registration nursing students. The tool requires further psychometric testing in different samples of nurses to enable validation in other settings.

Objectives To investigate the impact of the introduction of The Productive Ward Program¿ on two patient safety indicators; patient falls and medication errors. Design Retrospective quantitative study. Setting The study was conducted at a major metropolitan acute care hospital in Sydney, Australia. Subjects This study was conducted in a medical, surgical and two aged care wards, with a combined total of 120 inpatient beds over a 32 month time period. Main Outcome Measures The number of patient falls and medication errors for each of the participating wards. Results The implementation of The Productive Ward Program¿, did not have an overall significant statistical reduction in the number of falls and medication incidents. Aged Care 1, had a reduction of 13 falls between intervention and post intervention phase, these results were not statistically significant (OR 1.17; 95% CI 0.86, 1.59). For Aged Care 1 ward there was a statistically significant reduction in medication errors from 66 errors pre intervention to 27 medication errors post intervention (OR 2.73;95% CI 1.71, 4.38). Conclusion The results of this small study indicate that the implementation of The Productive Ward Program¿, did not have an overall significant statistical reduction in the number of falls and medication errors. This paper highlights the need for future research on the impact of the Productive Ward Program on patient safety.

Background: Transition from a registered nurse to a clinical nurse educator (CNE) poses several challenges. Providing professional development opportunities to ease the transition from a registered nurse to a CNE is considered critical to a successful career and to effectively teach. A self-directed educational program and mentoring (SEM) program was designed and implemented to support nurse¿s transition from a novice to a confident CNE. Aims: The aim of this studywas to explore noviceCNE¿s experience of learning and beingmentored. Design: Qualitative methodology was undertaken to conduct focus groups. Methods: All CNEs who completed the SEM program were invited to participate in the study. Willing participants provided informed consent to complete an in-depth semi-structured focus group and to record the focus group interview. Focus groups were facilitated by an independent researcher. A second researcher attended the focus groups to collect detailed notes. Data were transcribed verbatim and participants were de-identified. Simple thematic analyses were undertaken. Results: A total of 11 (58%) CNEs participated in the focus groups. Overall participants described their experience of the SEM program as positive. Three themes were identified: (1) perceived transformation of CNE practice, (2) beneficial relationships and (3) feeling connected. Mentoring relationships for some participants have continued beyond the self-directed learning, education and mentoring program. Barriers to the mentoring program included a theme of lack of time, role ambiguity and insufficient face to face education. Conclusions: Study findings highlight the benefits of providing professional development opportunities and mentoring programs for novice CNEs. Programs, such as the SEM enable transformation of a novice educator¿s practice, and the consolidation of new knowledge, skills and confidence to effectively educate less experienced nurses.

Background: To prepare nurses for a role in knowledge generation they need to engage in research training. Bachelor of Nursing (Honours) programs are a first step in this training. Developing a better understanding of current programs, their challenges and outcomes will provide an evidence base to inform curriculum development and policy making. Aim: The aim of this study was to explore current Australian Bachelor of Nursing (Honours) programs in terms of their composition, delivery and number of enrolments/graduates. Methods: Bachelor of Nursing Honours Coordinators or Heads of Schools of Nursing and Midwifery at Australian Universities were emailed an invitation to participate in an online survey. Findings: Of the 19 academics who responded to the survey, 15 (78.9%) reported currently offering a Bachelor of Nursing (Honours) program in their institution. A steady decline in mean enrolments was evident over recent years. There were clear differences in course delivery and assessment tasks between courses. Conclusion: This paper highlights the need to further explore Bachelor of Nursing (Honours) programs across Australia to ensure consistency in outcomes and to explore innovations in course delivery and project development. Such changes should incorporate feedback from students, supervisors, curriculum developers and professional stakeholders to ensure that programs address their various needs.

