Vicki Cope

INTRODUCTION: Adolescent idiopathic scoliosis is the most common spinal deformity encountered in adolescents and larger curves are more prevalent in girls. For females with scoliosis, women’s health issues are of particular concern, especially pregnancy. The aim of this review was to summarise the best available evidence to determine the influence of pregnancy on scoliosis-related outcomes in women with scoliosis and whether scoliosis affects maternal-health outcomes, differentiating between patients who have been managed conservatively and/or surgically.
EVIDENCE ACQUISITION: A search was conducted using CINAHL, Scopus, Cochrane Database, MEDLINE, and EMBASE from inception to May 2023 to identify relevant articles in any language. The scoping review followed the PRISMA-ScR guidelines. Studies were eligible if they included pregnant women (primiparous or multiparous) with a diagnosis of scoliosis of unknown aetiology. The results were summarized by outcomes, including pregnancy and scoliosis-related outcomes and type of management.
EVIDENCE SYNTHESIS: Our comprehensive search strategy identified 6872 articles, of which 50 articles were eligible for this review. Back pain appears to be more prevalent in this population during pregnancy and associated with the major curve and the decrease of lumbar lordosis. There have been reports of failed attempted spinal anaesthesia among patients with instrumented scoliosis correction and minor complications related to epidural anaesthesia at a higher rate compared to non-instrumented patients and healthy controls, however successful spinal analgesia can be achieved in patients with instrumented scoliosis correction. Overall, the caesarean section rate was similar in scoliosis patients compared to controls without scoliosis and to national averages. Curve progression occurs in some but not all patients during pregnancy, and this phenomenon occurs irrespective of the treatment received.
CONCLUSIONS: Higher-quality prospective longitudinal research is needed to understand the relationship between pregnancy and adolescent idiopathic scoliosis. Further, the patient’s perspective, concerns and fears surrounding pregnancy with scoliosis are yet to be explored. Exploring the impact of pregnancy on women with adolescent idiopathic scoliosis would have clinically relevant outcomes and could help provide pertinent answers to patients and healthcare workers and help guide future research.

Australia has an aging population with increasing numbers embarking on the major life transition to retirement when compared to previous decades. The Australian university sector has experienced considerable upheaval as it has undergone austerity measures to attempt to manage the impact of the pandemic. The objective of this study was to conduct interviews with Australian university academics who have recently transitioned into retirement, to explore their experience of transitioning to retirement in a COVID-19 environment. The study followed the COREQ guidelines for qualitative studies. Participants were selected based on having recently retired within the previous two years from an Australian university. We conducted semi-structured interviews to explore the participants' in-depth experience of the transition to, as well the actual experience of retirement. Thematic analysis was conducted. Six participants with a mean age of 64.7 years were interviewed for this study. Five super-ordinate themes emerged; 'dissatisfaction with the university,' 'desire to continue to be involved,' 'financial considerations,' 'loss of identity, meaning and belonging,' and 'the need to plan and maintain a structured life.' Retirement was seen as an important change in life. There appeared to be a weighing up of the value of quality of life, perhaps influenced by a growing awareness of its shortness. The respondents believed it is extremely important to plan retirement and to start this process early. Proffered recommendations included the making of plans to remain mentally and physically active, and to maintain purpose into retirement.

Aim

To understand the practice readiness of the early career registered nurse in their first five years of practice within very remote hospital healthcare provision.

Background

The practice readiness of early career registered nurses is often questioned; this is particularly true of nurses in rural and remote settings where, due to a transitory workforce, adequate support may not be forthcoming.

Method

Qualitative descriptive design using semi-structured interviews involving early career (n = 4) and later career (n = 3) registered nurses in very remote hospitals. Data were analysed using Creswell's six-step approach to thematic analysis.

Findings

Practice readiness includes both professional and personal readiness. Early career registered nurse participants felt not ready for remote area employment. Later career registered nurses suggest that critical care placements in an emergency department or intensive care unit are necessary for preparedness to work in rural and remote areas. Key to supporting and developing practice readiness is organisational support, adequate, consistent staffing, and structured orientation across all departments.

