Academic literature on the topic 'Community health nursing Standards Australia'

Australia has a high number of people from culturally and linguistically diverse (CALD) backgrounds whose primary language is not English. CALD population groups have comparatively lower levels of education and health literacy, and poorer health outcomes compared with the Australian-born population. The delivery of consumer health information to people from CALD backgrounds usually includes the use of translated resources. Unfortunately, the quality of translated resources available on health issues is highly variable and may impact efforts to address the disparities in health outcomes. Currently applied guides to translation focus on accuracy and literalness of the translation; however, for health translations, conveying meaning and incorporating culturally relevant information is essential. Minimum standards for developing translated resources are needed to provide an indication of quality for end users, including healthcare providers, the client and carer. This paper describes the development of a Translation Standard, led by a community nursing organisation in collaboration and consultation with CALD community members and peak community organisations in Melbourne, Australia. The Translation Standard includes 10 components that have been identified as necessary to ensure a minimum standard of translation that is of high quality and caters to the health literacy levels of the target audience. What is known about the topic? There are many people from CALD backgrounds who have worse health outcomes than people who are Australian born. There is a gap in guidance to health professionals on how to develop high-quality translations of consumer health information that consider culture and health literacy. Higher-quality translations are needed to better inform CALD groups about their health. What does this paper add? The description of a new Translation Standard to guide the development of culturally relevant consumer health translations, considering the cultural needs and health literacy level of the target audience. What are the implications for practitioners? The Translation Standard provides assurance to practitioners that any translation that has followed this Standard is of high quality and increases the likelihood that the target audience will find the information relevant and understandable. The Translation Standard can assist consumers to make more informed choices and decisions about their health. Future translations would benefit by using such a guide.

Health reform is increasingly targeted towards strengthening and expansion of primary health systems as care is shifted from hospitals to communities. The renewed emphasis on prevention and health promotion is intended to curb the tide of chronic disease and sustain effective chronic disease management, as well as address health inequities and increase affordable access to services. Given the scope of nurses’ practice, the success of Australia’s health system reforms are dependent on a nursing workforce that is appropriately educated and prepared for practice in community settings. This article reports on the results of an Australian national audit of all undergraduate nursing curricula to examine the extent of professional socialisation and educational preparation of nurses for primary health care. The results of the audit are compared with Australian nursing standards associated with competency in primary health care. The findings indicate that Australian nursing competencies are general in their approach to skills and knowledge, not specifying any particular competencies for primary health care, while undergraduate student preparation for practice in primary health and community settings is patchy and not keeping pace with reform agendas that promote expanded roles for nurses in primary health care, prevention and health promotion. The implication for nursing curriculum reform is that attention to achieving nursing graduate capacity for primary health care and health promotion is a priority.

Objective This paper presents analysis of consumer focus groups that were undertaken as a part of the project to develop the now current Nursing and Midwifery Board of Australia’s Nurse Practitioner Standards for Practice. Methods Six focus groups were conducted with consumers around Australia, including urban and remote areas. One purpose for these groups was to explore what was known of nurse practitioners and whether consumers could articulate the difference between the regulated titles of enrolled nurse, registered nurse and nurse practitioner. Results Consumers’ knowledge of nurses’ roles in the Australian primary healthcare system, and hence system literacy (particularly in terms of navigating the system), was low. Of perhaps greatest importance is the fact that those consumers with low health systems literacy also exhibited a low level of motivation to seek new knowledge. Many consumers relied on the medical profession to direct care. Conclusion The low levels of health literacy raise questions of how to meaningfully include health consumers in innovative health-related policy work. What is known about the topic? Health literacy includes individual attributes and those of the system in which the context of care is placed. Individual attributes include not only knowledge and confidence but also motivation. It is known that consumer knowledge related to the nursing workforce is low. What does this paper add ? This paper adds the finding that along with knowledge that consumer motivation is low to find out more about the nursing workforce in general. This finding extends to Nurse Practitioners in particular. This is occurring in the context of frequent contact with nurses in the context in which care is received. What are the implications for practitioners? This finding informs strategies to build health literacy in the community, as the approach that will lead to success is clearly not just one of providing accessible information. The factor of motivation warrants attention.