Mentoring has become an increasingly popular supportive method for empowering nurses and assisting them to progress in their careers. Evidence from the literature demonstrates that not all experienced and highly qualified nurses are effective mentors. The aim of this study was to explore and describe the experiences of neophyte nurse mentors following their first formal mentoring relationship using a qualitative exploratory design. Data were collected using dual moderated focus group methods. The focus group was digitally recorded and transcribed verbatim. Interviews were analysed using thematic analysis. Six neophyte nurse mentors participated in the focus group. The themes identified included (1) Readiness for mentoring, (2) Venturing into the unknown, (3) Having the right fit (4) Frustrations of mentoring (5) Reciprocal professional relationship. The findings highlight how neophyte nurse mentors perceive mentoring and the importance of providing them with adequate preparation and support in order to efficiently transfer valuable knowledge and skills to their mentees.

Background: Trans-radial access has rapidly become the standard for percutaneous coronary procedures in the last decade. As proceduralists overcome the learning curve and become more competent in trans-radial access, alternative safe access sites such as the ulnar artery have been increasingly used for emergent and elective procedures. The aim of this study was to synthesize the best available evidence of the impact on major adverse cardiac events (MACE) of ulnar artery compared to radial artery cardiac catheterization. Methods: This review considered randomized controlled trials that included adult patients who had a percutaneous coronary procedure via the radial or ulnar artery. The intervention of interest was the use of ulnar compared to radial artery for cardiac catheterization. An extensive search was undertaken for published and unpublished trials up to May 2017. Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) checklist. Data were analyzed using Review Manager. Results: A total of six trials were included in the review. There was no statistically significant difference in the incidence of MACE between patients who underwent trans-ulnar or trans-radial artery catheterization (OR 0.90; 95% CI 0.65¿1.25). Complications associated with access including hematoma formation, (n = 6 trials) pseudo-aneurysm, and arterio-venous fistulae formation (n = 5 trials), were investigated in a total of 5,276 patients, with no difference in these complications noted between the two groups. There were no differences in arterial access time, fluoroscopy time, and contrast load between the two groups. Conclusions: There is evidence to support safe use of the ulnar artery as an alternative to the radial artery for access for cardiac catheterization.

Background: Caring for self by maintaining emotional well-being is important for pre-registration nursing students if they are to graduate as confident and competent health professionals. Purpose: The purpose of this cross-sectional study was to identify the predictors of emotional well-being of pre-registration nursing students by measuring their levels of anxiety, depression, behavioural control, positive affect and general distress. Method: A cross-sectional study designed facilitated an examination of the level of emotional well-being of pre-registration nursing students (enrolled in their first, second and third year) in an Australian university across five campuses using the Mental Health Index (MHI). Purposive, all-inclusive sampling was used to recruit 920 nursing students. Data was collecting during a two month period (August to October 2016). Regression analyses were used to identify predictors of emotional well-being. Results: Results indicate that employment status was one of the major predictors of students¿ emotional well-being. Conclusion: Given this finding, and the importance that paid employment appears to have as a protective factor nurse education programs need to support these students to effectively balance their academic performance and employment. Innovative ways to structure course curriculum and modes of delivery to support work and study demands should be a focus of future research.

