Eric Lim

Aim
This paper presents a pilot study evaluating the acceptability, feasibility and effectiveness of an education program incorporating virtual reality for teaching aggression management among final-year undergraduate nursing students at one university in Western Australia.

Background
Virtual reality can be useful for simulating high-risk clinical situations without exposing nursing students to the potential consequences of encountering the event in the real world. As such, virtual reality is useful when incorporated into education on the prevention and management of aggression, preparing students to be industry-ready. However, there is a gap in the literature regarding the use of virtual reality in teaching in this area of the curriculum.

Design
This is a pilot study that used a quantitative pre- and post-education survey design.

Methods
Nursing students completed pre-education surveys, participated in an educational program that incorporated virtual reality (VR) to teach aggression management and then completed post-education surveys.

Results
The participants (n = 11) completed both the pre- and post-education surveys, as well as provided qualitative responses. The findings showed that the education program was effective in increasing nursing students' confidence in managing aggression (p > 0.022). Participants also reported that the use of virtual reality was realistic to simulate the aggressive clinical scenario (M = 6.18, SD = 0.75), to stimulate experiential learning to manage aggressive persons (M = 6.18, SD = 0.60) and that the debrief helped them to reflect and consolidate their learning (M = 6.36, SD = 0.67). They also reported that the Virtual Reality Aggression Management education program was more effective than traditional didactic methods of teaching this subject area (M = 6.45, SD = 0.52).

Conclusions
The findings of this pilot study will be further explored and developed based on the findings of this pilot work. Further research will be conducted with a larger scale of nursing and other healthcare students.

Facilitating voluntary disclosures of non-suicidal self-injury (NSSI) has emerged as a promising approach to catalysing personal recovery and early support-seeking for people who self-injure. However, approximately half of individuals who self-injure have never disclosed their NSSI. To date, there is a lack of theoretical explanations available to conceptualise the decision to disclose NSSI. However, various anticipatory cognitions (e.g., anticipated stigma) have been implicated in the disclosure process. As such, this scoping review used Social Cognitive Theory as a theoretical framework to identify and synthesise the social cognitive factors underlying NSSI disclosure. This review considered all published empirical articles and theses that 1) reported on populations with a history of NSSI, 2) examined NSSI disclosures, and 3) reported on at least one social cognitive factor associated with NSSI disclosures. The review was guided by Arksey and O’Malley's 5-step methodological framework and Joanna Briggs Institute's guidelines for conducting scoping reviews. The findings from 43 studies support the applicability of Social Cognitive Theory in conceptualising NSSI disclosures. Specifically, factors underlying the decision to disclose often aligned with the theory's fundamental tenets of self-efficacy, outcome expectancies, and social modelling. Across the literature, we identified cognitions that were consistently implicated as barriers or facilitators of NSSI disclosure. The findings indicate that expectancy-challenge interventions may be effective in facilitating disclosures of NSSI. Despite this, the findings of the review call for future research validating the utility of Social Cognitive Theory in the disclosure context, particularly among culturally diverse populations.

Background
Attention-Deficit/Hyperactivity Disorder (ADHD)/Hyperkinetic Disorder (HD) is linked to increased risks of morbidity, comorbidity and mortality, with higher prevalence in clinical populations. The differential prevalence of ADHD/HD across adult and pediatric clinical populations, influenced by factors such as time trends, sex, age, geographic regions, and comorbidities, has not been systematically assessed.

Methods
MEDLINE, CINAHL, Embase and PsycINFO databases were searched from inception to 1st August 2023 for eligible full-text papers published in English, and reviewing reference lists of identified studies and review papers. Studies reporting ADHD/HD prevalence in adult and pediatric clinical populations were included. Meta-regression evaluated the effects of geographic region, year of publication and sample size.

Results
From 30,740 citations, we reviewed 521 full-text articles, yielding 311 studies for inclusion (including 653,558 pediatric and 43,311 adult participants). Overall, worldwide pooled prevalence of ADHD/HD in clinical settings for pediatrics was 32.4% (95% CI 31–34%), and in adults 21.4% (95% CI 20–23%). Prevalence was higher in outpatient settings than inpatient settings. Prevalence based on rating scales was higher than studies using diagnostic interviews or clinical record review. Prevalence varied significantly across subspecialist settings for children and adults. No significant time trend was detected between 1981–2023. Pediatric prevalence appears influenced by geographic region but not year of publication or sample size. For adults, larger sample sizes were associated with lower prevalence estimates.

Conclusions
ADHD/HD prevalence in clinical populations is 8-9-fold higher than community estimates. With these patients at risk for many adverse outcomes, our findings underscore the critical importance of resource allocation for screening, diagnosing and treatment.