This article provides an overview of the extent of casualisation of the nursing workforce in Australia,focusing on the impact for those managing the system. The implications for nurse managers in particular are considerable in an industry where service demand is difficult to control and where individual nurses are thought to be increasingly choosing to work casually. While little is known of the reasons behind nurses exercising their preference for casual work arrangements,some reasons postulated include visa status (overseas trained nurses on holiday/working visas); permanent employees taking on additional shifts to increase their income levels; and those who elect to work under casual contracts for lifestyle reasons. Unknown is the demography of the casual nursing workforce, how these groups are distributed within the workforce,and how many contracts of employment they have across the health service - either through privately managed nursing agencies or hospital managed casual pools. A more detailed knowledge of the forces driving the decisions of this group is essential if health care organisations are to equip themselves to manage this changing workforce and maintain a standard of patient care that is acceptable to the community.

The extraordinary (unplanned) review of clinical privileges is the means by which an organisation can manage specific complaints about individual practitioners’ clinical competence that require immediate investigation. To date, the extraordinary review of clinical privileges for doctors and dentists has not been the subject of much research and there is a pressing need for the evaluation and review of how different legislated and non-legislated administrative processes work and what they achieve. Although it seems a fair proposition that comprehensive processes for the evaluation of the clinical competence of doctors and dentists may improve the overall delivery of an organisation’s clinical services, in fact, little is known about the relationship between the safety and quality of specific clinical services, procedures and interventions and the efficiency or effectiveness of established methodologies for the routine or the extraordinary review of clinical privileges. The authors present a model of a structured approach to the extraordinary review of clinical privileges within a clinical governance framework in the Australian Capital Territory. The assessment framework uses a primarily qualitative methodology, underpinned by a process of systematic review of clinical competence against the agreed standards of the CanMEDS Physician Competency Framework. The model is a practical, working framework that could be implemented on a hospital-, area health service- or state- and territory-wide basis in any other Australian jurisdiction. What is known about the topic?In Australia, there is a national standard for credentialing and defining the scope of clinical practice for doctors working in hospital settings. However, there are no published reports in the national arena on established processes for the extraordinary review of clinical privileges for doctors or dentists and, despite the major inquiries investigating health system failures in Australian hospitals, the effectiveness and adequacy of existing processes for the extraordinary review of clinical privileges has not yet been prioritised nationally as an area for improvement or reform. Internationally, health care organisations have also been slow to establish frameworks for the management of complaints about doctors or dentists. What does this paper add?This paper makes a significant contribution to the national and international safety and quality literature by presenting an exposition of a working model for the extraordinary review of clinical privileges of doctors and dentists. The authors describe a methodology in the public health sector that is territory-wide (not hospital-based), peer-reviewed, objective, fair and responsive. Because the model is a practical, working framework that could be implemented on a hospital-, area health service- or state- and territory-wide basis in any other Australian jurisdiction, this paper provides an opportunity for policy makers and legislators to drive innovative change. Although incursions into the provision of care by other health professionals have been avoided, the model could be readily adopted by clinical leaders from the nursing and allied health professions. What are the implications for practitioners?An organisation dedicated to investigating serious complaints with a real sense of urgency, objectivity and transparency is far less likely to fester a climate of disquiet or anger amongst staff, or to trigger concerns of a ‘cover-up’ or disregard for accountability than an organisation not adopting such an approach. Anecdotal experience suggests the model has the potential to minimise, if not prevent, the occurrence of the kinds of complaints that become much-publicised in the media. This is positive because these types of damaging high profile cases often have the effect of diminishing community confidence in the health care system, in particular, confidence in the medical profession’s ability to self-regulate. Often, they also lead to a misrepresentation of the medical profession in the media, which is unfair since the overwhelming majority of doctors do meet the standards of their profession.