Review objective: The objective of this review was to investigate the effectiveness of nurse-led cardiac rehabilitation programs following coronary artery bypass graft surgery on patients' health-related quality of life and hospital readmission. Introduction: Coronary heart disease is a major cause of death and disability worldwide, putting a great strain on healthcare resources. For the past two decades, population-wide primary prevention and individual healthcare approaches have resulted in a dramatic decline in overall cardiac mortality. Over the intervening years, surgical techniques in cardiology have also improved substantially. As a result, long-term outcomes in patients treated with coronary artery bypass graft surgery have established the treatment's effectiveness and survival benefit. Furthermore, participating in cardiac rehabilitation following coronary artery bypass graft surgery has also demonstrated a significant decrease in all-cause cardiac mortality in these patients. Inclusion criteria: This review included studies with participants aged 18 years and over, post coronary artery bypass graft surgery that evaluated nurse-led cardiac rehabilitation (CR) programs compared with usual care or other forms of CR. The outcomes of interest were the health-related quality of life and hospital readmissions following coronary artery bypass graft surgery and measured using validated scales. Randomized controlled trials reported in English between 2000 to June 2017 were considered for inclusion. Methods: The search strategy aimed to find both published and unpublished studies using a three-step search strategy. An initial search of MEDLINE, CINAHL and Scopus was undertaken, followed by a search for unpublished studies including Dissertation Abstracts International, ProQuest Dissertations and Theses, Google Scholar, MedNar and ClinicalTrials.gov. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal tools from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Quantitative data was extracted from papers included in the review using the standardized data extraction tool from JBI-SUMARI. No meta-analysis was undertaken due to heterogeneity of the outcome measures. All results were subject to double data entry. Effect sizes expressed as risk ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis. Results: Three trials involving 329 patients were included in the final review. The trials that investigated the effect of home based cardiac rehabilitation programs compared to usual care at six weeks, three months and six months follow-up demonstrated no statistically significant difference in health-related quality of life at any of the follow-up periods. However, one study demonstrated significantly higher scores related to health-related quality of life among those who received nurse-led home based cardiac rehabilitation (154.93±4.6) compared to those who received usual care (134.20±8.2) at two months follow-up. No trials were identified that compared the effectiveness of nurse-led cardiac rehabilitation programs following coronary artery bypass graft surgery on readmissions to hospital. Conclusion: There is not enough evidence to support or discourage nurse-led cardiac rehabilitation programs on health-related quality of life in patients following coronary artery bypass graft surgery. However, the sparse data available suggests improvements in health-related quality of life at two months follow-up among those who received a nurse-led program. Further large-scale multicenter trials with standardized methodology are needed to determine the effect of nurse-led cardiac rehabilitation programs on health-related quality of life and rates of readmission...

OBJECTIVE: The objective of this review was to identify the effectiveness of topical medications on radial artery spasm (RAS) in patients undergoing transradial percutaneous coronary procedures. INTRODUCTION: Percutaneous coronary procedures were traditionally carried out via the femoral artery; however, over the last 20 years there has been a global increase in the number of proceduralists carrying out percutaneous coronary procedures via the transradial approach. Radial artery spasm remains an issue for the transradial approach, potentially leading to procedural failure. Topical medications have been suggested to reduce the occurrence of RAS during transradial percutaneous coronary procedures. INCLUSION CRITERIA: This review considered papers that included participants aged 18 years and over undergoing non-emergency transradial percutaneous coronary procedures. This review considered papers on the utilization of topical medications prior to commencing the transradial approach for percutaneous coronary procedures to reduce RAS. Topical medications were compared to other medications. The primary outcome was the incidence of RAS as assessed by angiography or ultrasound or resistance felt by the operator while manipulating the catheter. Other outcomes of interest included change in radial artery diameter, measured by angiography or ultrasound, change in radial artery patency and side effects of medications administered. Randomized and quasi-randomized controlled trials were considered. METHODS: A three-step search strategy was utilized in this review. A search of various databases was carried out followed by a search for unpublished literature between 1989 to January 2017. Only papers published in English were included in the review. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instrument from the Joanna Briggs Institute (JBI). There was no need for a third reviewer. Quantitative data was extracted from papers included in the review using the JBI data extraction instrument and entered in to RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane). All results were subject to double data entry. Effect sizes were expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis. RESULTS: Only three studies involving 697 participants met the inclusion criteria. There was a statistically significant reduction in the incidence of RAS in patients treated with a eutectic mixture of local anesthetics compared to subcutaneous lidocaine (OR 0.26; 95%CI 0.07,0.96). However there were no significant differences in RAS in studies that compared eutectic mixture of local anesthetics and placebo or a combinations of lidocaine with nitroglycerine compared to placebo. CONCLUSIONS: It is difficult to draw a valid conclusion, given the low number of studies, small sample sizes and heterogeneity between the studies.