Discussion

Early career registered nurses understand their limitations; however, organisational support through appropriate orientation, supernumerary time, and adequate education is often not available.

Conclusion

To support early career registered nurses to be practice ready, it is the organisation's responsibility to provide the adequate support, information, and preparatory education to ensure an effective transition to practice for future proofing of the rural and remote nurse workforce.

Background

Inter-Hospital Transfer (IHT) may require an escort from the referring hospital, either a Registered Nurse (RN), physician or both, leading to a sudden drop in staffing levels within the referring department potentially increasing risk to patients and staff.

Aims

To explore the perspectives of RNs and physicians of differing experience levels when left behind due to an escorted IHT, and the decision-making protocols for IHT.

Method

A qualitative exploratory approach of 5 RNs and 4 physicians selected using purposeful sampling. Data were collected through semi-structured interviews and thematically analysed.

Findings: Five themes were identified: the impact of being left behind; the burden of transfer; missed care; a triangulation of competing needs upon the decision-making process; and the effect of inter-hospital transfers on staff with different experience levels.

Conclusion

IHT is described differently by less experienced RNs compared to their more experienced counterparts especially concerning safety and risk. Physicians described the department as vulnerable with ad-hoc decision-making protocols surrounding IHT the norm.

An exploratory qualitative study was performed to evaluate the experiences of nursing staff (N = 10) working in a residential aged care facility (RACF) during the coronavirus disease 2019 (COVID-19) pandemic lockdown. Semi-structured, in-person interviews were performed, and thematic analysis was used to analyze the data. Care staff had little or no knowledge of how to cope with a lockdown necessitated by a pandemic. However, management developed proactive plans as they aligned with the changing care circumstances and ongoing government directives. Five major themes were identified: Prolonged Use and Shortage of Personal Protective Equipment; “Blind Leading the Blind”; Communication and Teamwork; Lack of Education; and Resident Response. RACF staff described working under stressful conditions during the initial COVID-19 pandemic lockdown; yet with experience, care staff and the management team adapted to pandemic requirements to meet the needs of residents in their care. RACFs should be prepared for the impact of pandemics on staff and ensure care resources and support are available for the continuity of safe and quality care of residents.

Background The COVID-19 global pandemic was declared in March 2020. By June 2022, the total deaths worldwide attributed to COVID-19 numbered over 6.3 million. Health professionals have been significantly impacted worldwide primarily those working on the frontline but also those working in other areas including nursing, midwifery, and paramedic higher education. Studies of occupational stress have focused on the clinical health professional roles but scant attention has been drawn to the pressures on university-based academic staff supporting and preparing professionals for frontline health work. Design and objectives This qualitative study sought to explore the challenges experienced by health academics (nurses, midwives and paramedics), during COVID-19 and identify strategies enlisted. Setting and participants Six Australian and two United Kingdom universities collaborated, from which 34 health academics were individually interviewed via video or teleconference, using six broad questions. Ethical approval was obtained from the lead site and each participating University. Data analysis Thematic analysis of the data was employed collaboratively across institutions, using Braun and Clarke's method. Results Data analysis generated four major themes describing academics': Experiences of change; perceptions of organisational responses; professional and personal impacts; and strategies to support wellbeing. Stress, anxiety and uncertainty of working from home and teaching in a different way were reported. Strategies included setting workday routine, establishing physical boundaries for home-working and regular online contact with colleagues. Conclusions The ability of nursing, midwifery and, paramedic academic staff to adapt to a sudden increase in workload, change in teaching practices and technology, while being removed from their work environment, and collegial, academic and technological supports is highlighted. It was recognised that these changes will continue post-COVID and that the way academics deliver education is forever altered.