Background and Aim: Micro‐elimination education can improve access to life‐saving treatments for patients with hepatitis C, co‐occurring mental health conditions, and alcohol and other drug use disorders. The Hepatitis C virus (HCV) is disproportionately prevalent among people with mental health conditions and alcohol and other drug issues, reducing their life expectancy. Although hepatitis C is a curable condition, this population frequently remains untested and untreated. Micro‐elimination programs are necessary to enhance hepatitis C virus screening and treatment rates. This study aims to evaluate the impact of micro‐elimination education on healthcare providers' confidence in identifying high‐risk HCV populations, conducting HCV screenings and treatments, and managing comorbid substance use disorders. Additionally, it will assess referrals to a nurse‐led HCV treatment clinic.

Methods: A quasi‐experimental pre‐posttest intervention design was used. The intervention was an education program targeted at HCV micro‐elimination and linkage to care.

Results: Questionnaires were administered to (n = 101) healthcare providers to measure changes in confidence in screening and treating HCV in people with comorbid mental health conditions and alcohol and other drug disorders pre‐ and post‐ intervention. Pre‐intervention, healthcare providers reported the highest confidence levels in treating mental health conditions. A significant increase in post‐education confidence in screening and treating the HCV across all healthcare provider roles was observed (p < 0.05). Twenty‐three referrals were received at the nurse‐led hepatitis C virus treatment clinic, with the majority (n = 11) of referrals received from nurses.

Conclusion: This study underscores the significance of micro‐elimination education programs in enhancing healthcare provider confidence in treating hepatitis C. Leveraging the mental health nursing workforce to connect high‐risk populations with hepatitis C care will expand timely access to life‐saving treatments and optimize healthcare outcomes. Targeted hepatitis C micro‐elimination education will further accelerate progress toward the 2030 elimination goals, enhancing the overall well‐ being of vulnerable populations.

Background and aim: Research on international students conducted during the COVID-19 pandemic has persistently highlighted the vulnerabilities and challenges that they experienced when staying in the host country to continue with their studies. The findings from such research can inevitably create a negative image of international students and their ability to respond to challenges during unprecedented times. The aim of this study is two-fold: (1). To provide insights into the pandemic’s impact on CaLD international nursing students. (2). To explore the lived experiences of CaLD international students in overcoming the challenges during the pandemic.

Method: A descriptive qualitative research design guided by constructivist grounded theory was used in this study. Students were recruited via flyers posted on the institutional digital learning platform. Nineteen in-depth 1 to 1 online interviews were conducted using an interview guide. Verbatim transcripts were analyzed using constant comparison analysis.

Results: Three themes emerged from the collected data that described the participants’ lived experiences, and they were (1) viewing international education as the pursuit of a better life, (2) focusing on personal growth, and (3) coming out of the ashes we rise. Discussion: The findings highlight the importance of recognizing the investments and sacrifices that CaLD international students and their families make in pursuit of international tertiary education. The findings also underscore the importance of acknowledging the qualities that CaLD international students have to achieve self-growth and ultimately self-efficacy as they stay in the host country during a pandemic.

Conclusion: Future research should aim to identify effective strategies that support CaLD international nursing students in achieving personal growth and self-efficacy. This is particularly important during times of uncertainty, such as a pandemic, to ensure that they can continue their studies successfully in the host country. Recognizing the investments and sacrifices made by these students and their families, as well as acknowledging their qualities and resilience, is crucial for developing supportive educational policies and practices.

Graduate nurses are now comprehensively prepared in Australia and have limited mental health knowledge and experiences to work in acute mental health settings. As such, graduate nurses would need the support that they can get from their respective mental health services to progress from novice to advanced beginner. Nursing education is an important support for graduate nurses to develop the knowledge and skills required for them to transition successfully into acute mental health settings. This study explored 12 graduate nurses' experiences with the nursing education of one mental health services in Western Australia. Q methodology was the approach chosen to conduct this study as it is a 'ready-to-use' mixed method research approach that can enable the researchers to obtain in-depth and accurate understanding of the researched topic. Data analysis generated four factors which revealed that nursing education needs to: (1) be tailored to the area of speciality for graduate nurses who experience challenges of being accepted by their nursing team; (2) provide advanced specialist mental health training for graduate nurses who have low self-confidence about their mental health nursing knowledge and skills to practice in acute mental health settings; (3) provide clinical supervision for graduate nurses who experience challenges to apply their mental health knowledge and skills to difficult clinical situations; and (4) change the way mental health education and training are delivered for graduate nurses who feel confident with their mental health knowledge and skills and accepted by their nursing team. The findings of this study highlighted the usefulness of Q methodology in nursing research. The findings of this study can be used by nurse educators to provide more individualised education and training for graduate nurses. Future research will be conducted to test the use of different teaching and learning approaches for the different categories of graduate nurses in acute mental health settings and develop evidence-based nursing education.