Aim: The aim of this study is to establish a valid and reliable culturally adapted instrument which can be used in the Arabian context to measure emotional well-being. Design: The Mental Health Inventory tool was used to investigate the emotional well-being of Saudi nursing students. The instrument was originally developed in English and in a western cultural setting. As such, there was a need to translate and validate the instrument in Arabic for use in the Arabian setting. Methods: The Arabic version MHI 38 (AV-MHI-38) was translated, reviewed and revised, then evaluated with a sample of Arabic-speaking nursing students from Saudi Arabia using cross-sectional multicentre survey approach. An iterative forward-backward-forward sequence of item translation and review by a bilingual and bicultural expert panel was then¿completed. The psychometric properties of the AV-MHI-38 were examined through an exploratory factor analysis, confirmatory factor analysis, correlation among factors and reliability assessment. Results: The sample consisted of 252 nursing students from two different universities located in different geographic regions in Saudi Arabia. The mean age was 20.93¿years, made up of 230 female and 22 male participants. An a priori two-factor model showed satisfactory fit with modifications. Results indicated two component AV-MHI-38 with 46.09% of the total variance and excellent internal consistency. The AV-MHI-38 had good psychometric properties and the two subscales had good internal consistency with Cronbach's and acceptable reliability measures. The AV-MHI can be used to assess emotional well-being among Arabic-speaking populations of nursing students, nurses and other healthcare providers. The instrument can be used to identify the emotional well-being of students and initiating strategies to support them to decrease their study and work-related stress, anxiety and depression.

Objectives To investigate the effectiveness of computerised insulin dosing calculators for the management of continuous insulin infusions in adult patients who underwent cardiac surgery. Method A systematic review was conducted. The CINAHL, MEDLINE and Cochrane databases were searched for primary studies that compared a computerised insulin dosing calculator to a paper protocol. The main outcome measures were mean Blood Glucose Level (BGL), time to achieve BGL target range, time spent within BGL target range, the incidence of hyperglycaemia and the incidence of hypoglycaemia. Results Five studies were included in the final review. Pooled data demonstrated significant improvements in mean BGL (MD -14.24, 95% CI -26.93 to -1.55), p¿=¿0.03 and significantly lower rates of hypoglycaemia (OR 0.038, 95% CI: 0.16¿0.90), p¿=¿0.03 amongst the computer calculator groups in comparison to the paper protocol groups. No significant difference in the incidence of severe hypoglycaemia was demonstrated (OR 0.21, 95% CI 0.02¿1.79), p¿=¿0.15. No difference was found in time (hours) to reach target blood glucose range (MD -1.47, 95% CI -3.75 to 0.81), p¿=¿0.21. Conclusion There is some evidence to support the use of computerised insulin dosing calculators for insulin infusion management within critical care environments.

Background: Globally, many nurses and midwives are working at an advanced practice level. The role of a Nurse and/or Midwife Consultant encompasses a diverse and complex interaction between five specified domains namely Clinical Service and Consultancy, Clinical Leadership, Research, Education, and Clinical Services Planning and Management. Objective: The objective of this replication study was to identify the key drivers and mitigating factors that impact the role of Australian Nurse and/or Midwife Consultants. Design: Cross-sectional survey. Methods: The study was conducted in a large metropolitan health district in Sydney, Australia. Participants for this study consisted of all Nurse and/or Midwife Consultants working within a health district in New South Wales (NSW). Data were collected by an anonymous online survey. Key drivers and mitigating factors perceived to influence their role were identified using previously implemented instruments. Data were analysed using SPSS version 21. Results: Responses were obtained from 122 Nurse and/or Midwife Consultants. The number of years of experience as a Nurse and/or Midwife Consultant ranged from 6 months to 25.5 years. Personal attributes which included personal motivation and own communication skills were identified as key drivers to role performance with a mean score of 7.7±0.6. Other key drivers included peer support, organisational culture, personal attributes, professional learning, Nurse and/or Midwife Consultant experience, and collaborative relationships. Of the 14 mitigating factors to the role, the most common factors were lack of resources to set up and develop the role (2.6 ± 0.9), lack of secretarial support (2.6 ± 1.1), lack of managerial support (2.45 ± 1.1), and lack of understanding of the role by other health professionals (2.40 ± 0.8). Conclusions: Understanding the key drivers and mitigating factors that influence the role of the Nurse and/or Midwife Consultant is important for healthcare managers. Given the changing landscape of nursing and midwifery practice, organisational strategies to provide ongoing support to address the mitigating factors are urgently needed. It is pivotal that nursing management implement strategies to empower Nurse and/or Midwife Consultants to perform and reach their potential to deliver advanced nursing care.