Background Dementia education that meets quality and safety standards is paramount to ensure a highly skilled dementia care workforce. Web-based education provides a flexible and cost-effective medium. To be successful, Web-based education must contain features that promote learning and support knowledge translation into practice. The Dementia Care Competency and Training Network (DCC&TN) has developed an innovative Web-based program that promotes improvement of the attitudes, knowledge, skills, behavior, and practice of clinicians, regardless of their work setting, in order to improve the quality of life for people living with dementia. Objective This review aims to (1) determine the key features that are associated with an effective and functional Web-based education program—an effective and functional Web-based program is defined as one that measures results, is accessible, is user friendly, and translates into clinical practice—and (2) determine how these features correlate with the DCC&TN. Methods Six electronic databases—Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AusHealth, Nursing@Ovid, and Google Scholar—were searched for articles published between 2009 and 2018 using the following keywords: Education, Distance, Continuing, Learning, Online, Web-Based, Internet, Dementia, Program Evaluation, Validation Studies, Outcome and Process Assessment Healthcare, Nursing, Assisted Instruction, and Facilitated. The Critical Appraisal Skills Programme (CASP) and Kirkpatrick’s model for the evaluation of training were used to ensure quality and rigor of the analysis. Results A total of 46 studies met the inclusion criteria. In total, 14 key features were associated with an effective Web-based learning environment, which enabled the environment to be as follows: self-directed, individualized, interactive, multimodal, flexible, accessible, consistent, cost-effective, measurable with respect to participant satisfaction, equitable, facilitated, nurturing of critical thinking and reflection, supportive of creating a learning community, and translated into practice. These features were further categorized into five subgroups: applicability, attractiveness, functionality, learner interaction, and implementation into practice. Literature frequently cites Kirkpatrick’s four-level model of evaluation and application in the review of education and training; however, few studies appeared to integrate all four levels of Kirkpatrick’s model. Features were then correlated against the DCC&TN, with an encouraging connection found between these features and their inclusion within the content and structure of the DCC&TN. Conclusions A total of 14 key features were identified that support an effective and functional Web-based learning environment. Few studies incorporated Kirkpatrick’s salient elements of the model—reaction, learning, behavior, and results—in their evaluation and clinical application. It could, therefore, be considered prudent to include Kirkpatrick’s levels of training evaluation within studies of dementia training. There were few studies that evaluated Web-based dementia education programs, with even fewer reporting evidence that Web-based training could increase staff confidence, knowledge, skills, and attitudes toward people with dementia and be sustainable over time. The DCC&TN appeared to contain the majority of key features and is one of the few programs inclusive of hospital, community, and residential care settings. The 14 key features can potentially enhance and complement future development of online training programs for health sciences education and beyond. The DCC&TN model could potentially be used as a template for future developers and evaluators of Web-based dementia training.

THIS BOOK AIMS to be a comprehensive insight into community nursing in Australia. The text largely achieves this claim and in doing so has provided one of the first texts of its type contextualised specifically at Australian community nursing issues. The book comprises 24 well organised and clear chapters around the three primary elements: the organisation of community nursing in Australia; the rapidly changing environment of community health delivery; and the specific practice elements of community nursing care. The chapters are well set out and include a focussed conclusion that really distils the essential elements. The text makes appropriate use of case studies, and scenarios add to the quality of the overall product. One area that could have been given more prominence would have been a specific chapter on issues concerning the community nursing care of Australia?s Indigenous population, as well as a chapter on community nursing approaches to stigmatised and marginalised groups. While reference is made to these groups within other chapters, it may have been more powerful had chapters been specifically written on these groups. Despite this, there is a lot to like about this Australiancentred nursing text. In addition to what you would routinely expect to find in a text on community nursing, the book includes chapters on risk management; organisation culture and organisational change; the changing professional role of community nursing; and the changing focus of research. Overall, the book is easy to read and provides an excellent overview of community nursing in Australia. Additionally, as outlined earlier in this review, the text takes the reader further than what you would expect from a book of this nature. The book would suit a wide variety of readers, from those wanting a greater understanding of the complexities of nursing in the community to nurses working in a range of community health settings.

This descriptive• study discusses the development of community mental health (CMH) in Western Australia (WA) and describes the current practising population of CMH nurses. The study explores literature pertaining to the emergence of the CMH movement and the deinstitutionalisation of the mentally ill. A conceptual framework was developed by adapting Lewin's change theory. CMH nurses practising in WA (n= 130), were invited to participate in the study and were asked to complete a survey questionnaire. This resulted in a 66% response rate (n = 86). Quantitative data was analysed using the Statistical Package for the Social Sciences (SPSS). Open ended questions were analysed using Colaizzis steps. The study found that mental illness has been treated according to contemporary beliefs. In the 1950s multiple forces within society led to the movement away from institutionalisation of the mentally Ill toward deinstitutionalisation. The first community clinic was established in 1956 to manage the deficit between the ever expanding population needing mental health care and the paucity of available hospital beds. The need for follow up of clients in the community resulted in the development of CMH nursing. The study also provides a profile of the current practicing population of CMH Nurses in WA, demographic details, qualifications, the work environment, educational needs, work role and job satisfaction have been described. Recommendations have been developed from the findings and are directed towards, the dissemination of information, the need for role identification/development, staff development needs, future education needs, industrial issues, clinical practice issues and areas for further nursing research

Rural palliative care nurses (RPCNs) in Western Australia (WA) are a small population, who have embraced the specialist palliative care role since the first palliative care service in rural WA began in 1990. However, there are some challenges involved with being a specialist nurse in a generalist health care setting. fu particular, there is a suggestion in the literature that RPCNs may be professionally isolated, may be prone to burnout, and may therefore experience decreased job satisfaction and may consider leaving the palliative care field.