Objective Remote area nurses provide primary health care services to isolated communities across Australia. They manage acute health issues, chronic illness, health promotion and emergency responses. This article discusses why their generalist scope of practice should be formally recognised as a specialist nursing practice area. Design Constructivist grounded theory, using telephone interviews (n = 24) with registered nurses and nurse practitioners. Setting Primary health care clinics, in communities of 150–1500 residents across Australia. Participants A total of 24 nurses participated in this study. Results Nurses' perceived their clinical knowledge and skill as insufficient for the advanced, generalist, scope of practice in the remote context, especially when working alone. Experience in other settings was inadequate preparation for working in remote areas. Knowledge and skill developed on the job, with formal learning, such as nurse practitioner studies, extending the individual nurse's scope of practice to meet the expectations of the role, including health promotion. Conclusion Remote area nursing requires different knowledge and skills from those found in any other nursing practice setting. This study supports the claim that remote area nursing is a specialist–generalist role and presents a compelling case for further examination of the generalist education and support needs of these nurses. Combined with multidisciplinary collaboration, developing clinical knowledge and skill across the primary health care spectrum increased the availability of health resources and subsequently improved access to care for remote communities. Further research is required to articulate the contemporary scope of practice of remote area nurses to differentiate their role from that of nurse practitioners.

Objective To explore the experiences of newly qualified registered graduate nurses’ clinical and professional learning experiences, during their first six-months of post registration employment within a graduate nurse transition program in a Neonatal Intensive Care Unit (NICU). Method Narrative inquiry with thematic analysis was used to explore the newly qualified registered graduate nurses’ accounts via semi-structured interviews, conducted between January 2018 – January 2019, of their clinical and professional learning during their employment in the Neonatal Intensive Care Unit. Setting In total, eight newly qualified registered graduate nurses employed at two Western Australian Hospitals sites were recruited. Findings Themes identified included: feeling unprepared; experiences of horizontal violence; the need for a supportive structural environment and seeking feedback. Participants reported overwhelming feelings of stress, emotional exhaustion, concerns for patient safety and for some, fear of early career burnout. Conclusion In this study, newly qualified registered graduate nurses were clinically underprepared for entering a Neonatal Intensive Care Unit with all participants reporting high levels of psychosocial distress. This was further compounded by a lack of structured support, horizontal violence, and inadequate or no regular feedback from preceptors, resulting from a negative workplace culture and poor educator behaviours. Recommendations for improving the experiences of newly qualified registered graduate nurses employed in the Neonatal Intensive Care are discussed.

Aims To critically appraise contemporary literature and synthesize common components of nurse manager development programmes. Background Although the need for nurse manager development programmes has been well documented, minimal recent research exists which identifies and evaluates the common components in these programmes. Furthermore, nurse managers continue to be poorly prepared and supported in role transition, contributing to poor organisational and role performance and decreased retention. Method A structured literature review saw 14 original research publications appraised for quality, analysed and included in the review. Results The common components identified in nurse manager development programmes include curriculum, method of delivery, support, and funding components. Various subthemes were also identified. Conclusion The components identified within existing nurse manager development programmes are varied. Although there are common components within nurse manager development programmes, these individual components have not been evaluated for effectiveness. There is a clear need for further development of nurse manager development programmes and evaluation of the specific components within. Implications for Nursing Management An understanding of the common components in NM development programmes is useful for designing and implementing robust evidence‐based programmes. Inclusion of these components may facilitate a smoother role transition, enhance performance and improve recruitment and retention of nurse managers.

Aims To explore and analyse the current bed management processes and understand the perspectives of nurse managers on mixed‐gender accommodation in a regional hospital in Australia. Background Mixed‐gender accommodation was introduced to help manage the increasing demand for hospital beds. Yet, some health services identify same‐gender accommodation better aligns with patient‐centredness. Method This qualitative research was conducted at a public hospital in regional Australia and focused on the experience in the general wards. Eight nurse managers were selected using purposeful sampling. Data were collected through face‐to‐face semi‐structured interviews and thematically analysed. Results Three main themes were identified: current admission processes—managing admissions, bed allocation considerations, patient involvement and managing mixed‐gender rooms; impacts on patients—participant views, patient experience and bathrooms; and barriers and facilitators—capacity, infrastructure, safety and risk, bed swapping and organisational factors. Conclusions The study demonstrates a lack of structure and patient‐centredness with mixed‐gender allocation processes. Local organisational guidelines are suggested to support improvement in patient‐centred inpatient hospital accommodation.