100

Educating the nurse of the future

Professor Steven Schwartz1

1University of Western Australia, Perth, Australia

In 2018, the Australian Government commissioned Steven Schwartz to review nursing education to ensure the nurses of the future are adequately equipped to meet the needs of Australia’s future health system. Nurses are the largest single health profession in Australia and comprise more than 40 per cent of Australia’s health workforce. The Government called for this review because significant changes have occurred in health care, higher education, and demographics since nursing education was last examined in 2002. The review examined the effectiveness of the current educational preparation of, and articulation between, enrolled and registered nurses and nurse practitioners in meeting the needs of health service delivery. • The respective roles of the education and health sectors in the education of the nursing workforce. • Regional needs and circumstances. • National and international trends. Extensive public consultation informed the review. More than 1,100 educators, clinicians, supervisors, policymakers, patient group members, students, managers, and union representatives attended consultations. The review also received 84 written submissions, commissioned four research papers, and conducted surveys of specially targeted groups. Steven Schwartz talk summarises the review’s findings and recommendations for the educational preparation required for nurses to meet the future health, aged care, and disability needs of the Australian community. This includes clinical training, attracting people to a career in nursing, and exploring the best way to encourage diversity.

101

A systematic review and meta-analysis of Nursing Assistant activities: Role creep an indicator of the future nurse?

Dr Nicole Blay1,2,3, Associate Professor Michael Roche4

1Western Sydney University, Campbelltown, Australia, 2Ingham Medical Institute, Liverpool BC, Australia, 3South Western Sydney Local Health District (SWSLHD), Liverpool BC, Australia, 4University of Technology Sydney, Ultimo, Sydney, Australia

Aim/Objective: To explore the published literature to identify nursing activities undertaken by the unregulated Nursing Assistant or global equivalent in the acute and primary health care environment. Method: The databases MedLine/PubMed, ProQuest and Google Scholar were systematically searched as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, for publications that addressed the work activities of the Nursing Assistant. Inclusion criteria were empirical research published between 2008 and 2018 in the English language. The initial search yielded 2944 publications of which 71 publications were retained for full-text review. Following this process, twenty publications were included for review and meta-analysis. Results: The 20 publications from eight different countries isolated 233 descriptors of activities performed by Nursing Assistants globally. Activities were collapsed into 44 nursing activities and categorised into six groups previously utilised in work sampling studies. The majority (57%) of identified Nursing Assistant activities were categorised as direct (patient) care and 13% as indirect care. Of concern is that more than one in ten activities were within the scope of the Registered Nurse rather than the Nursing Assistant, and that 9% of direct care activities required advanced clinical knowledge or skills. Conclusion: This is the first study to explore and quantify work performed by Nursing Assistants and their global equivalents. Findings provide insight into the future nurse by highlighting that nursing activities considered today to require an advanced level of comprehension, education and/or skill, are creeping into the realm of the unregulated Nursing Assistant.

102

How postgraduate leadership education can impact knowledge, skills and attributes needed for practice

Dr Rebekkah Middleton1, Mr Keith Jones2, Ms Margaret Martin2

1University Of Wollongong, Wollongong, Australia, 2South East Sydney Local Health District, Sydney, Australia

Key health reports internationally have highlighted and recommended the need for effective and visible leadership in health (Francis 2013, Garling 2008). The reports identified that absence of good nursing leadership had a negative impact on patient care, with one of the key recommendations being to support leadership development for nurses and midwives. There is considerable reported work around leadership development but little that demonstrates impact and effectiveness of formal leadership education in healthcare practice. This presentation will report research that investigated nurses and midwives perspectives on the impact of theoretical knowledge gained from undertaking a postgraduate subject ‘Effective Leadership in Health’ at a regional university in Australia on aspects of practical leadership in healthcare in relation to organisational culture, interpersonal relationships, processes and systems. Group interviews were conducted and data analysed through thematic analysis. Themes that emerged were ‘Learning to Lead’, ‘Academic Study’, and ‘Teamwork.’ The results from this research are being used to support nurses and midwives to become transformational person-centred leaders. The impact of postgraduate leadership study on approaches to practice and relationships is irrefutable, results and stories from practice will be shared to demonstrate findings from the research. References Francis, 2013, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Executive Summary. Garling, 2008, Final Report of the Special Commission of inquiry, Special Commission inquiry – Acute Care Services in NSW public hospitals.

103

Genomics in nursing practice in Australia

Dr Helen Wright1, Professor Melanie Birks1, Professor Jane Mills2, Dr Lin Zhao3

1James Cook University, Townsville, Australia, 2Massey University, Wellington, New Zealand, 3RMIT University, Melbourne, Australia

Aim/Objective: Genomics is beginning to reshape healthcare delivery by changing the way we prevent, diagnose, treat and monitor illness, providing the opportunity to offer more precise and tailored treatments. As genomic developments change healthcare so too are they changing the nursing profession. This presentation will discuss the findings of a study that aimed to determine how nurses engage with genomics in nursing practice in Australia. Methods: A single holistic case study was conducted. Data were collected via a cross-sectional survey of Australian registered nurses and midwives in 2016, and via semi-structured interviews with registered nurses working in oncology departments within a regional Australian hospital in 2018. Key case findings were generated using thematic analysis. Results: Findings indicate that Australian nurses have limited engagement with genomics at the point of learning (education), point of reference (professional expectations) and point of care (clinical practice). Nurses’ engagement at each of these points is sequential, meaning that if nurses are not knowledgeable about genomics and are unclear about professional expectations, they cannot be expected to adequately integrate genomics into their practice. This limited engagement with genomics has consequences for the nurse, the patient and the wider nursing profession. Conclusion: The ‘genomic revolution’ will require further development of Australia’s capacity, capability and infrastructure if these are to support the integration of genomic information and technology into the national health system. It is recommended that (i) genomics be embedded throughout the nursing curricula with healthcare applications made clear to the learner (point of education), (ii) nursing policy articulates the alignment between the NMBA’s Standards for Practice and genomic competencies (point of reference), and (iii) nurses incorporate genomics knowledge and skills into practice (point of care). As the largest component of the Australian health workforce, nursing cannot ignore the opportunity before us.

104

Who are primary health care nurses and what are their chronic disease management and healthy ageing training needs?

Ms Jane Henty1

1Australian Primary Health Care Nurses Association (APNA), Melbourne, Australia

Aim/Objective: The purpose of the consultation phase of the Chronic Disease Management and Health Ageing Program was to identify the training needs and preferences of primary health care nurses. Methods: An online survey was distributed to primary health care nurses across Australia. It was based on a scoping of the literature on best practice for delivering continuous professional development to nurses, and an existing survey called the Chronic Care- Training Needs Analysis. It included questions about demographics, knowledge and skills relating to core competencies of chronic disease management and healthy ageing, nurses’ recent training, and preferences for receiving training. Results: Analysis of over 700 responses demonstrated that respondents preferred model for continuous professional development was attending a one-day workshop on a Wednesday, Thursday or Friday. The results indicate the demographic profile of nurses completing this survey was primarily: female, over 31 years old, with a range of experience (but more than 1 year), working in general practice, and a registered nurse. The survey results highlight several strengths of participating nurses, with respect to their confidence in providing chronic care. These include assessment and care planning, engagement and communication, wound care, and communication with older persons. The data also points, however, to some areas in which health providers reported lower levels of confidence including: clinical risks, support and empowerment, cancer and its care, kidney disease and its care, oral health, memory loss, core competencies of geriatric clinical assessment and key clinical management approaches, diseases and disorders common in older people, end of life care, pain management, sensory alterations, and advanced care planning. Conclusion: On this basis, it is recommended that training organisations use the findings of the consultation to design and target continuous professional development to nurses in primary health care. Keywords: training needs, primary health

105

Using restorative practice to grow as an ally to Aboriginal and Torres Strait Islander peoples for the future

Dr Holly Northam1

1University of Canberra, Canberra, Australia

In this presentation I will apply a ‘restorative’ lens to critically review my work as a First Nations ally nurse/ midwife academic. As a non-Indigenous woman, I draw from my recent experience at the CATSINaM Conference and LINMEN professional development day, as well as research and teaching experience of working with vulnerable patients, their families, students, colleagues and other professionals. In this presentation I present an argument using restorative justice principles, to posit that it is only by authentically attempting to decolonise ‘self’, that non-Indigenous nurses and midwives can address critical relational problems relating to voice, respect, acknowledgement and reciprocity for the most vulnerable. By doing this I argue that nurses and midwives will be better prepared to address social injustice in healthcare and contribute to ‘closing the gap’. I will discuss the strength, support and mentoring guidance that has inspired me to learn more and become a passionate First Nations advocate. I question the role of healthcare leaders in creating culturally safe places for patients, their families, students and staff. I present the idea that it is time for an apology from nurses and midwives for harms perpetrated by our professions on Aboriginal and Torres Strait Islander peoples since colonisation. I reflect on current influences that impact on my ability to contribute positively to the work required in healthcare to own and ‘close the gap’. To conclude, I present a future imagining of educationally prepared nurses and midwives who have the strength and determination to own and overcome healthcare injustice in their various guises. I suggest that the evidence for this will be when we see nurses and midwives collectively authentically engaging with the most vulnerable people in their area of practice. Keywords: Restorative practice; nurse/ midwife; decolonise

106

Clinical placements in nursing as sites of learning and contribution: Student and health service perspectives

Prof Marie Gerdtz1, Prof Tracey Moroney2, Prof Deborah Hatcher3, A/Prof Phil Maude4, Prof Moira Williamson5, Dr Leeane Heaton5, A/Prof Robyn Woodward-Kron1, Prof Elizabeth Molloy1, A/Prof Jennifer Weller-Newton1, Dr Zerina Tomkins1, Dr Luke Molloy2

1The University of Melbourne, Carlton, Australia, 2The University of Wollongong, Woolongong, Australia, 3Western Sydney University, Sydney, Australia, 4Royal Melbourne Institute of Technology University, Melbourne, Australia, 5Central Queensland University, Noosa, Australia

Background: With limited healthcare resources, student clinical placements are often considered in terms of a fee for service agreement between education providers and health services. This transactional lens obscures the value of work integrated learning for students and for health services. Aim: We sought to document the bi-directional benefits of clinical placements in entry to practice programs and will present: a scoping review of existing literature along with the perspectives of students and health service providers. The study’s theoretical framing is Gheradi’s Practice of Community Methods: A mixed-method multi-site research project was conducted July-December 2019. The setting for the study included four acute care hospitals in metropolitan and regional centres across three Australian states. Participants were students undertaking an entry-to-practice degree in nursing in one of four Australian universities, and education providers/clinical supervisors of nursing clinical placements. Presentation 1: A scoping review of the literature was undertaken to map the benefits and challenges of clinical placements in healthcare. Presentation 2: An online survey of student perceptions of learning activity and perceived areas of contribution to health service delivery was conducted using RedCapTM Presentation 3: Focus group interviews with students and health service providers in the field is currently underway. All interviews have been audio-recorded and transcribed verbatim. Thematic analysis of survey free-text comments and interviews will be analysed using NVivo software. Results: The collection and preliminary analysis of all data for this research project is due by the end of November 2019. Discussion: We expect to make explicit the benefits of clinical placements to students, health services and the community. It is anticipated the outcomes of our work may provide the foundation for a work integrated curriculum framework that focusses on providing consistently high-quality learning experiences and ultimately delivers to the community graduates that are workforce ready.