The aim of this study was to determine the ability and proficiency of the newly qualified professional nurses in utilising psychiatric nursing skills at Chris Hani District Psychiatric Health Care Services in the Eastern Cape, South Africa. The research method was a qualitative, phenomenological approach. A purposive sample of newly qualified professional nurses and supervisors participated in the study. The data were collected through interviews and focus group discussions, using semi – structured interview guides. Interviews responses were recorded on the interview guide. Data were analysed using the computer software Atlas ti and manually. Positive and negative themes were identified. Ethical considerations were ensured by means of privacy, anonymity and confidentiality. Ethical clearance was obtained from the University of Fort Hare and permission from the Provincial Department of Health and Chris Hani District Health and Mental Health Institution at Queenstown was sought. The findings revealed that newly qualified professional nurses performed well, according to the perception of their supervisors. Newly qualified professional nurses were faced with challenges such as shortage of resources, mental illness not considered as a priority and lack of skills development. The study also revealed that newly qualified professional nurses focussed on the curative aspect of ailments, rather than preventive care. However community health workers (CHW) focussed on the preventive aspect of care. Limitations and recommendations based on the findings of the study are presented.

This thesis comprises two interrelated sections. The first section is a substantial piece of creative writing, which l have cailed 'Other People's Country: A Memoir, in the genre of travel memoir, and an essay. The memoir borrows techniques from fiction, drama and poetry to tell a story of a middle-aged, middle-class city nurse, who travels to a remote settlement at the edge of the Western Desert of Western Australia to provide health care for a fluctuating population of around 400 people, for whom English is a third or fourth language. Writing that includes stories about vulnerable people from another culture, whose lives have touched those of the writer, demands sensitivity to differences, as well as an ethical approach. Writing about Aboriginal people also demands an awareness of what is appropriate when writing about cultural material. To achieve the voice of a trustworthy narrator is a challenge that faces all writers of narrative non-fiction, including memoir. The truth is subjective; perception is unreliable; memory can be distorted; error slips in unwittingly; deliberate falsification is possible. In spite of all this, a writer of memoir makes a contract with the reader that the story is significant, and that it is the writer's truth, told as honestly as possible. The pivotal concern of this thesis is the question, 'What are some of the important considerations for a memoirist who is attempting to develop the voice of an ethical and trustworthy narrator writing about experiences encountered when living and working within an unfamiliar culture? The second part of the thesis is an essay which develops a theoretical framework in response to some of the major dilemmas I encountered in this undertaking. It embraces memory, aspects of Aboriginal vulnerability, and ethics through which to explore the concepts of truth and honesty in memoir-writing.

This study investigated current use of American Association of Colleges of Nursing guidelines in preparing the baccalaureate nurse graduate to practice nursing in the community health sector of the healthcare delivery system and use of community based healthcare delivery sites by baccalaureate programs located in non-urbanized and urbanized areas. The extent of guidelines adoption, plans by colleges not currently using them to do so in the future, and impact of accreditation visits on the adoption of the guidelines were also explored. A qualitative survey design was used to describe the use of AACN guidelines in the development of baccalaureate nursing education.