Background Effective nursing teamwork is an essential component of quality health care and patient safety. Understanding which factors foster team work ensures teamwork qualities are cultivated and sustained. Objective This study aims to investigate which factors are associated with team work in an Australian acute care tertiary hospital across all inpatient and outpatient settings. Methods All nurses and midwives rostered to inpatient and outpatient wards in an acute care 600 bed hospital in Sydney Australia were invited to participate in a cross sectional survey between September to October 2013. Data were collected, collated, checked and analysed using Statistical Package for the Social Sciences (SPSS) Version 21. Factors reporting a significant correlation with where p¿<¿0.05 were analysed in a multiple regression model. Results A total of 501 surveys were returned. Nursing teamwork scores ranged between 3.32 and 4.08. Teamwork subscale Shared Mental Model consistently rated the highest. Mean scores for overall communication between nurses and team leadership were 3.6 (S.D. 0.57) and 3.8 (SD 0.6) respectively. Leadership and communication between nurses were significant predictors of team work p¿<¿0.001. Conclusion Our findings describe factors predictive of teamwork in an acute care tertiary based hospital setting across inpatient and outpatient specialty units. Our findings are of particular relevance in identifying areas of nurse education and workforce planning to improve nursing team work.

Background: Breast cancer is a major health concern and remains the most common malignancy in women worldwide and in Turkey. Mammography, clinical breast examination (CBE), and breast self-examination (BSE) are recommended methods to detect early breast cancer in women. Many strategies have been developed to increase the rates of mammography, CBE, and BSE among Turkish women. Despite the benefits of breast cancer screening, these modalities are still underutilized by the majority of Turkish women. Aim: To systematically review the scientific evidence on the effectiveness of various strategies aimed at improving screening behaviors for breast cancer in Turkish women. Methods: A systematic review of the literature published between 2000 and 2015 was conducted, searching 10 databases of Ovid MEDLINE, PubMed, Cochrane CENTRAL Register of Controlled Trials, CINAHL, PsycINFO, Web of Knowledge, Scopus, Google Scholar, ULAKBIM Turkish Medical Database, and Council of Higher Education Thesis Center. Results: Twenty-three studies were included in the final review. The majority of the studies investigated the effects of multiple strategies to improve BSE. Group education comprised educational sessions, printed and audiovisual materials, which significantly improved BSE, CBE, and mammography screening rates at 3 months, 6 months, and 12 months after the intervention. One-to-one education demonstrated no significant difference in BSE rates at 6-month and 12-month follow-up. However, one-to-one education demonstrated significant differences in CBE and mammography rates at the 3-month follow-up. Linking Evidence to Action: The use of group education comprising a multicomponent intervention demonstrated an increase in breast-screening behaviors among Turkish women. Further research investigating the duration of educational interventions is needed in order to suggest a ¿dose response.¿.