107

Becoming a nurse: Contributions students make to health services while on clinical placements and the reciprocation of knowledge

Professor Marie Gerdtz1, Professor Tracey Moroney2, Associate Prof Phil Maude3, Professor Deborah Hatcher4, Professor Moira Williamson5, Associate Professor Jennifer Weller-Newton1, Professor Elizabeth Molloy1, Associate Professor Robyn Woodward-Kron1, Dr Zerina Tomkins1, Dr Luke Molloy2, Ms Leanne Heaton5

1The University of Melbourne, Parkville, Australia, 2University of Woolongong, Woolongong, Australia, 3RMIT University, Melbourne, Australia, 4Western Sydney University, Paramatta, Australia, 5Central Queensland University, Rockhampton, Australia

Aim / Objective: This study explored student nurses’ contribution to the clinical placement environment across four universities in three Australian states Methods: Content analysis was undertaken of three short answer questions included in an online survey of student nurses (N = 236). These findings arise as part of a multi-phase mixed methods study. Findings: Students were asked to consider the three most important factors they gained from a clinical placement Six emerging concepts were: 1) Communication and empathy (patients/ team); 2). Time management /planning patient care; 3) Skills / knowledge attainment; 4) Role socialisation; 5) Confidence; and 6) Critical thinking /reflection skills. A second question asked for their most important contributions to the work of the health service during clinical placement. Three concepts arose: 1) Being an extra pair of hands; 2). Comforting, listening/ caring for patients; and 3) Questioning/ checking practice. The third question sought further ways that students contribute to the work of health organisations. Students indicated they: 1) Assisted with day to day tasks; 2). Were able to be with patients when other staff could not; 3) Advocated and questioned practice, which enhanced the safety of the environment; and 4) Valued the role of the nurse. Conclusion: Students perceive the clinical environment as a valuable contribution to developing skills as well as improving their identification with the nursing profession. Students considered their confidence and ability to contribute grew as they moved into their final year of study. They identified ways they could contribute which also assisted them to integrate into the professional team. Students gained time management, practical experience and could apply knowledge to real life situations. This contribution included assisting staff with the many task required, being with the patients which involved listening and advocating and they contributed to patient safety by checking and questioning practice.

108

Students and supervisors’ perspectives of activity and contribution to clinical placements

Prof Marie Gerdtz1, Jennifer Weller-Newton1, Assoc Prof Phil Maude3, Professor Tracey Moroney2, Professor Deborah Hatcher4, Moira Williamson5, Elizabeth Molloy1, Robyn Woodward-Kron1, Zerina Tomkins1, Leeanne Heaton5

1University of Melbourne, Australia, 2University of Wollongong, Australia, 3RMIT University, , Australia, 4Western Sydney University, , Australia, 5Central Queensland University, , Australia

Background: In the current climate of increasing student numbers, and changing funding models, it is important to better understand the ways in which nursing students interact with the health service in their role as learners and contributors. Aim: The aim of this phase of the study was to gather students and supervisors’ perceptions of the benefits of clinical placement, including their perceived contributions and typical activities each makes to the health service. Methods: A mixed-method design incorporating several points of data collection. Focus group interviews with student nurses from four universities, across year levels is being undertaken. During the interviews, students complete an activity profile log indicating their perceived time undertaken a range of care/work activities whilst on clinical placement. Focus group interviews with registered nurses across four health-services engaged in supervision of nursing students along with completion of supervisors’ activity profile logs is also being collected. The project’s analytical framework is the Clinical Placement Research Framework (Molloy et al., 2018) and further informed by Billett et al.’s (2018) work on pedagogically rich activities (PRA) and Gheradi’s (2009) theoretical positioning of practices of community (PoC). Results: At the time of abstract submission, data collection and preliminary analysis are on-going and will be completed late 2019. Discussion: The outcomes of this project will provide unique insights and evidence into the activities and contributions that both students and their supervisors perceive are undertaken during clinical placements. Implications for workplace curriculum design and recommendations on how to encourage practices of community for nurses and students will be offered. References: Billett, S., Noble, C. & Sweet, L. (2018). Pedagogically rich activities in hospital work, Handovers, ward rounds and team meetings (ch15) In Delany, C. & Molloy, E. (eds) Learning and Teaching in Clinical Contexts: A Practical Guide, Elsevier. Australia Gherardi, S. (2009) Community of Practice or Practice of Community? Ch27 In S. J. Armstrong, & C.V. Fukami (Eds): The SAGE Handbook of Management Learning, Education and Development. Thousand Oaks, CA: SAGE Publishing (pp. 514–530) DOI: http://dx.doi.org/10.4135/9780857021038.n27 Molloy, E., Lew, S., Woodward-Kron, R., Delany, C., Dodds, A., Lavercombe, M., & Hughson, J. (2018) Medical student clinical placements as sites of learning and contribution. Melbourne: University of Melbourne; 2018. https://medicine.unimelb.edu.au/__data/assets/pdf_file/0017/2800115/MDANZ_Project_Report_April-2018.pdf Keywords: Student Nurses, Registered Nurses, Clinical Placement, Activities, Contributions

109

Preparing nursing students for now and the future: Integration of patient electronic medical records into the undergraduate curriculum

Dr Lyndall Mollart1, Ms Rachel Newell1, Ms Carol Norton1, Mrs Danielle Noble1, Dr Sara Geale1,2, Prof Anthony O'Brien1

1University Of Newcastle, Callghan, Australia, 2Australian Catholic University, Sydney, Australia

Australian public healthcare organisations have introduced patient electronic medical records (EMR), however this digital technology has not yet been included in clinical skills teaching in Bachelor of Nursing (BN) programs. The Australian Nursing and Midwifery Accreditation Council identified digital learning such as EMR as an important inclusion in undergraduate curricula. Developing and integrating a teaching-learning platform for the use of an academic EMR (AEMR) prior to clinical placement, however, has been hampered by lack of empirical evidence. In early 2019, our research group with the university technology team, developed a fit-for-purpose AEMR program which required content and face validity testing. The study aimed to investigate the views of third year nursing students on the integration of patient EMR in the nursing program; and conduct pre-integration content validity of AEMR tools with expert nurse educators. Method: Third year BN students (n=540) were invited to complete an online survey on their educational preparedness for clinical practice using paper-based records and the perceived benefits of integrating EMR into the curriculum. Nursing educators (n=5) tested AEMR using a case scenario and completed a face content validity survey. Results: Student survey response rate was 13% (n=70). Most students did not feel prepared (71%) or confident (65%) using EMR during their first-year clinical placement based on university paper-based learning. Most (98%) believed it would be beneficial to learn to use EMR in simulation lab sessions and to increase confidence (98.5%) for clinical experience. Nursing educators rated the AEMR at high levels for both face validity and content validity (81-88%). Conclusion: Student participants support the integration of patient EMR into the first-year curriculum. The findings confirm the AEMR has high face validity, and structures and learning steps confirm the content validity. This learning strategy addresses a gap in the teaching of EMR for student’s preparation for practice.

110

Students employed as students in nursing (SIN) or students in midwifery (SIM) – a study across six North Queensland Hospitals

Dr Tracey Ahern1

1James Cook University, Townsville, Australia

Aim/Objective: To increase knowledge about SIN and SIM roles in selected NQ health facilities and identify the relationships between students working in these roles and their respective University program. Explore how these roles consolidate or augment student learning, contribute to their professional portfolio, improve professional socialization, and increase post-graduation employment opportunities. Methods: SINs and SIMs were surveyed using Qualtrics to explore their hours of work, area(s) of employment, year level within their respective university degree, and how they believed their work experience contributed to their learning and role development. Nurse Unit Managers of the wards where SINs/SIMs were employed also completed an online survey and participated in individual interviews, to ascertain their attitudes toward, and experiences with, SINs or SIMs. Results: Sixty-eight (68) students in either SIN or SIM roles completed the online survey. Eight (8) Nurse Unit Managers were individually interviewed. The employment and deployment of SINs and SIMs across and within public and private hospitals in North Queensland appears to be highly variable. There is currently no formal relationship between the work undertaken by students in SIN/SIM roles, and their respective University program. Student respondents indicated that time management, communication, clinical skills, socialisation and confidence were enhanced through these roles. Nurse Unit Managers indicated that SIN/SIM roles formed an important component of their workforce, however their limited scope of practice meant that they were being under-utilised. Conclusion: SIN and SIM roles provide students with important opportunities to consolidate clinical skills, become socialised in the hospital environment, and increase their likelihood of employment following graduation. If these roles are to continue, Universities and health facilities need to explore ways in which more formal structures and processes could be implemented to ensure students are supported and their work is recognised. Keywords: employment, students, nursing, midwifery.

111

Nurse academics’ experience of contra-power harassment from under-graduate nursing students in Australia

Prof Martin Christensen1, Dr Judy Craft2, Dr Sara White3

1Western Sydney University, Sydney, Australia, 2University of the Sunshine Coast, Sippy Downs, Australia, 3Bournemouth University, Bournemouth, England

Background: There is growing concern around inappropriate behaviour being perpetrated by under-graduate nursing students towards nursing academics. Coined contra-power harassment, is defined as the harassment of individuals in formal positions of power and authority by those that are not. The type of harassment behaviours reported include verbal and physical violence, character assassination through social media, stalking and sexually motivated behaviours. The most often cited reasons for the escalation in these behaviours are seen with course progression and the awarding of grades. Aim: The aim of this study was to better understand the extent to which nursing academics experience contra-power harassment from under-graduate nursing students. Method: A convenience sample of nursing academics (n=82) in Australia were contacted and provided with an introductory letter, a participant information sheet and a link to an online questionnaire. A 41 item Likert scale (Strongly agree-strongly disagree) was used to elicit responses to statements on academics’ experiences of and the contributing factors associated with contra-power harassment. In addition, three open end questions elicited qualitative data that was analysed using inductive content analysis Results: The main contributing factor identified from this study was seen as the consumerism of higher education; in particular paying for a degree gave a sense of entitlement with academics experiencing the highest levels of student harassment around grades. There were three themes identified form the open end questions. The consumer is always right, a sense of entitlement and unrealistic expectations. Conclusions: Contra-Power harassment is becoming common place in higher education especially in nursing education. The competitive nature of obtaining employment post-university has meant that some nursing student’s behaviours are becoming increasingly uncivil, challenging and unprofessional. Keywords: Contra-power harassment, student harassment, bullying, sexual harassment, behaviour, incivility

112

Nurse academics leading a positive workplace culture: Practical applications to influence professionalism in undergraduate nursing students

Associate professor Melanie Bish1, Associate Professor Louise Ward2

1La Trobe Rural Health School, La Trobe University, Bendigo, Australia, 2School of Nursing and Midwifery, La Trobe University, Melbourne, Australia

The demand for nursing professionalism is greater than ever with increasing expectation of the profession of nursing to lead care delivery in complex healthcare systems. The performance of nurses is closely linked to the productivity and quality of care provision at an organisational level¹. It has been suggested that all nurses regardless of setting or position have an ethical obligation to create and sustain healthy workplaces and to foster an atmosphere of dignity, professionalism, and respect². As research confirms organisational culture as a significant predictor of nursing professionalism³, in turn, the practice of professional behaviours is essential to facilitate an organisational culture to enable positive outcomes including: quality of care, patient safety, teamwork, innovation and professional development of healthcare professionals⁴ ⁵. Understanding that the ability of nurses’ to practise in a professional manner will be influenced by the organisational culture of their work environment, it is essential for undergraduate nursing students to understand the relationship between organisational culture and professionalism in preparation to transition into the workforce. Nurse academics have the opportunity to influence the development of professionalism in nursing students by leading the ‘co-creation of professional norming’, knowledge sharing and role modelling. The power of individuals in visible leadership positions to influence organisational culture and climate is well documented¹⁴⁶⁷. As a profession leader, nurse academics are compelling role models; their actions communicate messages as to what is considered acceptable behaviour. As people are more likely to follow the performance cues of those with power or social status within an organisation³, nurse academics must capitalise on their sphere of influence to shape students development of professionalism over the duration of their undergraduate nursing education.