La prestation coordonnée de soins de santé primaires (SSP) a été éprouvée comme améliorant la qualité et l’accès des soins prodigués aux Canadiens. Plusieurs études ont notamment confirmé les avantages des infirmières praticiennes (IP) et des modèles interprofessionnels en SSP pour le système de santé. Les écrits suggèrent toutefois que l’intégration des IP en SSP est jalonnée de tensions et restructurations en raison d’une confusion supposée de leur rôle. À ce jour, les recherches ont principalement ciblé les barrières et facilitateurs de l’intégration du rôle des IP. Une analyse critique des dynamiques socioprofessionnelles et politiques de l’intégration des IP n’a toutefois pas encore été réalisée. Une ethnographie critique combinant la Théorie de l’acteur-réseau et les concepts foucaldiens de discours, savoir et pouvoir a permis l’examen des interactions sémiotiques caractérisant certains milieux de SSP. Différents modèles interprofessionnels de SSP (2 centres de santé communautaire, 2 équipes de santé familiale et 2 cliniques dirigées par les IP) ont été investis. Les données issues d’entrevues semi-dirigées avec des IP (n=23), d’observations directes de milieux et de rencontres interprofessionnelles, et d’analyse documentaire ont été soumises à une analyse thématique puis une analyse critique de discours. Les résultats montrent que la valeur morale des IP, les finalités organisationnelles des milieux de SSP, les normes de pratique, la collaboration interprofessionnelle et la prise en charge des patients disposent les IP à la négociation de leur rôle et à certains enjeux socioprofessionnels et politiques qui génèrent plusieurs contrecoups: pluralisme de leurs rôles professionnels, dissonance identitaire, sentiments d’incompétence et d’incertitude, glissements discursifs dans leurs propres discours, et divers états émotionnels et souffrances. Ces contrecoups commandent diverses stratégies d’adaptation et de résistance permettant aux IP de gérer ces tensions. Plusieurs entités non-humaines (inscription des clientèles, discours de soutien aux médecins et espaces physiques) émergent comme acteurs agissant sur l’intégration et la négociation du rôle des IP en SSP. Cette étude permet de décrire le processus de traduction du rôle de l’IP en SSP qui problématise certains discours tenus pour acquis en SSP. Elle permet également de proposer une nouvelle définition de l’intégration du rôle des IP en SSP.

D.Cur.
Nursing is a clinical discipline, strongly anchored in clinical practice. In order to learn the art and science of Nursing, it should be kept in mind that nursing is a complex and intrinsic process that entails skills that are highly cognitive. Community Nursing is one of the clinical disciplines in which clinical guidance takes place. Guidance in Community Nursing takes place on district health level and is based on the primary health care approach. With clinical guidance from a community nurse in the community nursing practice, students are given the opportunity to apply in clinical practice what they have learned in theory. Students learn in the clinical practice by working alongside a competent, experienced and registered community nurse. They are guided to realise their full potential, to develop self-confidence in psychomotor skills, as well as the good values which are an inherent part of nursing. Due to the fact that the clinical learning environment is dynamic, it is necessary to ensure value-sensitive clinical guidance in the community nursing practice. This implies that the values of all role players involved in clinical guidance, namely the students and nurses (the patients during clinical guidance) should be handled with the necessary sensitivity. The goal of the study was to explore and describe to what extent value-sensitive clinical guidance in Community Nursing takes place. As a result of the findings a concept analysis of the categories identified was done and standards for value-sensitive clinical guidance in Community Nursing were developed and refined. For the purposes of this study an explorative, descriptive and contextual design was used. Interactions taking place between the nurses and students during clinical guidance were explored for value-`sensitivity by means of video-recordings, participative observation, diaries, focus-group and semi-structured interviews. The data collected were analysed and coded by the researcher and the external coder. As a result of the findings in this research a concept analysis was done of the different categories (identified in phase 1). The findings were compared with the literature in the concept analysis and similarities and differences were highlighted. As a result of the concept analysis standards for value sensitive clinical guidance in Community Nursing were developed, described and refined after it was presented to experts from academic training institutions and the community nursing practice. The four main categories identified were communication, attitudes, respect and clinical opportunities during clinical guidance. Due to the fact that professional socialisation mainly takes place in the clinical practice clinical guidance should be well-planned. Nurses acting as clinical guides should always keep in mind that they are acting as role models who are in possession of sufficient theoretical and clinical knowledge, and that they must maintain high nursing care standards. Nurses must approach the clinical guiding situation with an open and accommodating attitude. Students should be respected as human beings in order to establish open communication channels whereby clinical learning in students could be facilitated. Therefore a supportive, non-threatening clinical practice should be established, so that students will take the liberty to ask questions and will have the confidence to participate in clinical nursing actions under the direct supervision of nurses. The standards for value-sensitive clinical guidance in community nursing are aimed at all role players involved with clinical guidance. These role players include the service providers (the nurses, clinical co-coordinators and managers), as well as the academic training institutions (lecturers and students).

By 2014 the NHS is expected to make �21 billion in efficiency savings and increase productivity by 6% per annum, while maintaining or improving the quality of care. Given that the cost of the 1.7 million strong workforce represents 60% of the NHS budget, changes are likely. This context of innovation and cost-effectiveness has resulted in an ever greater emphasis to fully engage and support community nursing.