Background: In Australia over 1100 people are living on dialysis while waiting for a kidney transplant from a deceased donor. Worldwide there are an estimated 170,000 people who wait an average of three years before an organ becomes available. Objective: To provide an understanding of the lived experience of people waiting on dialysis for a kidney transplant from a deceased donor. Approach: A qualitative descriptive research design was used. Participants were recruited from a large metropolitan hospital. Two focus groups were conducted with six participants ranging in age from 29¿63 years, with dialysis experience of 10¿72 months. Data saturation was achieved and thematic analysis was used to interpret the data providing a descriptive account of the experience of waiting for a kidney transplant. Findings: Waiting for a kidney transplant takes place in the context of living on dialysis. Four main themes were identified: living on dialysis is physically and mentally demanding; living with uncertainty; altered relationship dynamics; and feelings towards the deceased donor. Conclusions: This study provides a descriptive summary of what it is like to live on dialysis while waiting for a kidney transplant from a deceased donor from the perspective of the person waiting. People are burdened by; uncertainty; the experience of the dialysis therapy; and the thought of the human cost of transplantation. These findings suggest that this cohort may benefit from strategies to relieve uncertainty such as effective communication from the treating team and peer support from the dialysis community.

Background Transradial access to percutaneous coronary procedures is becoming the preferred access route, and it is being increasingly used for emergent and elective procedures. However, radial artery occlusion (RAO) continues to remain an adverse occurrence following sheath removal or in the first 24 hours following sheath removal due to the smaller diameter of the artery. Objectives The overall objective of this study was to synthesize the best available research evidence related to the effects of methods used to achieve hemostasis on RAO rates after percutaneous coronary procedures. Inclusion criteria Types of participants The current review considered trials that included adult patients (18 years and over) who have had a coronary angiography or coronary re-vascularization intervention via the radial artery. Types of intervention(s) The interventions of interest were the use of various hemostatic methods compared to traditional interventions to prevent RAO. Types of studies All randomized and quasi-randomized controlled trials evaluating the effect of various hemostatic methods on RAO rates after percutaneous coronary procedures were included in the review. Outcomes The primary outcome of interest was the incidence of RAO at the time of discharge and persistent occlusion at the time of follow-up. Search strategy The search aimed to find published and unpublished trials through electronic databases, reference lists and key reports. An extensive search was undertaken for the following databases ¿ CINAHL, Embase, PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL). Databases were searched up to May 2016. The search for unpublished trials included Dissertation Abstracts International, World Cat, Clinicaltrials.gov, ProQuest Dissertation and Theses and MedNar. Methodological quality Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute Meta- Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) checklist. Disagreements that arose between the reviewers were resolved through discussion. Data extraction Quantitative data were extracted from papers included in the review by one reviewer using the standardized data extraction tool from JBI-MAStARI. The data extracted were checked by a second reviewer. Disagreements that arose between the reviewerswere resolved through discussion. All resultswere subject to double data entry in ReviewManager. Data synthesis Statistical pooling of the data was not possible due to the heterogeneity of the trials; therefore, the findings are presented in narrative form. However, figures have been used to illustrate the results. Results A total of seven trials were included in the review. One trial demonstrated a significant reduction in RAO rates in patients who had a mean arterial pressure (MAP)-guided TR band to a standard TR band (odds ratio [OR] 0.08; 95% confidence interval [CI] 0.02, 0.37). A statistically significant reduction in the incidence of RAO was observed among patients who received a biopolymer dressing (Chitosen) compared to those who received the TR band (OR 2.20; 95% CI 1.20, 4.02). No statistically significant difference in the incidence of RAO was reported between those who received the TR band and those who received either the elastic bandage (P¼0.08) or T band (P¼0.76). Similarly, no statistically significant difference in rates of RAO among patients was reported among those who had pro-coagulant dressings compared to those who had short or long manual compression. One trial that compared the TR band to a MAP-guided TR band demonstrated no statistically significant difference in the time taken to obtain hemostasis between the two groups (P¼0.61). A statistically significant reduction in the time taken to obtain hemostasis was observed among patients who received the hemostatic biopolymer dressing compared to the TR band. No statistically significant difference in the incidence of hematoma was iden...