113

How to become #digitally #professional in Australia: Enabling an educative approach for #nurses

Associate Professor Kathleen Tori1, Dr Carey Mather1, Associate Professor Annette Marlow1

1University of Tasmania, East Launceston, Australia

Work readiness for digital professionalism To ensure the next generation of student nurses are educationally prepared for a digital future in healthcare, swift action is required. The knowledge, skills, attitudes and behaviours required for digital professionalism to flourish need to be systematically implemented and embedded within curricula. How to become prepared for the future The Australian Nursing and Midwifery Accreditation Council Registered Nurse standards for Practice and Explanatory Note outline expectations for education of students including health technology and informatics. The Australian Nursing and Midwifery Federation has developed nursing informatics competency standards, and the Australian College of Nursing, Health Informatics Society and Nursing Informatics Association position statement also provided guidance. These documents when coupled with the National Australian Digital Health Agency strategy provides direction for adoption of digital technology by health professionals and organisations by 2022. Similarly, the Australian Commission on Safety and Quality Health Service standards supports organisations to integrate digital technology for the benefit of all stakeholders. Australia now has the policies and standards for adoption of health technology and health informatics at all levels. Outcome of preparation Legitimisation of safe, appropriate and effective use of digital technology by students of nursing who are educationally prepared on campus through simulation activities, guided during work integrated learning by their host supervisors and enabled by organisations to be work ready can occur when clear direction is provided at a National level. Synthesis of these documents need to be undertaken in consultation with the National Boards. The outcome of consultation would be a joint national policy overseen by Australian Health Practitioner Regulation Agency. The publication of clear guidelines for all current and beginning level registered health practitioners would ensure digital professionalism can be a ‘safe, seamless and secure’ integral component of professional identity formation of students, nurses and midwives.

114

Putting the professional pieces together: Enabling cross sectoral interprofessional education across the continuum of learning.

Prof Fiona Bogossian1,2,6, Dr Nigel Barr1, Mr Roger Carter1, Dr Kendall George1, Dr Anita Hamilton1, Dr Nicole Masters1, Dr Gregory Nash1, Professor Fiona Pelly1, Associate Professor Jane Taylor1, Dr Karen New2, Dr Rebekah Shakhovskoy1,2,3,4, Dr Natalie Dodd4, Associate Professor Jen Williams4, Mr Mark Reilly5

1University Of The Sunshine Coast, Maroochydore, Australia, 2The University of Queensland, St Lucia, Brisbane, Australia, 3Sunshine Coast Hospital & Health Service, Birtinya, Sunshine Coast, Australia, 4Griffith University Medical School, Birtinya, Sunshine Coast, Australia, 5TAFE (Qld), Birtinya, Sunshine Coast, Australia, 6Sunshine Coast Health Institute, Birtinya, Sunshine Coast, Australia

Introduction: Interprofessional education (IPE) represents an innovative, pedagogical response to creating a professional, collaborative, practice-ready health workforce and improving the quality and safety of care in health systems. The XX Health Institute (XXHI) is a newly dedicated education, training and research facility, formed through a partnership between a tertiary health service, two tertiary education providers and a vocational education and training provider. It provides a unique opportunity to implement cross-sectoral interprofessional education across the continuum of learning to underpin interprofessional collaborative care and improve health outcomes. Aim: This presentation will report on projects and progress towards a unified approach to IPE and the development of faculty in the XXHI. Methods: Concurrent projects have resulted in a XXHI Model of IPE and highlighted the need for a unified, consistent approach to faculty development. However, within each partner organisation, the level of sophistication of IPE varies and few staff from each of the XXHI partners have the training and skills to facilitate learning using a truly IPE approach. Recognising the need for a cross sectoral faculty development approach, we have undertaken four scoping reviews which address the practical facilitation skills required to design, implement, assess and evaluate IPE regardless of the sector or the setting. Results: Despite the volume of literature on IPE there are few primary studies (n=8) to underpin professional education practice. Scoping reviews inform the development of a best practice introductory module to provide all staff with a common understanding of IPE. We report on the content validation, piloting, uptake and evaluation. Conclusion: Enabling cross sectoral interprofessional education across the continuum of learning provides challenges and opportunities. The development of an introductory best practice module underpins a suite of in-depth modules to provide comprehensive IPE skills to those seeking credentialing as IPE faculty.

115

Professional Presentation Program for nursing and midwifery academics

Assoc Prof Lauren McTier1, Dr Jo McDonall1, Professor Nikki Phillips1

1Deakin University, Burwood, Australia

In the School of Nursing and Midwifery’s undergraduate programs the introduction of blended learning resulted in the move from face-to-face lectures to online narrated powerpoints. Since 2013, narrated powerpoints have been replaced by short video presentations that depict key content and concepts. The video presentations are delivered online prior to students’ attendance on campus in order to facilitate application activities in the classroom to foster deeper understanding of the learning material. In order to ensure our students, receive highly effective, engaging and professional video resources online our School has recently engaged a media training and professional presentation organisation to deliver a Professional Presentation Program for our academics. The outcomes of the Professional Presentation Program will be presented including examples of before and after videos.

116

Resilient students: Transition to university, empowering program, learning and transformation

Dr Joy Penman1

1Monash, Monash Clayton Campus, Australia

Introduction: The difficulties of international students transitioning to Australian universities are known. Many universities have developed orientation programs that support the transition of beginning international students, but there is evidence that these are inadequate. Students’ capacity to reorganise under change and return to their ‘normal’ selves when transitioning to university may be facilitated by providing empowerment programs. Our intervention called ‘Empowering students for academic success’ attempted to enhance personal traits and extend internal and external protective factors, such as self-reliance, social networks, and good physical and mental health to achieve resilience. A key theme in the program was teaching students about the ability to adapt to change, which is the primary ingredient of resilience. The program emphasised coping skills and strategies, self-organisation, flexibility and ability to transform to adapt successfully. Method: The program consisted of three components: four workshops, peer-mentoring and online support through a closed Facebook page. A qualitative descriptive approach to research involving post-training surveys and in-depth interviews were conducted to explore the perceptions about the program. Content and thematic analyses were undertaken. Results: Twenty-five students participated in the program. Analysis of the findings showed that resilience and stress management skills and psychoeducation were the most important outcomes of the program. The best aspects were the opportunity to share and learn coping skills from each other. Four themes emerged: self-discovery; connection and interaction; present help and future framing; and safe, enjoyable place. The program impacted on the students’ self-management abilities with translatable results. Conclusion: Empowering programs are beneficial; orientation programs alone are not sufficient to help students transition into university. The consortium of academics from multiple disciplines collaborating with mentors and beginning students enabled the development of a toolkit for successful university transition. The program should continue to be implemented, and its durability determined.

117

New graduate nurse transition to practice: How does this effect patient safety?

Dr Melanie Murray1

1Murdoch University, Murdoch, Australia

Aim To develop an understanding of new graduate registered nurses’ patient safety knowledge and actions within the first year of registration. Methods A longitudinal mixed methods design was used to develop an understanding of new graduate registered nurses’ patient safety knowledge and actions within the first year of nursing registration and offer important insights into NGRNs’ transition with a patient safety focus. New graduate registered nurses employed in graduate nurse programs at two Australian metropolitan hospitals were invited to participate. Data collection took place from August 2016 to February 2018. Results Quantitative data was collected via a closed-ended questionnaire delivered at three time points during the graduate program to monitor the evolution of the NGRNs’ knowledge, feelings and attitudes regarding medical errors and patient safety over time. Qualitative data was collected by semi-structured one-on-one interviews to gain a deeper appreciation of the NGRNs knowledge of patient safety and challenges of integrating this knowledge into their clinical practice. Quantitative data were analysed using ANOVA One-way analysis of variance, or General Linear Model for repeated measures to measure difference, if any, between the time points. Qualitative data analysis was guided by Braun and Clark’s six steps of thematic analysis. Quantitative results were categorised into the four subcategories of knowledge of medical error; knowledge of actions regarding medical error; attitudes to compromised patient safety; and intentions regarding patient safety prior to analysis. Thematic analysis revealed five main themes: patient safety and insights; time management; making a mistake; experiential learning; and transition. Conclusions Medical errors and time management persist as during transition to the registered nurse role. New graduates reported moderate knowledge of safety and quality issues, however, questioning of their own abilities overshadowed growth in their involvement in patient safety. Keywords: new graduate nurses; transition; patient safety; mixed method.

118

The transition curriculum: An evidence-based framework

Dr Helena Harrison1, Professor Melanie Birks1, Professor Jane Mills2

1James Cook University, Townsville, Australia, 2Massey University, Palmerston Nth New Zealand

Aim/Objective: Despite advances in nursing education in recent decades, preparing nurses for practice has come under increasing pressure from numerous factors. These include the increasing complexity of the nursing role, contracting academic study periods and the cost and competition associated with professional experience placements. This presentation draws on research conducted into stakeholders’ perceptions of the practice readiness of newly graduated registered nurses. The aim of the presentation is to propose a curriculum framework that will assist nursing students in transitioning to the professional role. Methods: The research underpinning this presentation used a multiple case study approach to obtain perspectives of a diverse group of stakeholders in four healthcare services in one Australian state. Individual and focus group interviews were used within a constructivist and symbolic interactionist framework to describe conceptions, descriptions and meaning of workplace readiness. Results: Transition to the professional role occurs along a continuum spanning four years. Transition begins with the initial enrolment into a nursing program and ends following the first year of practice as a registered nurse. Readiness for practice is cultivated in four integrated domains of practice: Personal readiness; Professional readiness; Clinical readiness; and Industry readiness. Establishing personal readiness is critical to ensuring successful development in the other domains. External factors, including reciprocal partnerships between industry and higher education, and having the right environment in which neophyte nurses can flourish, are also significant in ensuring successful preparation and transition to practice. Conclusion: If we are to adequately prepare nurses for future practice, nursing curricula must focus on ensuring this preparedness from day one of their development as a nurse. The curriculum of the future will embed the four domains of readiness across the continuum of study. Keywords: graduate nurse; nursing curriculum; practice readiness; transition

119

A collaborative approach supporting transition to practice: Registered Nurses undertaking a Clinical Honours degree

Mrs Michelle Phillips1, Mrs Toniele Shearer1

1University Of Tasmania, Australia

The University of Tasmania’s Bachelor of Nursing (BN) with Clinical Honours (Transition to Practice) degree supports Registered Nurses (RN) who are in the transition phase of their career. Making the transition from student to RN is a challenging period as they experience professional socialisation, transition shock while endeavouring to develop their professional identity. The majority of newly graduated RNs seek employment with organisations offering graduate transition programs. Industry graduate transition programs are diverse in terms of program content, quality, resourcing and length. The experiences of graduate RNs during their initial year of practice influences their decisions to stay or leave the employing organisation and/or the profession. In response to feedback from healthcare employers and alumni, the University of Tasmania established in collaboration with industry partners a unique course, the BN with Clinical Honours (Transition to Practice). This highly successful course that is undertaken as part of an industry graduate program was conceptualised to develop and retain a professionally competent new graduate RN workforce. The course supports development as an RN and consistent with the Australian Qualifications Framework level 8 honours specifications, graduates apply knowledge and skills to demonstrate autonomy, well-developed judgement, adaptability and responsibility within the professional practice framework of the registered nurse in Australia. These attributes coupled with the those expected of a RN reflect the expected learning outcomes of this collaborative approach supporting the transition to practice of new graduate RNs.