The social phenomenon of stress and workplace burnout has spanned over five decades. Despite a plethora of literature that exists, there still remain problematic issues that neither scientific investigation or government legislation have been able to resolve. The literature examined throughout this research is extensive and does reflect this 50-year period. It demonstrates that studies into this phenomenon have attempted to define stress, identify causal factors of workplace stress, workplace burnout and environmental congruence; and discusses strategies (focused on both the individual and organizational levels) that have been implemented to effect beneficial outcomes for individuals affected by any one of these. As this thesis continues, the more recent literature gives a greater recognition to violence in the workplace and legislative enactments as preventative measures to reduce the heavy burden of costs, both physical and financial, to organizations. This extensive literature review indicates no answer to the problem has been identified to date and that this phenomenon remains, giving a clear indication that further scientific investigation is required to find a solution to what was described as the most serious health issue of the 20th century. Based on the literature examined this health issue has now gone well beyond the 20th century, giving relevance to the research study described in this thesis. The investigation is validated as vital and should be used as a basis for further research. This study undertook a collaborative social process, action research, empowering participants to identify and change stressful factors identified within their practice indicative to rural remote community mental health teams. A critical social theory arose out of the problems within the context of the research setting, based on the ideal that the significant issues for this group of individuals within this organization could be solved through the action research process. The group ‘existed’ within the issues indicative to this rural remote area, however these issues were outside their control. Through the implementation of the action research process courses of actions were undertaken that provided enlightenment in self-knowledge with dialogue heightening collective empowerment to effect change within their practice. The action research process, being a holistic process, facilitated this change in practice, developed and refined theory as it proceeded in a cyclic fashion within this local setting. It concerned actual not abstract practices in the social world in which these participants practice. This methodology facilitated examining the significant stressors identified by the Community Mental Health Support Team (CMHST) that caused distress, allowing them to implement changes in their practice. The forum provided an avenue that could reduce stressors significantly and prevent ongoing occupational stress that contributes to workplace burnout. It offered an opportunity to work with a group of participants in a nonhierarchical and non-exploitative manner and enabled members of this group to identify their roles as effective practitioners, empowering them to effect the changes they deemed as essential criteria to reduce the stress they were experiencing indicative to their remoteness. Critical reviewing throughout the data collection attempted to understand and redefine these significant issues. It aimed to acknowledge the way things were relative to how things could be improved from organizational, personal and wider community perspectives. Simple principles and guidelines of action research were followed potentiating acceptance as a rigorous research approach from a positivist perspective whilst retaining the attributes that characterise action research. There are solutions to the dilemma of the employee overcoming the debilitating effects of stress leading to workplace burnout. This includes the cooperation of managers, policy makers, academic researchers and government officials working collaboratively to reduce the impact of occupational stress. Through this collaborative process, changes can be effected to ensure the health of the nation improves and that relevant recognition is given to the fact that there is a significant threat to a healthy workforce. Examining the nursing profession from a social perspective provides alternatives to medicalising workplace injuries and illnesses.
Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

Growth in use of digital technology for leisure and learning has created challenges for healthcare environments globally. Its rapid evolution in nursing continues to outpace the more sporadic updating of registered nurse standards, guidelines and codes of professional conduct. Revised standards in Australia and the United Kingdom establish the contemporary governance context for the educational preparation of registered nurses. A document analysis of these standards reveals an omit of guidance regarding the expected knowledge, skills, attitudes and behaviour of undergraduate nurses about when and how to access and use of digital technology on campus, and during work integrated learning. Documents governing nursing do not currently foster the development of digital professionalism, an essential component of professional identity formation, which is necessary to acquire prior to graduation as a registered nurse.

Nursing Informatics emerged in Australia during the early 1980s and drove the Professional development and acceptance of Health Informatics. Milestones achieved include the development of a national journal, the establishment of the Health Informatics Society of Australia and the Australasian College of Health Informatics (now collectively the Australasian Institute of Digital Health), nursing participation in Health Informatics standards development activities, adoption of the HL7 messaging standard, the delivery of numerous workshops, an annual national health informatics conference since 1993, hosting international conferences, the development and delivery of Health Informatics post graduate programs and establishing a research centre where the first prototype for an archetype repository was developed. This became the openEHR Clinical Knowledge Manager. The most recent milestone was the establishment of a private company that became a Registered Training Organisation. Continuing challenges include workforce capacity building to address the poor understanding of the need for improved data and IT governance at every level, the need to comply with proven scientific and technical principles and a need to transform national and international traditional infrastructures no longer fit for purpose to enable adequately support for global sustainable digital health ecosystems. Desired personal and aggregate data supply chains must be taken seriously and be supported by the best available technologies. Our collective biggest challenge is to improve multidisciplinary and intersectoral collaboration, semantic interoperability and optimum digital support to maintain global public health.