Background Buruli ulcer (BU) disease is a chronic ulcerative skin disease caused by Mycobacterium ulcerans, which can lead to extensive destruction of the skin, soft tissues and occasionally of bones. Although several antibiotics have demonstrated bactericidal activity against M. ulcerans in vitro, no consensus on their clinical efficacy against M. ulcerans in humans has been reached. Objectives The objective of the systematic review was to examine the clinical effectiveness of various antibiotic regimens for the treatment of BUs. Inclusion criteria Types of participants The current review considered trials that included patients of all ages with BUs. Types of intervention(s) The current review considered trials that evaluated antibiotic regimens compared to no antibiotics or surgery in patients with BUs. Types of studies The current review considered randomized and non-randomized controlled trials (RCTs). In the absence of RCTs, other research designs such as before and after trials and clinical trials with only an intervention arm were considered for inclusion in a narrative summary. Outcomes The primary outcome of interest were the treatment success rates among the various antibiotics used. Secondary outcomes included changes in lesion size, recurrence of ulcers and incidence of adverse events. Search strategy The search strategy aimed to find both published and unpublished trials. A three-step search strategy was utilized in this review and included English language trials published after 1990. A search across the major databases was conducted up to December 2014. Methodological quality Using the Joanna Briggs Institute (JBI) standardized appraisal tool, two reviewers independently assessed the methodological quality of the trials. A third independent reviewer was available to appraise trials if the two original reviewers disagreed in their assessments. There were no disagreements in findings between the two independent reviewers. Data extraction Data were extracted using the standardized JBI data extraction instruments. Data synthesis Statistical pooling was not possible due to heterogeneity, hence results have been presented in the narrative form. Results Seven studies involving a total of 712 patients were included in the final review. Higher treatment success rates ranging from 96% to 100% at the six months follow-up were reported among patients treated with rifampicin-streptomycin for eight weeks (RS8) in two studies. Treatment success with rifampicin-streptomycin for 12 weeks, with surgery at the 12 weeks follow-up, was 91%. In the two studies that investigated the effect of rifampicin-streptomycin for two weeks followed by rifampicin-clarithromycin for six weeks and rifampicin-streptomycin for four weeks followed by rifampicin-clarithromycin for four weeks, treatment success was reported to be 93% and 91%, respectively, at the 12 months follow-up. A significant decrease in the median lesion size at the eight weeks follow-up was reported in patients who were treated with RS8, and a 10-30% decrease in lesion size was reported in those treated with RS12 at the four weeks follow-up. Conclusion Treatment success and reduction in lesion size were higher in patients treated with RS8 in the only RCT that compared rifampicin-streptomycin for four weeks followed by rifampicin-clarithromycin for six weeks to RS8, and there was no difference in outcomes, which indicates that local preferences could dictate the treatment option. Evidence obtained from this systematic review indicates that surgery will remain necessary for some ulcers; however, detection of early lesions and treatment with antibiotics would have a greater impact on the control of M. ulcerans disease. Further large multicenter RCTs investigating the type and optimal duration of oral antibiotic treatment for patients with M. ulcerans disease are urgently needed.

BACKGROUND: Long-term breastfeeding, including exclusive breastfeeding for six months and continuation of breastfeeding with complementary food until two years of age, has been recommended by the World Health Organization. However, despite the clear benefits of long-term breastfeeding (six months and beyond), the rates of breastfeeding still continue to remain low. Although there are some individual interventional studies that aimed to increase prolonged breastfeeding rates among both multiparous and primiparous women, there is no systematic review or meta-analysis to examine the effectiveness of those interventions among primiparous women who had no previous breastfeeding experience.