120

Transitioning from student to graduate: Navigating a career path

Dr Mahnaz Fanaian1, Associate Professor Amanda Johnson1, Dr Christine Chisengantambu-Winters1, Mrs Irene Mayo1

1Australian Catholic University, North Sydney, Australia

For many nurses a career path has been adhoc and opportunistic rather than a planned approach. Few studies exist to determine the knowledge and skills an undergraduate or registered nurse require to successfully plan a career path. Where retaining nurses in the workforce is paramount and building our professional leadership capability is pivotal, understanding the importance of career planning is an essential element to achieving job satisfaction. This element is critical to generating a sustainable workforce and cannot be underestimated. Limited understanding to systematically determining a career path is reinforced by undergraduate curricula which focus primarily on acute surgical and medical care with minimal exposure to the broader scope of nursing practice coupled with a nurse’s initial employment being largely in the acute sector (Parker et al., 2009). Graduates face exposure to a myriad of professional roles often creating a sense of being overwhelmed. When this occurs in conjunction with a lack of coaching targeted at career path planning the registered nurse finds it challenging to discern what and how to participate in this activity. Within this context, the nursing workforce continues to be insufficient to meet population demands in particular with the exponential growth in an ageing population placing increased demands on health services. Further burden is being imposed by the multi morbidity of disease presentation across the general population (Johnson & Chang, 2017) necessitating health services redesign themselves in response to this requirement. This paper presents an exploration of the literature. It seeks to bring to the forefront the need for capacity building in this area in both undergraduate curricula and in organisational coaching to maximise the success of graduates to participate in career path planning. It is proposed that research be undertaken in the Australian context to provide an evidence-base to support career path planning practice

121

Great expectations: Postgraduate education and advancing careers

Ms Jo Gibson1, Prof Karen Strickland1, Dr Holly Northam1, Prof Patrick Crookes1

1University Of Canberra, Bruce Canberra, Australia

Nursing education focuses on response-based practice, with practice described in terms not limited to the provision of clinical care. This extended understanding of practice includes the use of nursing knowledge and skilful doing that might include ‘direct non-clinical relationship with clients, working in management, administration, education, research, advisory, regulatory, policy development roles or other roles that impact on safe, effective delivery of services in the profession and/or use of the nurse’s professional skills’ (NMBA, 2016). In a powerful recent editorial in the Journal of Clinical Nursing, Carryer (2019) articulates a compelling case for nurses to take ‘power over our own practice and to assert greater leadership of the health system to enable individuals and communities with leadership coming from ‘a health rather than a medical lens’(Carryer, 2019). Preparation for leadership commensurate with this extended understanding of practice requires education to enhance the ‘scope, breadth and value of the contribution and leadership’ of nurses in multiple settings (Carryer, 2019). It is important to acknowledge that postgraduate education is pivotal in the enablement of nurses to engage in their full scope of practice to leverage the knowledge nurses hold that is essential for health outcomes. This presentation aims to be a catalyst to start (or reignite) an important conversation in the academy and the nursing profession broadly to begin formulating and identifying new nursing career pathways and the post graduate educational andragogy and modality required to meet the expectations of the community and the profession to transform nursing careers for the future. We would like to engage others in debate and discussion to explore the effectiveness of current postgraduate educational provision in meeting the needs of health service delivery and help us to identify how to improve this to support the development of nursing into the future.

122

Growing new mental health nurses - a collaborative educational partnership between a regional hospital and health service and a university.

Simone Barton1, Alexander Foley1, Andrew Kennedy2, Jen Mulvogue2, Ms Jennifer Mulvogue2, Katherine O’Neill1, Susan Webster1

1Wide Bay Mental Health and Specialised Services (WBMHSS), 2Central Queensland University,

Introduction and Aims: WBHHS is seeking to develop their mental health nurse workforce. WBMHSS has accomplished strong outcomes historically via the Transition Support Program. WBMHSS were seeking new opportunities to stimulate strong foundations in life-long learning and to promote mental health nursing as a rewarding and specialised career option. The service is trialling a new partnership with CQUniversity to evolve the graduate nurse program to the next level. Design and Methods: An industry-academic collaborative program has been developed which streamlines theoretical learning with clinical practice exposure and substantially reduces the system redundancies. The program is offered in flexible delivery with academics and industry educators co-presenting to provide meaningful, contemporary learning experiences. Advantages for the students are a university qualification on completion, unit credits for workshop attendance and an easy pathway to the Master of Mental Health Nursing. Results: The program commenced in 2019, with this student cohort completing and the end of the year. The program articulates to postgraduate qualifications. There were three participants in the first cohort. All have completed semester 1 successfully. Discussion and Conclusions: The industry partnership between WBMHSS and CQUniversity has generated a new pathway for local mental health nurses who are vital to the delivery of safe, efficient and high-quality mental health care. The industry partnership is an innovative, progressive graduate model resulting from a strong, collaborative partnership between WBMHSS and CQUniversity.

123

Building a genomics ready nursing and midwifery workforce: A discussion piece on why it matters

Prof Jane Maguire1, Dr Joel Zugai1, Ms Nicki Watts1, Dr Helen Wright2, Dr Karen Watson1, Mr Ying Ho Wong1, Dr Debra Palesy1, Dr Deborah Debono1, Dr Jacqui Pich1, Ms Leonie Kelly1, Dr Allison Cummins1, Prof Tracy Levett-Jones1, Dr Lynn Sinclair1

1University of Technology Sydney, Ultimo, Australia, 2James Cook University, Townsville, Australia

Objectives: To accelerate genomic medication literacy in Australian nurses and midwives; equip them with skills and knowledge required to be resilient in a genomics era workforce. To prepare pharmacogenomic literate nurses and midwives as genomic science leaders in a rapidly changing Australian and international healthcare environment, engaged in safe medication prescribing practice and workforce ready. Rationale: Medication safety is an essential aspect of everyday clinical care for all nurses and midwives. Early detection of adverse events is available through critical review of genetic information about medications. Since 2003, UK and USA nurses and midwives have had pharmacogenomic evidence imbedded in their curriculum. This is not the case in Australia, despite nursing and midwifery standards requiring that registered nurses and midwives employ critical ‘thinking strategies and the best available evidence in making decisions and providing safe, quality nursing practice within person-centred and evidence-based frameworks’ (Standard 1). Pharmacogenomics defines how genes associate with drug response and is a prime example of person centred care. For example, genetic variants can influence how medications are metabolised and thus how an individual will respond. Pharmacogenomic tests identify a person’s individual genetic structure and people who will experience an unexpected medication response, identifying the most suitable drug and dose for that person. Of note, a recent Position Statement by the Australian Nursing and Midwifery Federation on Nursing and Midwifery Prescribing endorses a change to the scope of medication administration practice for registered nurses and midwives. Additional prescribing practice education will be required. The influence of pharmacogenetic associations on medication safety needs to be included. Conclusion: Medication safety seen through the lens of pharmacogenomic evidence needs to be included in all nursing and midwifery Australian undergraduate and postgraduate tertiary institution curriculum to improve medication safety for our patients and increase pharmacogenomic literacy of our future workforce.

124

Future proofing the profession: The nurse or midwife of the future.

Assoc Prof Kathleen Tori1, Professor Karen Francis1

1University of Tasmania, Launceston, Australia

Nurses and midwives are uniquely qualified to provide optimal patient care across a number of health-related environments given opportunity, education and practise. Since the 1960s the development of advanced practice nursing roles has seen nursing’s scope of practice expand markedly across diverse specialty areas. Nurses and midwives of the future will be able to work at the top of their scope to offer timely, accessible and equitable care for their patients, either autonomously as in the case of nurse practitioners, or collaboratively within multidisciplinary health teams. To future-proof the profession we need to start planning now. Nurses are well placed to contribute effectively to what the future health care system will look like and, in most cases, lead the discussions. For this to be achieved we need to acknowledge the significant role that nurses’ and midwives’ currently play and enable them to have a collective voice as to the future of the profession. Innovative nursing models that collaboratively address health service gaps are not only required but warranted to meet the future demands. Thorough exploration of the challenges and enablers for futuristic nursing models are required at the organisational, local and national government level, including legislative, to ensure that implemented nursing models are supported and, more importantly fiscally sustainable. This presentation will look at the required knowledge, skills and attributes necessary for empowering and equipping the nurse and midwife of the future to best meet complex patient health needs and to augment the current health care system.

125

Improving cultural competence for postgraduate nurses and midwives; the development of Kaatidjin, a cultural competency online module.

Dr Beverley Ewens1, Dr Rosemary Saunders1, Ms Michelle Pedlow1, Ms Rebecca Schultz1, Ms Agatha Caracciolo1, Mr Nigel Andrews1, Ms Leitha Delves1

1Edith Cowan University, Joondalup, Australia

The recruitment and retention of Aboriginal and/or Torres Strait Islander nurses and midwives is key to the delivery of culturally appropriate health care and improving health outcomes. Aboriginal and/or Torres Strait islander nurses and midwives remain underrepresented in the nursing and midwifery workforce (CATSINaM, 2015). Disproportionate representation of Aboriginal and Torres Strait Islander people is particularly evident within higher education; the importance and benefits of higher education to economic and social progress has been recognised (Dandy, Durkin, Barber, & Houghton, 2015). The School is committed to the recruitment and retention of Aboriginal and/or Torres Strait Islander students, and the development of cultural competence for all students. The creation of a culturally safe environment for Aboriginal and/or Torres Strait Islander students and the development of culturally competent nurses and midwives is a fundamental tenet of the School. Within accredited programs discreet Aboriginal health units were delivered, but within the postgraduate non-accredited programs, content was scaffolded across units. This did not ensure postgraduate students had the opportunity to engage in structured content to develop their cultural competence and appreciation of Aboriginal history and culture. An online module; Kaatidjin, was developed in collaboration with Aboriginal people, which has provided students with an understanding of Aboriginal history, culture, social determinants of health and the importance of collaborating with Aboriginal people in clinical and research contexts. The framework which underpins the Kaatidjin Module has a positive approach, myth-busts common misconceptions and celebrates the diversity and contribution of Australia’s First Peoples. Sustainable and contextualised interactive content is embedded throughout the Module. Evaluation of the student experience is ongoing to ensure content remains contemporary and relevant. All students complete the Kaatidjin module during their orientation to the University. This paper will describe the collaborative development of the Kaatidjin Module and will provide a tour of the site.

126

Undergraduate nursing students’ perceptions of their educational preparation for management of peripheral intravenous catheters

Dr Alison Craswell1, Assoc Professor Deb Massey2, Associate Professor Amanda Ullman3,4, Dr Gillian Ray-Barruel3,4,5, Professor Marie Cooke3,4, Dr Nicole Marsh3,4,6, Professor Marianne Wallis1

1University of the Sunshine Coast, Maroochydore DC, Australia, 2Southern Cross University, Gold Coast, Australia, 3Griffith University, Nathan, Australia, 4Menzies Health Institute, Gold Coast, Australia, 5QEII Jubilee Hospital, Brisbane, Australia, 6Metro North Hospital and Health Service, Herston, Australia

Aim/Objective: We sought to critically explore the current status of education regarding peripheral intravenous catheters (PIVCs) from the perspectives of undergraduate nursing students. Despite being the most frequently used invasive medical device for the care of hospitalised patients, PIVCs are responsible for significant adverse events during insertion; and use. Adverse events, including dislodgment, occlusion, infiltration, phlebitis, and infection, lead to PIVC failure, resulting in patient discomfort, delays in treatment, and increased healthcare costs. Knowledge and understanding about the skills required by undergraduate nurses to safely assess and maintain PIVCs is limited, even though the majority of undergraduate nurses assess, access, maintain and remove PIVCs as part of their clinical learning experiences. To date, no study has explored undergraduate nurses’ perceptions of the PIVC education they receive. Methods: This qualitative study involved semi-structured interviews with third-year undergraduate nursing students. Data was collected across two sites in Queensland, Australia. Fourteen face-to-face interviews were conducted with final year nursing students. A modified 5-step qualitative content analysis was used to analyse the data. Two researchers analysed the data independently, with differences managed via consensus. Results: PIVC knowledge development coalesced around four themes: 1) practice drives undergraduate nurses learning about PIVCs; 2) disconnection between theory and practice impedes learning about PIVCs, 3) educational preparation about PIVCs is essential for clinical decision making and 4) valuing of psychomotor skill over evidence-based practice. Conclusion: Current undergraduate curriculum related to PIVC management can be disjointed and inconsistent. While there is an emphasis on specific aspects of care (e.g. administering medications using PIVCs) there is a lack of emphasis on assessment, empowerment of nurses in clinical decision making (e.g. removal of redundant PIVCs), and evidence-based decision making in practice. Improving educational programs focused on PIVC management will support the overarching aim of improving patient safety and health service outcomes.