The chapter first explores the issues involved in how and why mental health nurses come to learn about the decisions that they need to take in clinical practice, and why these are crucial to the establishment and maintenance of therapeutic relationships. It must be noted that various terms will be used throughout this chapter that refer to individuals requiring care and support from nurses—that is, ‘patients’, ‘service users’, and ‘clients’. We will also explore some of the challenges and tensions that can arise when there is a difference between what the professional and the service user might feel is the right decision. Reference is made to the prevailing mental health legislation in the United Kingdom and, in particular, the legislation around care being provided possibly against an individual’s wishes and while he or she is living in the community. If you are not living or studying in the UK, you should seek out the relevant legislation that applies to your country. You might want to see where the similarities and differences are between that and the UK legislation. The chapter concludes with a discussion of how the mental health nurse can ensure that inclusive and informed decision making leads to safe, secure, and effective mental health care. By means of the case studies and the discussion, it will enable you, as the student nurse, to learn how different kinds of decision making can influence outcomes of care, and it will also help you to work towards achieving the Nursing and Midwifery Council (NMC) competencies as they relate to decision making in nursing practice. Note that while the case studies are based on real-life examples of decision-making situations, all names in the case studies have been changed, in keeping with The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives (NMC 2008). Mental health nurse education, practice, and research have long championed innovative approaches to improving our understanding of the impact, on individuals, the communities in which they live, and wider society, of the decisions and actions taken in the name of therapeutic endeavour.

Psychiatric nursing as an entity has really only evolved since the Second World War. Psychiatric nurses (now often referred to as mental health nurses in the United Kingdom and Australasia) can now be found in most countries of the developed world, although in the developing world, psychiatric nursing is still not defined as a specific discipline. In many countries, psychiatric hospitals are still staffed by untrained ‘Attendants’ who may have some supervision from general trained nurses. Nevertheless, a number of initiatives, notably those of the Geneva Initiative in Psychiatry in Eastern Europe and the former Soviet Union and the World Health Organization in African countries, have provided specific training in psychiatric nursing techniques. The development of psychiatric nursing across the world needs to be seen in the context of changing and evolving patterns of mental health care. De-institutionalization, with the attendant setting up of community mental health teams, has prompted a range of innovations in psychiatric nursing and the psychiatric nurse of today, who in the United States and Europe is likely to be a university graduate, is a very different person to that of the nurse working in the post-Second World War asylums of 40 years ago. In this chapter, we examine the development of psychiatric nursing in some detail and particularly emphasize the role of psychiatric nurses working in the community. Community psychiatric nursing first developed in the United Kingdom nearly 50 years ago and this model has been followed in countries such as Australia and New Zealand. However, this community role has not developed to any great extent in the United States, where the main presence of psychiatric nursing remains in hospital-based care. Furthermore, in the United Kingdom and Australasia, the development of community initiatives has seen the role of the psychiatric nurse blurring with that of other mental health professionals. Chapters such as this cannot really do justice to the whole range of techniques used by psychiatric nurses; neither can it examine in any detail the differences between psychiatric nursing practices across the world. However, a description of psychiatric nursing in six important areas will provide the reader with an appreciation of the range and diversity of psychiatric nursing skills:♦ Inpatient care ♦ Psychosocial interventions in the community ♦ Prescribing and medication management ♦ Cognitive behaviour therapy ♦ Primary care ♦ Psychiatric nursing in the developing world.