BACKGROUND: The uptake of percutaneous coronary procedures via the radial artery has increased internationally due to the decreased risk of complications and increased patient satisfaction. The increased susceptibility of the radial artery to spasm however presents a potential risk for procedural failure. Although most experts agree on the need for prophylactic medications to reduce radial artery spasm, currently there is inconsistency in literature regarding the most effective vasodilatory medication or combination of medications.

Aims and objectives: Medication adherence in people with cirrhosis is largely unknown. This study aims to determine adherence patterns and factors associated with adherence in patients with cirrhosis. Background: Prescribed medications are a pivotal component in the clinical management of cirrhosis with potential to retard disease progression and reduce complication risks. Medication adherence is necessary to optimise health outcomes. Understanding why medications are missed may help to develop strategies and inform nursing practice. Design: Prospective cohort study. Methods: Participants (n = 29) diagnosed with cirrhosis attending a tertiary hospital consented to complete a self-reported survey. Demographic information, adherence to medications, patient knowledge and quality of life data were collected, collated, checked and analysed using spss version 21. Results: Less than half of the 28 patients who completed the adherence questionnaire (n = 13, 46%) reported that they had never missed medication. Being forgetful, being away from home and falling asleep contributed to nonadherence. Having less abdominal symptoms, less fatigue and increased emotional well-being were significantly associated with patients never missing medications. Conclusions: To our knowledge this is the first published study to describe adherent behaviour and the reasons medications are missed in this population. The percentage of nonadherent participants is of concern considering the potential morbidity risk that is associated with missed medications and rebound symptoms of cirrhosis. Strategies to improve and sustain adherence levels are required including enhanced adherence counselling offered to patients who are deteriorating or experience periodic exacerbation of symptoms. Relevance to clinical practice: Study findings have the potential to change clinical practice especially the way nurses target motivational adherence counselling, key treatment messages, education and adherence monitoring. The results presented here provide a basis for developing adherence strategies and nursing management plans to improve adherence and health outcomes in people with cirrhosis.

Coronary heart disease (CHD) has been estimated to be the leading cause of mortality in developing countries in 2010, particularly among Asian Indians. When compared to other populations globally, Asian Indians less than 40¿years of age are at an increased risk of myocardial infarction. The objective of this study was to identify the predictors of knowledge of heart disease among younger and older Asian Indians adults. A cross-sectional survey was undertaken in Sydney Australia. One hundred and forty-four participants of Asian Indian descent who attended the health promotion stall at the Australia India Friendship Fair in Sydney participated in the study. All participants completed a self-administered questionnaire. The Primary outcome of the survey was knowledge of heart disease as measured by the 25 item Heart Disease Facts Questionnaire. All six modifiable risk factors for heart disease namely smoking, high blood pressure, diabetes, high cholesterol, physical inactivity and overweight were identified by 45.2¿% of those aged below 40 and 53.5¿% of those aged above 40¿years of age respectively. For younger adults, only smoking status was significant and was an independently predictor of knowledge related to CHD (b¿=¿-10.6, p¿=¿0.001, sr2¿=¿0.16). For older adults, smoking status and duration of residence were significant predictors of knowledge related to CHD (b¿=¿-7.4, p¿=¿0.000, sr2¿=¿0.24; b¿=¿0.13, p¿=¿0.001, sr2¿=¿0.069 respectively). Although suboptimal, there were no statistically significant differences in the level of knowledge among older and younger Asian Indians. Nevertheless, strategies to improve the knowledge of heart disease among this cohort are warranted.

BACKGROUND: Epilepsy is a global public health problem affecting people of all ages, sex, races, nations and social class. The majority of the 50 million people with epilepsy live in developing countries, with a prevalence rate of five to 10 people per 1000. The disease poses an enormous psychological, social and economic burden on patients. An estimated 90% of people with epilepsy in developing countries do not receive treatment due to sociocultural, economic and political factors. Current treatment interventions are limited to the clinical management of the disease and are largely driven by the healthcare provider's perspective, ignoring the experiences of people living with epilepsy (PLWE).