127

Strengthening consumer voice: Using stories to educate and shift mental health stigma

Assoc Prof Gabrielle Brand1, Associate Professor Christopher Etherton-Beer2, Professor Rhonda Clifford2, Mrs Liza Seubert2, Mrs Carli Sheers3

1Monash University, Frankston, Australia, 2The University of Western Australia, Perth, Australia, 3Consumer Representative for UWA research project facilitated by the Consumer & Community Health Research Network, Perth, Australia

Introduction/background: The World Health Organisation (WHO) asserts that to reduce increasing burden of mental disorders, priority should be on mental health prevention and promotion that includes education strategies to reduce mental health stigma as it impedes recovery of people experiencing mental illness. Aim/objectives: The purpose of this research was to use mental health consumers’ stories of mental health stigma and recovery to co-design an educational tool for widespread use in health professions education. Methods: This project used an Exploratory Participatory Action Research (PAR) methodology that involved three phases. Phase 1 involved establishing an advisory group of mental health consumers to story their experiences and their perceptions relating to stigma. Phase 2 drew on co-design methods to translate and communicate research findings through the development of a series of “real life” vignettes based on consumer voice. The vignettes serve both research and pedagogical purposes that are embodied in different innovative teaching methods (photo-elicitation, role play, verbatim theatre, mind maps, visual thinking strategies and reflective prompts) to surface unconscious stigma, inspire questioning and in-depth discussions and teach current and future healthcare professionals to listen for stories of strength and possibility. Phase 3 (in progress) will test vignettes on sample size of 100 health profession students and 50 mental health practitioners to evaluate the impact of the anti-stigma education. Issues/questions for exploration or ideas for discussion: Integrating co-produced resources into health workforce education has the potential to challenge and transform hierarchical health care relationships and refocus our lens to holistic, recovery centred models of mental health care. Keywords mental health stigma; reflective practice; co-design; consumer voice

128

Impact of nursing and midwifery higher degree research training on career trajectories, a mixed methods systematic review

Assoc Prof Kerry Inder1,2, Dr Victoria Pitt1, Dr Vanessa Clark1,2

1School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia, 2Hunter Medical Research Institute, New Lambton, Australia

Background: The increased requirement of health services to be research intensive to improve health outcomes necessitates more nurses and midwives to develop research skills, disseminate and implement research findings and translate findings into practice. While nurses and midwives perceive research to be part of their role and agree that research plays an important role in improving patient care, a significant proportion report a deficit of knowledge, training, confidence and support from management to carry out research. A nurse or midwife with a doctorate has the training needed to conduct research, add to the body of nursing and midwifery research and inform evidence-based practice. However, career trajectories and pathways for nurses and midwives with doctorates are unknown. Objective: To identify and describe the impact of doctoral research training for on nurses and midwives career trajectories. Methods: Five electronic databases and grey literature were searched for original qualitative, quantitative and mixed methods studies on the impact of doctoral training for nurses and midwives on their career. Studies published in English language for the period 2000 to 2019 were included and underwent critical appraisal using a validated mixed methods appraisal tool by two reviewers. Data extraction, synthesis and integration was conducted using a convergent integrated approach. Results: Initial searching revealed a paucity of research in this area outside the doctor of nursing practice in the United States. Details of a full comprehensive search and synthesis of findings will be presented and discussed with recommendations for future models of doctoral training in nursing and midwifery. Conclusions: Preliminary search findings indicate this is an under-researched area and suggest that greater consideration may be needed for future doctoral training programs to focus on a range of skills not limited to the practice of research, broadened to include leadership, team work, communication, networking and career pathways.

129

Factors that impact on learning during simulation-based education in pre-registration nursing curricula

Dr Leeanne Heaton1, Associate Professor Patrea Andersen2, Associate Professor Marc Broadbent2

1CQUniversity, Mackay Australia, 2University of the Sunshine Coast, Sippy Downs, Australia

Aim/Objective: It is thought that simulation provides participants with an opportunity to practice skills related to their profession without harming real patients. It incites critical thinking and reasoning, as well as challenging emotional intelligence when participants are placed in an authentic and realistic level of interaction that replicates a real clinical event. This study highlights some of the factors that learners state impact on their learning experience. Methods: Interpretive Description (ID) methodology with semi structured interviews were used to collect data from pre-registration nursing students. Eleven learners from three universities in Australia participated in this enquiry. Data analysis used constant comparative analysis, a reading frame and schematic diagramming. Results: The findings of this research highlight that there are five factors that impact on fidelity and the learner’s overall learning in simulation-based education. These include the pedagogy, milieu, approach, physical and psychological. Further analysis reveals aspects such as the environment, the availability of resources including experienced staff, choosing a modality that fits the learning outcomes, adequate preparation and/or orientation for participants, the cognitive and emotional level of the participants and the degree of fidelity required for the situation, are critical to successful implementation and learning in simulation based education. Conclusion: For the learner to be fully immersed, there is a requirement for all of the factors to be at a high level. There is a need to consider the authenticity or reality of the milieu, the approach taken, the physical and psychological in order to maximise the learning experience. If there is an alteration in, or a factor missing, during an immersive simulation, then the participant can lose the sense of reality or suspension of disbelief. Learners reported that for them to best meet the stated learning outcomes, adequate orientation to the task and equipment, preparation and debrief were required.

130

A scoping study into the preparation of registered nurses for care of older people in Australia

Assoc Prof Deirdre Fetherstonhaugh1, Dr Jo-Anne Rayner1, Mr Kane Solly1, Prof Elizabeth Beattie2, Assoc Prof Ann Harrington3, Prof Yun-Hee Jeon4, Prof Wendy Moyle5, Prof Deborah Parker6, Prof Andrew Robinson7, Assoc Prof Christine Toye8

1La Trobe University, Bundoora, Australia, 2Queensland University of Technology, Brisbane, Australia, 3Flinders University, Adelaide, Australia, 4University of Sydney, Sydney, Australia, 5Griffith University, Brisbane, Australia, 6University of Technology Sydney, Sydney, Australia, 7University of Tasmania, Hobart, Australia, 8Curtin University, Perth, Australia

Aim/Objective. The current Royal Commission into Aged Care Quality and Safety has a focus on the education, training and skills of those who provide formal care to older people. The aim of our research was to explore how care of the older person is taught to student nurses at a theoretical level and through clinical placements; in essence, how are they prepared to provide care to older people as registered nurses. Methods. A semi-structured interview schedule was designed and piloted by the Australian Hartford Consortium of Gerontological Nursing Excellence (Aus-HCGNE). All Heads of Australian Schools of Nursing (n=35) were invited to participate and asked to nominate an appropriate academic/s to be interviewed. These academics were contacted, informed consent obtained, and interviews were conducted over the phone. The response rate was 100%. Interviews were recorded and transcribed. Quantitative data was analysed using descriptive statistics and qualitative data was thematically coded. Results. Six percent of Schools of Nursing in Australia teach care of the older person in stand-alone subjects, 34% only integrate it into content across the curriculum and 60% have a combination of stand-alone subjects and integrated content. Fifty percent of Schools of Nursing conduct aged care clinical placements in first year, but in 38% of Schools, the aged care placement can occur in any year, meaning that students can have multiple or no aged care placement/s. Only one School reported that they had an older person as a consumer on their Curriculum Advisory Board. Conclusion. There is no consistency in curriculum content about care of the older person, in its delivery or in the way aged care clinical placements are scheduled and managed in Australian Schools of Nursing. Research needs to be conducted into how this inconsistency impacts on the preparation of future registered nurses to care for older people. Keywords: care of the older person, nursing, curriculum, clinical placements

201

It's quite complex: Finding the balance for postgraduate mental health nursing andragogy: The registered nurse e- learning experience

Mrs Elizabeth Currie1, Ms Bronwyn Tarrant1

1University Of Melbourne, Carlton 3053, Australia

We know from the literature that e-learning is not novel for nursing students, in fact a number of studies have explored, in particular, blended models that are both online and face- face teaching. The evidence to date suggests that there is a varied approach to the online teaching methodology. A systematic review of 19 studies claims that there is still no definitive answer to which teaching methodology is more effective (McCutcheon, Lohan, Traynor & Martin (2015). More research is required to assess the effectiveness of this teaching andragogy for postgraduate students (Smyth et al., 2012). This paper examines the postgraduate mental health nursing students’ experiences and level of engagement using e-learning as part of the online curriculum. Drawing on Phillips, McNaught and Kennedy’s (2012) lifecycle stages of e-learning, this study reports on the findings of a mixed method sequential explanatory design. The findings suggest that there is diversity in the number of e-learning tools and Mental Health Postgraduate nursing programs need to consider the value-add of e-learning artefacts. Further recommendations that e-learning tools need to provide a higher level of engagement based directly on assessment outcomes. Finding the balance between level of engagement and assessment is quite complex.

202

New learning resources to enhance novice nurses’ insights and practice in pain management

Assoc Prof Susan Slatyer1

1Murdoch University, Murdoch, Australia

Nurses are critical to the effective pain management across care settings. However, pain is highly subjective, and it is evident that nurses’ and patients’ perceptions about pain are influenced by inherent and acquired values and beliefs, previous experience, and levels of empathy. Nurses expectations of the level of pain patients ‘should’ experience and opinions about analgesics can influence practice, and patients vary in the way they express pain experiences. Novice nurses have a beginning understanding of these complex interactions. New learning resources integrating innovative technologies offer the means to heighten nurses’ awareness of their beliefs about pain and how these influence pain management, while modelling current recommended clinical practice. Providing authentic, practice-based trigger materials assists novice practitioners to problematise and explore practice through reflection and feedback. Drawing on concepts of experiential and peer learning underpinned by reflection on and about practice, our team has used audio visual (AV) technology to develop a series of filmed vignettes featuring pain-related interactions between nurses and patients. Each was designed to highlight how patient characteristics can influence pain behaviours and consequent nurse-patient interactions. All feature nurses demonstrating empathy appropriate to the situation and evidence-based practice. The technique of the nurse ‘speaking to camera’ creates a personal interaction between the actor and the viewer, highlighting the clinical reasoning and decision-making of the nurse. The AV simulations have been trialed with Australian undergraduate nursing students and graduate nurses. Preliminary results indicate that the resources trigger higher order thinking and a greater awareness of the complexity of the nurses’ role in assessing and responding to pain. Once produced, AV simulations are suitable for multiple and on-line use, cost-effective, and widely accessible to nurses in their workplaces via telehealth. There is also potential to adapt this educational approach for application across nursing specialities and practice settings.

203

Three simulations in one: A multi modal approach to the care of patient who has experienced a stroke

Dr Jane Frost1, Dr Sarah Cope1, Dr Jane Kellett1

1University Of Canberra, Bruce, Australia

Stroke is a common presentation and most nursing students will care for a patient who has experienced a stroke during their training. To prepare students to care for patients who have experienced stroke and to develop empathy for patients left with disability from stroke, a simulation that used three complementary components was developed. This multi modal approach incorporated a VR experience, an empathy suit and a mixed reality experience. Method: A pre-post intervention study was completed using the Keirsma Chen Empathy tool and a specifically designed questionnaire to rate each experience in relation to developing empathy and relating towards the older adult. Results: Empathy scores increased from the pre-test to the post test. Students ranked the empathy suit most effective for promoting empathy and for relating to the older adult, closely followed by the 360-degree video. The Hololens had a positive impact on learning but this was not rated as high as the other types of simulation in the study. Conclusion: The combination of approaches assisted in the development of empathy for individuals who have experienced a stroke. The empathy suit and the immersive video as expected correlated more highly with empathy and relational aspects of care. The specific benefits of the mixed reality headset were not captured in this study, but it could be seen to augment the experience as whole and was positively rated by participants.