This chapter addresses the essential nursing responsibility to ensure that adequate nutritional care is offered to all patients, whether in hospital or community-based settings. To provide appropriate nutritional care to patients or clients, nurses must have a good knowledge and understanding of the principles of human nutrition, and be able to deliver nutritional support that is informed by current clinical guidelines and up-to-date evidence, as well as to evaluate that care. Healthcare organizations have a duty to ensure that patients and clients receive high-quality nutritional care. The Council of Europe (2003) has published guidelines on food and nutritional care in hospitals, and a recent Europe-wide campaign has been launched to improve nutritional care in all types of care facility (Ljungqvist et al., 2010). A European strategy to address obesity has also been launched (Commission of the European Communities, 2007). In England, the Care Quality Commission (CQC, 2010), which regulates care settings, has set national standards concerning nutrition. The provision of high-quality nutritional care involves a range of services and requires a multidisciplinary team approach. As a nurse, your role within the multidisciplinary team is fundamental in ensuring the delivery of appropriate nutritional care. In the UK, this is clearly identified by the incorporation of ‘Nutrition and Fluid Management’ within the Essential Skills Clusters for pre-registration nursing education (Nursing and Midwifery Council, 2010). Human nutrition is the study of nutrients and their effect on health, and the processes by which individuals obtain nutrients and use them for growth, metabolism, and repair. The term ‘human nutrition’ therefore incorporates many aspects of behaviour and physiology. The way in which the body obtains, ingests, digests, absorbs, and metabolizes nutrients is described in core anatomy and physiology textbooks (for example, Marieb and Hoehn, 2010), and it is important that a good knowledge and understanding of these processes is gained before considering the nursing management of nutritional care. This chapter considers the principles of human nutrition that underpin the nursing management of nutritional care and focuses on the key nursing interventions that you should be able to provide with confidence. The amount and type of nutrients that a person obtains influences his or her ‘nutritional status’.

[This Proceedings paper was revised and published in the 2019 issue of the Interdisciplinary Journal of E-Skills and Lifelong Learning, Volume 15.] Aim/Purpose This study aims to determine where nursing students from a metropolitan university subsequently work following graduation, identify the factors that influence decisions to pursue careers in particular locations, ascertain educational plans in the immediate future; and explore the factors that might attract students to pursue postgraduate study. Background The global nursing shortage and high attrition of nursing students remain a challenge for the nursing profession. A recurrent pattern of maldistribution of nurses in clinical specialities and work locations has also occurred. It is imperative that institutions of learning examine their directions and priorities with the goal of meeting the mounting health needs of the wider community. Methodology Qualitative and quantitative data were obtained through an online 21-item questionnaire. The questionnaire gathered data such as year of graduation, employment status, the location of main and secondary jobs, the principal area of nursing activity, and plans for postgraduate study. It sought graduates’ reasons for seeking employment in particular workplaces and the factors encouraging them to pursue postgraduate study. Contribution This study is meaningful and relevant as it provided a window to see the gaps in higher education and nursing practice, and opportunities in research and collaboration. It conveys many insights that were informative, valuable and illuminating in the context of nurse shortage and nurse education. The partnership with hospitals and health services in providing education and support at the workplace is emphasized. Findings Twenty-three students completed the online questionnaire. All respondents were employed, 22 were working in Australia on a permanent basis (96%), 19 in urban areas (83%) with three in regional/rural areas (13%), and one was working internationally (4%). This pilot study revealed that there were varied reasons for workplace decisions, but the most common answer was the opportunity provided to students to undertake their graduate year and subsequent employment offered. Moreover, the prevailing culture of the organization and high-quality clinical experiences afforded to students were significant contributory factors. Data analysis revealed their plans for postgraduate studies in the next five years (61%), with critical care nursing as the most popular specialty option. The majority of the respondents (78%) signified their interest in taking further courses, being familiar with the educational system and expressing high satisfaction with the university’s program delivery. Recommendations for Practitioners The results of the pilot should be tested in a full study with validated instruments in the future. With a larger dataset, the conclusions about graduate destinations and postgraduate educational pursuits of graduates would be generalizable, valid and reliable. Recommendation for Researchers Further research to explore how graduates might be encouraged to work in rural and regional areas, determine courses that meet the demand of the market, and how to better engage with clinical partners are recommended. Impact on Society It is expected that the study will be extended in the future to benefit other academics, service managers, recruiters, and stakeholders to alert them of strategies that may be used to entice graduates to seek employment in various areas and plan for addressing the educational needs of postgraduate nursing students. The end goal is to help enhance the nursing workforce by focusing on leadership and retention. Future Research Future directions for research will include canvassing a bigger sample of alumni students and continuously monitoring graduate destinations and educational aspirations. How graduates might be encouraged to work in rural and regional areas will be further explored. Further research will also be undertaken involving graduates from other universities and other countries in order to compare the work practice of graduates over the same time frame.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.