Introduction
In most western countries, international registered nurses are considered as an asset to meet the workforce shortage. Yet, international nursing students were initially urged to return to their parent countries during the COVID-19 pandemic. Nevertheless, some international nursing students remained in their host country.

Method
This paper reports on a Q methodology study to determine the factors critical to international students who remain in their host country during a pandemic.

Findings
The data from fifteen participants unanimously highlighted that international nursing students had made significant financial investments to study overseas and were determined to remain in their host country. Two critical factors were identified, and they were: (i) The importance of camaraderie during a pandemic, and (ii) The importance of experiencing personal growth during a pandemic.

Conclusion
The findings of our study highlighted the importance of universities to supporting international students to acculturate more effectively to experience a sense of community, and to incorporate self-care education into their curricula to develop personal growth during normal times to be better prepared for unprecedented times.

The international tertiary education sector was significantly affected by the COVID-19 pandemic due to the risk of negative learning and psychosocial experiences. Most international students who remained in the host countries demonstrated admirable resilience and adaptability during those challenging times. An integrative review of factors shaping international students’ learning and mental wellbeing during the COVID-19 pandemic was conducted. Five electronic databases—CINAHL, MEDLINE, ProQuest, PsycINFO, and Web of Science—were searched from 2020 to 2023 using the key search terms ‘international students’, ‘tertiary education’, ‘mental health and wellbeing’, and ‘COVID’. A total of 38 studies were included in this review. They revealed six factors across learning and psychosocial experiences. Predisposing factors for maladjustments included the students being younger and possessing poor English proficiency. Precipitating factors were related to online teaching/learning, and lack of accessibility and or insufficient learning and living resources. Perpetuating factors pertained to living arrangements. The protective factor identified was institutional support. This review highlighted that multifaceted factors were associated with international students’ experiences and mental health and wellbeing. In-depth understanding of risk and protective factors can help policymakers to prepare for unprecedented challenges and reduce disruptions to international students’ education and mental health when studying abroad.

Pre-registration nursing education has long moved away from preparing nurses with mental health specialisation to nurses with comprehensive knowledge and skills. However, the consumers' experiences of comprehensive-prepared nurses and their nursing care has not been widely explored. This paper reports on a study with consumers to explore their experiences with comprehensive-prepared graduate nurses and the nursing care that they provide in acute mental health settings. An exploratory qualitative study using semi-structured interviews was chosen as the research method. Purposeful sampling recruited 12 consumers and data saturation was achieved. Braun and Clarke's method of thematic analysis was used to analyse the collected data and three themes emerged. The themes are: (i) You got what it takes to be a mental health nurse, (ii) Slow down and spend quality time with us, and (iii) Read in between the lines when we share our negative lived experiences. The findings are useful for identifying strategies to develop evidence-based nursing education for comprehensive-prepared graduate nurses to improve the consumers' experiences of their nursing care.

Diagnostic overshadowing refers to a phenomenon whereby people with mental health conditions encounter inadequate or delayed medical attention and misdiagnosis. This occurs when physical symptoms are mistakenly attributed to their mental health condition. This paper presents a scoping review focusing on direct causes and background factors of diagnostic overshadowing in the context of hepatitis C infection in people who inject drugs and have concurrent mental health conditions. Despite significant strides in hepatitis C treatment with direct‐acting antiviral drugs, the complex interplay of mental health conditions and physical symptoms necessitates a nuanced approach for accurate diagnosis and effective screening. This review was conducted using Joanna Briggs Institute's methodology for scoping reviews. The databases searched included Medline, Embase, PsycInfo, Global Health, CINAHL and Scopus. This review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR). The search strategies identified 1995 records. Overall, 166 studies were excluded. Forty‐two (42) studies met the inclusion criteria. Three (n = 3) studies represented direct causes, and 39 (n = 39) with background factors related to diagnostic overshadowing. Studies highlighted six key themes encompassing diagnostic overshadowing, with communication barriers, stigma and knowledge deficiencies being the most prominent. Recognising and addressing diagnostic overshadowing in chronic hepatitis C will lead to increased screening, diagnosis and timely administration of life‐saving antiviral therapy, resulting in profound enhancements in well‐being and health outcomes. Moreover, this proactive approach will play a pivotal role in advancing the global effort towards eliminating hepatitis C by 2030.