204

Preparing future nurses and midwives to contribute to the quality improvement paradigm in the practice setting

Dr Jacqueline Jauncey-Cooke1,2, Dr Nigel Lee1

1The University of Queensland, St Lucia Australia, 2Queensland Children's Hospital, Children's Health Queensland, South Brisbane, Australia

Whilst the understanding and implementation of evidence-based practice (EBP) is an essential part of professional practice the inherent concepts can be challenging as students may consider EPB to be largely theoretical. Our School developed an innovative, collaborative approach requiring nursing and midwifery students to generate and implement EBP during clinical placement. The 13-week semester course tasked students to undertake a Quality Improvement (QI) project in their area of clinical placement. The Unit/Service Manager identified projects that were relevant to the area in collaboration with course academics. The students were appointed a clinical mentor at the placement site and an academic mentor at the university. The course content was underpinned by online-modules and learning resources that presented the concepts and differences of QI and research methods. Workshops and tutorial groups facilitated by the academic mentors supported the students as the projects progressed from initial concept to literature review, ethical considerations, project design, data collection, analysis and presentation of findings. Assessment items aligned with the project progress and included a literature review and project plan; an inservice presentation of the project on placement; and a poster and presentation at the course Conference Day. Students were encouraged to donate their poster back to the placement site for display. Course feedback was provided by students and industry partners which will contribute to future iterations including improving information and communication strategies between clinical areas, students and the university. This novel approach to combining academic and clinical teaching required unprecedented collaboration between the university, industry partners and practitioners enabling students to produce high-quality clinically relevant outcomes. Students achieved a greater understanding of EBP and experienced a deeper level of involvement in the clinical area. The students developed a range of skills that will strongly support their entry to the workplace and future studies.

205

Investigating the experiences and needs of nursing and midwifery academics teaching postgraduate courses offered entirely online

Dr Tracey Ahern1, Dr Narelle Biedermann1

1James Cook University, Townsville, Australia

Aim: The aim of this study was to understand the experiences, as well as the learning and professional needs, of university staff teaching 100% online and establish strategies to address the needs of this population. Methods: The study was conducted using a cross-sectional, online survey collecting predominantly quantitative data, with some options to provide additional information through an open-ended response. Participants included nurses or midwives who had taught in a fully online postgraduate course offered at an Australian university. Results: A total of 49 participants completed the survey. The majority of participants had been teaching in higher education for ten years or less (n=33, 67%) and rated their online teaching experience as competent (n=18, 36.7%) or proficient (n=19, 38.8%). Just over half the sample agreed that online teaching is isolating (n=25, 51%) and time consuming (n=18, 57.1%). The majority of participants agreed that online teaching is challenging (n=36, 73.4%). When asked about training and support, two thirds of the sample said they could be better supported in their role as an online teacher (n=30, 61.2%). Fifty-seven (n=28) claimed that they did not receive any training specific to online teaching before beginning to teach online and 59.2% (n=29) felt that they needed additional training to assist them in their role as an online teacher. Qualitative data revealed a range of barriers related to preparedness to teach and understanding and using the technology required for successful online teaching. There were also a wide range of barriers reported with regard to pedagogy in an online environment, along with a sense of discontent with online teaching when compared to the participants’ experiences of teaching in traditional classrooms. Conclusion: The results of this study have provided evidence to inform recommendations to better support academics teaching courses offered entirely online. Keywords: nursing faculty, online teaching

206

'What’s their story?': New graduate nurses' experiences in a Neonatal Intensive Care Unit

Mrs Renee Mckenzie1, Dr Susan Miller2, Dr Gabrielle Brand2

1Murdoch University, Perth, Australia, 2The University of Western Australia, Perth, Australia, 3Monash University, Melbourne, Australia

Aim: Transitioning from a nursing student to a novice Registered Nurse can be a complex and challenging time. Despite research studies being conducted in this transition, there is very little about graduate nurses’ experiences in acute specialities; including a Neonatal Intensive Care Unit. The purpose was to explore how graduate Registered Nurses’ perceive their learning and developmental experiences during their first six-month rotation in the Neonatal Intensive Care Unit. Methods: Qualitative Narrative inquiry with thematic analysis was used to explore the graduate Registered Nurse’s accounts of their emotional and professional learning journey. In total, eight graduates were individually interviewed. Findings: Themes included feeling unprepared, experiences of horizontal violence, the need for a supportive structural environment and seeking feedback. These themes resulted in overwhelming feelings of stress, emotional exhaustion and for some graduates, led to early career burnout within their first six months in the health care workforce. Conclusion: This research project deepens our understanding of how we can better tutor educators to support graduate nurses’ transitional needs in the Neonatal Intensive Care Unit. This includes addressing gaps in their previous neonatal education, considering generational attributes of millennial nurses and aligning the educational expectations of graduate nurses and Neonatal Intensive Care Unit staff members. This study calls for hospitals to invest in more comprehensive, transitional educational support programs for graduate nurses entering the health workforce in order to retain high quality graduate nurses in the Neonatal Intensive Care Unit. Keywords: Graduate Nurse, Neonatal Intensive Care Unit, Transitional, Preparedness for practice

207

Supporting experienced and graduate nurses’ transition to primary health care through a transition to practice program

Miss Rebekah Cox1

1Australian Primary Health Care Nurses Association, Melbourne Australia

Nurses transitioning into new areas of health care can often feel like a fish out of water, especially when they're transitioning into primary health care. Therefore, it is vital that both graduates and experienced nurses moving to primary health care, feel they have the knowledge, skills and confidence required to work and remain in primary health care. Recruitment and retention of nurses in the primary health care workforce, is becoming increasingly important, as nurses play a pivotal role in ensuring our health care system can meet the complexities and ever-increasing demands of primary health care. Transition to practice programs are one strategy for promoting recruitment and retention of nurses in primary health care. A two-tranche transition to practice pilot program explored how a supportive program for nurses new to primary health care might look. The pilot program concluded in 2017 and has since moved into a demonstration phase which commenced in 2018. The pilot program involved assessment of knowledge, skills and confidence, tailored formal education, and both professional and clinical guidance by experienced primary health care nurses through preceptorship and mentorship. Results of the pilot phase suggest that regardless of where nurses are in their transition phase (experienced nurses or recently graduated), they need a multifaceted approach. It became clear that structured support, guidance from an experienced nurse, and tailored education are all equally important ingredients to a successful transition. This presentation will discuss the design and implementation of the pilot program, the outcomes achieved, lessons learnt and where to for future programs.

208

Transitioning into university: Nursing students’ perception of belonging within a Bachelor of Nursing learning environment

Dr Rebekkah Middleton1, Professor Ritin Fernandez1, Ms Natalie Cutler1, Ms Carley Jans1, Ms Carolyn Antoniou1, Ms Katherine Riley1, Ms Baylie Trostian1

1University Of Wollongong, Wollongong, Australia

Commencing a university degree can be a turbulent experience, as students adjust to a new and unknown environment (Maunder 2017). This transitioning process into the university environment can impact student’s grades and overall satisfaction, along with their perception of belonging in this new environment. In addition, retention of students is reported to significantly improve when the University learning environment fosters a sense of belonging. Despite numerous efforts to reduce attrition, retention in undergraduate nursing degrees remains a global issue, with up to 40% of nursing students leaving before completing the degree (Smith-Wacholz et al. 2019; Mooring 2016). Aim: To investigate the perception of belonging to the School of Nursing (SN) among nursing students at a regional Australian University. Methods: Students completed a cross-sectional survey. Data were collected using the 24-item University Belonging Questionnaire (Slaten et al. 2018). Results: Online responses were obtained from 100 students. The mean score for overall Belonging was 70.5 (maximum obtainable 96), mean Scores for University affiliation, University support and acceptance and staff relations with students were 34.7, 24.1 and 11.8. There were no significant differences in overall University Belonging scores for the demographic variables including marital and employment status, highest level of education, studying on/off campus, being a domestic or international student, studying fulltime or part time. However, students who were studying at the university for less than a year reported significantly higher University Belonging scores compares to their colleagues. Conclusion: The results of this study will inform the development of strategies to facilitate meaningful ways of engaging students to be involved and feel connected to the School and each other throughout their study and thus improve retention.

209

Job Readiness Framework: Embedding and supporting structured transition points to nursing students in the final year of a nursing degree.

Mrs Nikki Meller1

1Western Sydney University, Castle Hill, Australia

Higher education facilities are under pressure to help nursing and midwifery students comprehend and prioritise the concept of employability as an approach encompassing more than clinical skills and experience, and distinct from academic performance. Providing resources with specific job readiness and self-directed employability assistance can potentially encourage and define a structured transition to professional practice experience, as “students no longer see themselves as grateful and passive receipts of a university education, indeed, students want more from their universities, and their expectations for both quality education and employment outcomes are increasing” (Hecht Harrison, 2016, p.42). The Job Readiness employability framework has not only influenced the student experience, but also enhanced learning and teaching through the final year of their undergraduate degree. Keywords: Graduate Employability, Transition to work, Student support

210

Developing employability skills in undergraduate nursing students – a whole of curriculum approach

Mrs Fiona Foxall1

1Edith Cowan University, Quinns Rocks, Australia

Over the last decade, the percentage of new graduates from the BSc Nursing at Edith Cowan University who obtain full-time work as a Registered Nurse has declined year on year. Although employment figures remain reasonably buoyant in comparison to other similar courses, a drive to increase students' employability was considered necessary. In view of this, a new employability strategy has been developed and implementation begins from course commencement and is woven across the whole curriculum. The aim of the strategy is to support students in the development of their career management skills over the period of their course. Specific objectives of the strategy are to increase students’ self-awareness of their skills, values and priorities in life, and to realise that these change during life stages. It also aims to assist students’ realisation that their skills, values, knowledge and professional attitude/identify will have a bearing on transitioning into their chosen profession. It enables students to explore different job searching methods and to use a variety of sources to find suitable positions, as well as supporting students to develop skills in self-marketing through the entire job application and interview process. The employability strategy also aims to achieve a number of course learning outcomes, notably: participate in ongoing professional development of self and others; independently communicate nursing knowledge, concepts and values clearly and coherently; demonstrate autonomy, accountability and judgement for own learning and professional nursing practice in accordance with the Nursing and Midwifery Board of Australia standards for practice. Evidence of learning, achievement of course learning outcomes and standards for practice is collated in a professional electronic portfolio, which is built upon throughout the course. The strategy is currently being rolled out and will be subject to stringent evaluation and will evolve in light of student feedback and success.

211

Does the development of key principles support undergraduate nursing students to gain safe practices in medication administration?

Mrs Susan Hull1

1Cairns and Hinterland Hospital and Health Service, Cairns, Australia

Background: Medication administration is one of the most complex skills undergraduate nursing students are required to undertake. Clinical placements provide undergraduate nursing students the opportunity to put theory into practice, however the environment and processes for administration of medication varies within each healthcare facility. Students are expected to rapidly adapt to the unfamiliar surroundings and supervision styles whilst demonstrating an ability to apply the ‘rights’ of medication administration, thus leading to increased anxieties and risk to patient safety. Whilst medication errors and risk to patient safety remains a major concern within the health industry, the education and clinical experience of undergraduate nursing students to develop safe practices in medication administration is vital. Aim/Objective: A nurse education unit within a regional health facility reviewed the principles of medication administration following an unprecedented number of unsupervised undergraduate nursing student medication errors. Method: In collaboration with university partners, medication administration was placed on ‘hold’ for the first week of each placement to allow the students to develop increased awareness of local policy and procedure; greater awareness of the environment, demonstrate knowledge and gain confidence in their communication. Five (5) key principles were developed to support nursing students and supervisors to apply safe medication administration practices in a clinical environment, thus provide emphasis and acknowledgement of the complexities of medication administration. The five principles included: knowledge, environment, communication, confidence and accountability. Results: Medication errors were reduced significantly for all year levels of undergraduate nursing students over a twelve (12) month period. Industry and academia collaboration increased awareness of the importance of education and learning for undergraduate nursing students in relation to medication administration. Conclusion: The increased clinical learning environment for undergraduate nursing students provided an awareness and acknowledgement of the complexities of medication administration and decrease in the risk to patient care.

212

A nursing curriculum philosophy to ensure professional and person-centred practice

Dr Rebekkah Middleton1, Prof Tracey Moroney1, Dr Sam Lapkin1

1University of Wollongong, Wollongong, Australia

The role of curriculum is to prepare students for work as a registered nurse (RN). The Bachelor of Nursing (BN) at a regional Australian University recently introduced a curriculum that used person-centred practice to connect and influence all curriculum decisions. This research considers whether a BN philosophy can influence the development of students’ person-centred practice. Students completed an online validated questionnaire – the Person-Centred Practice Inventory (PCPI) at multiple points throughout the BN. The PCPI uses a 5-point Likert scale to determine level of agreement from strongly disagree to strongly agree. The questionnaire constructs and statements were mapped to achievement in the curriculum according to year and session once subjects were completed. This presentation reports findings from the first 12 months of this longitudinal study. This research enables the researchers to determine whether the intended aims of the curriculum are being met and ensures the School of Nursing can develop strategies to facilitate students to understand what person-centred care is and how person-centred practice develops throughout the curriculum. Embedding person-centred practice by placing values at both the heart of the curriculum and the learning environment is essential to transforming workplace culture by preparing RNs for future leadership and practice. At the core of this education is the need for students to develop skills so that they can mold and shape a culture of person-centredness, necessitating them to develop critical thinking and reflective skills, and to practise authentically within their identified values and beliefs, in order to be effective change agents who actively contribute to the creation of healthful cultures.

213

Embracing wellbeing to future-proof nurses, midwives and others

Professor Anne Williams1

1Murdoch University, Coogee, Australia

Wellbeing is a positive mental and physical state and our understanding of what constitutes wellbeing has increased in recent years, as too our knowledge of strategies to optimise and promote it. Although advances in healthcare and technology have brought many benefits, increased demands for hospital care and interventions have escalated healthcare costs and stretched resources. Increasingly, compromises in patient safety are reported, and staff lacking in compassion observed. As advocates of healthcare, nurses and midwives should be leaders of wellbeing, but high levels of stress and burnout are currently being reported in the professions, together with concerns about workforce retention. The struggle of nurses, midwives and other health professions to experience wellbeing and facilitate the wellbeing of patients, is readily evident in literature worldwide. It is essential that we act now and embrace wellbeing. We need to ensure that our future nurses and midwives understand wellbeing and have the skills to protect themselves and others. A new model of wellbeing will be presented, developed through several research projects which have focused on the improving the wellbeing of cancer nurses. Strategies for increasing the capacity of nurses and midwives to cope with workplace stress will be outlined.

214

Educating new graduate nurses: Have we got it right?

Ms Lesley Doughty1, Associate Professor Robyn Dixon1, Dr Ann McKillop1, Associate Professor Claire Sinnema1

1University of Auckland, Auckland, New Zealand

Abstract: New graduate entry to practice (NETP) programmes aim to ensure that nursing graduates commence their careers in a well-supported and safe environment, developing, knowledge, skills and confidence in their clinical practice. Currently, the content and structure of these programmes vary. Some include a Postgraduate (PG) course but there is much debate and little empirical evidence about the value of including such in NETP programmes. Aim/Objective: The overall aim of this research is to explore how professional education that new graduates receive via the Nurse Entry to Practice (NETP) Programme impacts on nursing practice and patient care. This presentation specifically addresses the question: Does a PG course included in the NETP programme impact on new graduate nurses’ knowledge, skills and practice compared to those completing NETP without a PG Course? Methods: A pre/post design employing an online survey was used to gather data from the two groups on the commencement and completion of the NETP programme. Results: Subscale scores for knowledge, critical thinking, patient care, communication and confidence will be reported, along with a summary of differences between the two groups on those scales and key items. Responses to associated items will be presented and any difference between the two programmes will be highlighted and discussed (analysis of this data is underway). Conclusion: New graduate nurses are the future of nursing and the education they receive is vital to building a suitably qualified nursing workforce that will adequately serve the future population. Furthermore, resources are scarce, so it is imperative that we ensure that the education we provide achieves these goals. This study contributes much needed empirical evidence to the debate, and to the best of our knowledge, is the first to do so from the perspective of new graduate nurses completing the programmes. Keywords: new graduate, postgraduate education, nursing.

215

Overseas qualified nurse’s adjustment into the Australian Health Care System

Dr Maya Ebrahimi Zanjani1,2, Dr Tahereh Ziaian2, Dr Sandra Ullrich2

1Monash, Melbourne, Australia, 2University of South Australia, Adelaide, Australia

The ageing population phenomenon, and associated chronic medical conditions, are concerns in all developed countries. The proportion of older Australians is expected to grow to 22% (8.7 million) by 2056 and to 24% (12.8 million) by 2096. Thus, nursing workforce shortage is an increasing challenge for healthcare systems, health planners and scholars worldwide. One of the main solutions to this problem to date has been the recruitment of overseas-qualified nurses (OQNs) from developing nations. The trend to dependence on OQNs is similar in Australian, Canadian and the US healthcare systems. Migration to developed countries involves OQNs in a critical transition process of adapting to their host countries and to new healthcare environments and practices. This adaptation process is complex, including a host of cultural, linguistic and professional issues. These disparities often cause conflicts and misunderstandings between OQNs and host nurses in the workplace, all of which are obstacles to a smooth relocation. A literature review revealed that the integration of OQNs into the Australian healthcare system has not received adequate attention, from either the research community or the healthcare industry. The literature review reveals that the integration of OQNs into the Australian healthcare system has not received adequate attention, from either the research community or the healthcare industry. This is a significant gap given that OQNs come mainly from developing. Therefore, the aim of the current study is to identify the barriers and facilitators to the successful integration and adjustment of OQNs into the Australian healthcare system; the study explores their life satisfaction while resident in Australia and their level of job satisfaction while working within the healthcare system.

216

Virtual Reality (VR): Putting the ‘reality’ back into prioritizing care

Dr Jane Frost1

1University of Canberra, Bruce, Australia

Clinical reasoning and prioritization are key skills for final year nursing students. We used a combination of virtual reality and an individual experience of a busy ward, with augmented reality which allowed a group exploration of the ward environment to allow students to prioritize the care for a group of patients. This novel use of technology enhanced learning and created healthy discussion about whose needs were greater. This simulated activity allowed students to prioritize care needs and allocate resources to a group of patients, that they could visualize and identify with. As a small group challenge, it resulted in extensive discussions, engagement was high as students immersed themselves in the experience. As technology enhanced learning develops it is important to harness the powerful impact it can have in a classroom and use it in ways that provide powerful learning moments. We will present this novel simulation in which clinical judgement, prioritization, teamwork, conflict resolution and delegation were all explored and practiced.

217

Preparing undergraduate nurses and midwives for the future through culturally immersive initiative

Dr Olayide Ogunsiji1

1Western Sydney University, Liverpool, Australia

Aim/objective: Nurses and midwives occupy important role in the achievement of the United Nations Sustainable Development Goals, Agenda 2030 which promised to ensure that no one is left behind. Nurses and midwives’ encounters with people from culturally and linguistically diverse population will increase, suggesting the need to prepare them for this future of health care. This abstract aims to provide insight into teachers and students’ perception of learning and teaching cultural issues in health care and make a case for culturally immersive initiative as the approach for preparing future nurses and midwives. Methods: Using a mixed methods approach, we explored perspectives of nursing and midwifery undergraduate students (154) and teachers (12) on learning and teaching cultural issues in health care. Participants in this study were students enrolled in a second-year unit which focused on cultural issues in health care and teachers teaching the unit at the time of data collection in 2017 or have previously taught in the unit. Students and teachers responded to online survey questions which contained some open-ended questions. After the completion of the online survey, interested teachers were invited to participate in face-to-face or telephone digitally recorded in-depth interviews. Thematic analysis of the interview transcript and responses to open-ended questions revealed important themes namely: Teaching cultural issues in health care; preparing nurses and midwives for culturally sensitive health care and immersing in different cultures. Result: Teachers spoke about the value of teaching in the unit as well as the challenges and dangers of preparing students theoretically for culturally sensitive care. Meanwhile, for the students there was an overwhelming demand for cultural immersion in diverse cultures for them to be prepared to provide health care for an increasing culturally and linguistically diverse world populations. Conclusion: Preparing nurses and midwives for the future requires culturally immersive initiatives into diverse cultures. Keywords: Undergraduate nurses, undergraduate midwives, cultural immersion. Future nurses.

218

Enhancing the quality of nursing clinical placements in Australia. Development of the Placement Evaluation Tool (PET): A co-design project.

Prof Simon Cooper1, A/Prof Robyn Cant1, A/Professor Amanda Henderson2, Dr Kerry Hood3, Ms Elise Luders1, Professor Kerry Reid-Searl4, Ms Colleen Ryan4, A/Professor Marion Tower5, Professor Donna Waters6, Dr Georgina Willetts7

1Federation University Australia, Berwick, Australia, 2University of the Sunshine Coast 3Holmesglen Institute 4CQ University 5University of Queensland 6The University of Sydney 7Swinburne University

Background: In Australia and internationally nursing students are required to complete clinical placements as part of the educative process. Hours range from 800 hours in Australia to 2,800 in South Africa. There appears to be no foundation or evidence for the number of hours allocated and it is clear that students are often exposed to negative as well as positive experiences. With these considerations in mind it is imperative that rigorous evaluation instruments are available that measure the quality of placement experience, enabling improvements at placements sites and enhanced educational opportunities. Aim: Using co-design principles to develop a feasible, valid and reliable clinical Placement Evaluation Tool (PET) applicable to nursing student placements in Australia. Design: An exploratory mixed methods co-design project. Methods: The PET was developed in four stages: firstly, an extensive review of the literature to identify existing placement evaluation tools; secondly, development of a draft instrument with core stakeholders using two nominal group techniques; thirdly, content validity measurements with additional stakeholders, and fourthly, a PET pilot trial at seven Australian Universities. Results: The project will be completed in 2019. The final tool validated for use with nursing students will be presented at the conference. Conference Presentation: The presentation will include a summary of practice based educational approaches, contemporary considerations for clinical learning and future educational models.

219

Contemporary approaches in a pre-registration nursing course to prepare nurses for a future in the profession

Dr Leeanne Heaton1, Ms Justine Connor1, Dr Julie Bradshaw1, Professor Moira Williamson1, Professor Kerry Reid-Searl1

1CQUniversity, Mackay, Australia

Keywords: Pre-registration nursing, professional responsiveness, curriculum, innovation Aim/Objective: Learning about the profession of nursing presents many challenges to nursing students. Developing a curriculum that incorporates aspects to sufficiently prepare students with the necessary knowledge, skills and attributes needed for their practice is difficult and often gains scathing criticism from industry. This presentation highlights some of the innovative units incorporated in a new pre-registration course integrating features aimed to defy censure and ensure professional responsiveness in the future. Methods: Consultation with current students, alumni, industry partners, and consumers occurred over a period of several months. Informal conversations, course advice meetings and an online survey were used to gauge feedback about features of the existing curriculum and current issues that were deemed to be important to nursing in the future. Units were developed in an effort to offer a progressive and modern pre-registration curriculum. Results: A three-year curriculum designed to prepare nurses around professional aspects such as detecting and responding appropriately to the deteriorating patient, safe and effective medication administration, clinical and ethical decision making. It features assessments that utilise technology and reflect modern day requirements for the profession, ie e-portfolio. Conclusion: Development of a curriculum that promotes contemporary professional responsiveness and includes innovative ways of engaging students to provoke critical thinking and build confidence in dealing with professional aspects of the role of the nurse now and in the future.

220

What is the evidence for simulation as a substitute for clinical practice in nursing and midwifery?

Prof Fiona Bogossian1,3, A/Prof Robyn Cant2, Dr Emma Ballard3, Professor Simon Cooper2, Professor Tracy Levett-Jones4, Professor Lisa McKenna5, Associate Professor Philippa Seaton6, Dr Linda Ng3

1University of The Sunshine Coast, Maroochydore, Australia, 2Federation University Churchill Australia, 3The University of Queensland, St Lucia, Brisbane, Australia, 4University of Technology, Sydney, Australia, 5LaTrobe University, Melbourne, Australia, 6University of Otago, Christchurch, New Zealand

Background: Despite the Trans-Tasman Mutual Recognition Act 1997[1], there remains little congruence in the standards for accreditation of nursing and midwifery programs in Australia and New Zealand. This is unsurprising given the limited evidence supporting accreditation standards in general, and specifically the requirements for clinical practice and the role of simulation. Given the pressures on clinical placement capacity there is an urgent need for evidence relating to the substitution of clinical placements with simulation. Although the NCSBN study [2] in the USA provides some evidence for simulation replacement, these findings do not translate to Australia and New Zealand. Objectives: to examine the levels, quality of evidence, measures and outcomes when simulation is substituted for clinical placement; and to identify the optimal proportions, ratios, durations of simulation replacement Methods: A systematic review guided by PRISMA[3] of primary studies in which simulation was used to replace clinical practice hours. Elements of interest were carefully extracted and the quality of each study was assessed using the MERSQI[4]. Results: Ten primary studies were included; RCTs (n=6), quasi-experimental (n=3) and one analytic design. Overall methodological quality was moderate to high and inter-rater reliability was high to very high (k >0.7 and 0.8). A total of 2370 students were included from three health disciplines, across four countries. Studies reported briefly on types of simulation interventions, which varied considerably. The proportion of substitution ranged 5-50% with most substituting 1:1 simulation for clinical practice hours. The duration ranged from 21 hours to 2 years. Adherence with the simulation interventions was reported in some studies. Evaluations addressed participant reaction, learning and behaviour transfer. Conclusion: Although there is limited evidence supporting the substitution of clinical placements with simulation, emerging evidence does suggest that equivalent learning outcomes can be achieved through the use of simulation.

221

Two thirds of a triangle

Dr Frank Donnelly1, Mr Paul McLiesh1, Ms Sally-Anne Bessell1

1The University of Adelaide, Adelaide, Australia

Background: The Affective Domain describes learning associated with feelings, values and emotions. Despite this domain being clearly described in a taxonomy from the late 1960s there remains an over-emphasis in many tertiary, government and accreditation bodies for students in health disciplines for skill and knowledge. This emphasis comes despite reports and findings from around the world of decreasing standards of practice and renewed debate of the place for empathy and care. The emergence of newer technologies such as 360-degree video provides an opportunity to revisit ways to design and deliver affective learning. Method: Using the Affective Domain taxonomy as a scaffold, a 360-degree video was created to give nursing and medical students an insight to the patient experience and to provide an orientation to the operating theatre. Results: Careful planning and consideration of how the Affective Domain can inform design of learning and teaching material resulted in an engaging and informative learning experience. Being aware of how each level of the domain informs the next is essential to developing effective affective teaching plans. Conclusion: Affective learning has traditionally been seen as difficult to deliver and assess. Technology such as 360-degree virtual reality provides an engaging, reproducible and consistent platform for innovating and delivering a domain of education that has been neglected for too long.

222

Fostering interprofessional collaboration with midwifery and medical students

Ms Nicki Hartney1, Mrs Sherryn Evans1, Ms Nicole Shaw1,2

1Deakin University, Geelong, Australia, 2Barwon Health Geelong, Australia

Background: There is mounting evidence demonstrating that inter-professional collaboration improves maternity clinical outcomes. Despite this the current convention of single profession facilitation of midwifery and medical students in birth suite persists. Students are in direct competition for clinical experiences creating a hostile environment where neither appreciate or understand each other’s role and skill set, impeding collegiality and collaboration. Intervention: A large regional health service conducted an exploratory project in birth suite in 2016. Findings were consistent with the literature demonstrating tension between midwifery and medical students. This prompted the implementation and evaluation of an inter-professional model of student facilitation. The model utilises clinical educators who support and facilitate learning opportunities for both midwifery and medical students whilst maintaining a woman centred approach. They offer opportunities for students of both disciplines to participate in learning activities which are inclusive and supportive. Students undertake formal and informal learning activities together, giving them the opportunity to enhance professional appreciation and respect. The facilitated activities focus on awareness of, and skills in, inter-professional collaborative practice. Outcome: Student and educator evaluation revealed a positive learning environment free of competitive hostility. Quantitative data indicated more women had midwifery and/ or medical students involved directly in their intrapartum care after the model was introduced. Students met their clinical requirements sooner and reported their time in birth suite as a positive learning experience. Further evaluation of how the model influences students, staff and the birthing woman is planned. These outcomes support consideration of wider adoption of this model of clinical education beyond the birth suite. Keywords: inter-professional, collaboration, midwifery

223

Using the safety attitudes questionnaire to enable professionals to engage in meaningful change

Mr Christopher Hinder1,2

1University of Wollongong, Wollongong, Australia, 2Illawarra Shoalhaven Local Health District, Wollongong, Australia

Aim: The aim of this study is to discover what clinical environments do with feedback provided from the SAQ report to improve the patient safety culture at the ward level. The objectives include: • To understand how clinical teams have engaged with the data to identify quality improvements. • To understand how data is used to inform quality improvement. • To determine if using the data led to improvements resulting in better scores between surveys. Methods: This study uses a descriptive multiple case study design to investigate how staff on a ward utilise data from the Safety Attitudes Questionnaire (SAQ) to improve their safety culture over one year. Participants have been drawn from the two wards that elected to participate in the study along with their managers. Focus groups were conducted on each ward with staff and managers of the two wards were interviewed. The 2018 and 2019 survey results for each ward were also included. Results: Focus groups and interview data are being analysed with preliminary themes emerging such as ; staff do not appear to be engaged with the data, there is a focus on ‘hospital management’ and their lack of visibility as a contributing factor to poorer safety outcomes as well as an emphasis on staffing levels which is less about the amount of staff and more about skill mix. Conclusion: These preliminary results emphasise the importance of engaging frontline staff meaningfully in understanding the safety culture at the unit level. There is a need to address staff concerns e.g. improving skill mix, as well as supporting staff to make improvements within their own practice environment using available evidence such as data, they themselves have contributed to.

224

The registered nurses’ preparedness to take on a leadership role in a multi-tiered nursing team

Dr Felicity Walker1, Dr Sonja Cleary2, Prof Madeleine Ball2, Dr Heather Pisani2

1Southern Cross University, Coolangatta, Australia, 2RMIT, Bundoora, Australia

Aim/Objective: Pressures on the Australian health system and forecasted healthcare workforce shortages have required a re-evaluation of the framework of healthcare delivery and the composition of the healthcare workforce in the Australian public health sector. This study aimed to examine the case of unregulated Nursing Assistants (NA) practicing in an Australian tertiary-level acute care hospital. Methods: A single case, embedded, descriptive case study research design was used. Nurse leaders (policy makers, mangers, supervisors and educators), nurses (Registered Nurse/ Enrolled Nurse) and NAs participated in individual interviews or focus groups to inform this research. Documentary evidence was collected to augment and triangulate the themes that emerged from interview data. Results: To maintain the quality of patient care and patient safety it is imperative that all members of the nursing team are appropriately educated and trained in their role, responsibilities and the roles and responsibilities of others. It was revealed that that there were some gaps and contention within the nurse’s (RN/EN) understanding of their responsibilities and level of accountability in relation to working with the NA. Further emphasis was required on developing the nurses’ leadership skills particularly in relation to their understanding of the practices of supervision and delegation. In this case teamwork was enhanced by strong interpersonal skills, communication, shared expectations, support and leadership. Conclusion: As the NA role becomes more prevalent in the Australian context, Australian nurses need to take professional responsibility to ensure quality care is provided to their patients by a wider team. It is important for RNs to be introduced to their role as a leader at the undergraduate level. A focus should be placed on the nurse’s responsibilities and accountabilities when working with lower trained workers, developing interpersonal skills, leadership skills and supervision and delegation during their undergraduate training.

225

Understanding motivation and resilience in novice nurses and midwives

Ms Anna O'Connell1, Dr Maureen Miles, Dr Jennifer Angwin 1Deakin University, Burwood, Australia

Background: As graduate nurse/midwives move into their second year of practice, greater independence and autonomy is accompanied by increased responsibility and expectation, of themselves as well as by others. Motivation and commitment to achieve high standards of care are tested in complex care environments. Career abandonment at this professional time point is unfortunately common. Intervention: A preliminary study within a tertiary health service in Melbourne, Australia used a Hermeneutic phenomenological approach to explore the motivational challenges and lived experiences of seven (n=7) novice nurse/midwives in their second year of practice. Informal semi-structured interviews revealed a high level of stress and frustration expressed by the participants at this early career stage. Despite the articulation of commitment to care and empowerment for those they cared for and declaration of fellowship with more senior colleagues, exhaustion and compassion fatigue were evident. Outcome: The study highlights emotional and physical distress in a novice nurse/midwife workforce and echoes the statistics that indicate high levels of career abandonment within the first five years after graduation. In the face of a global shortage of nurses and midwives, the impact of this on the development of skilled, knowledgeable leaders for the next generation of students and novice practitioners is deeply concerning and requires attention and intervention.

226

Students’ perceptions of their preparedness to communicate with their patients about more than their illness: A pre-post intervention study.

Ms Fellon Gaida1, Dr Jane Frost1

1University Of Canberra, Bruce, Australia

Understanding narratives is important but being able to elicit narratives from patients in order to connect, be present and understand our patients is central to the art of nursing. We combined simulation techniques in a multi modal approach to prepare students for clinical practice. A Technological platform with interactive hotspots, 360-degree video and Mask-Ed™ provided a unique combination of experiences. Aim: To explore the potential of a new way of enhancing communication skills and increasing preparedness of students to build therapeutic relationships Method: A pre-post intervention survey design was used to explore students’ confidence in communicating before and after the intervention described above. A cohort of first year Bachelor of Nursing Students enrolled in a specific unit of study were invited to participate Results: 146 first year nursing students completed the questionnaire, a response rate of 51% Discussion: The opened ended questions post intervention suggested that this multi modal approach assisted students in gaining confidence about making conversation and building rapport with patients. We will present the findings of this study in relation to students self-reported confidence in communicating pre and post the tutorial and their experience of the different elements of the tutorial and the tutorial overall.

POSTER 1

A collaborative approach to Bachelor of Nursing course delivery: Fellowship Program

Dr Grainne Lowe1,2, Assoc Prof Lauren McTier1,2, Mrs Jane Walker1, Mrs Michelle Rutherford3, Prof Nikki Phillips1,2

1Deakin University, Geelong, Australia, 2Centre for Quality and Patient Safety Research, Burwood, Australia, 3Eastern Health, Box Hill, Australia

Aim/Objective: To explore students’ perceptions of one, small collaborative Fellowship Program within the Bachelor of Nursing (BN) course. The Fellowship incorporates delivery of both theoretical and clinical components of the BN course in a partner health service, with a conjoint appointed education team. Method: A pilot study was undertaken to ascertain student perceptions of a Fellowship Program. The descriptive study used a mixed methods design and was conducted in two phases. Phase 1 involved a focus group and was conducted when students had completed the first semester of the Fellowship Program. Phase 2 was an online survey undertaken when students had completed the final semester of the Fellowship, two years later. Results: Six students (n= 6/25, 24%) participated in the Phase 1 focus group and nine (n= 9/26, 35%) completed the Phase 2 survey. Key themes identified from the Phase 1 analysis were student belonging, supportive environment, high expectations and employability. These findings were quantified in Phase 2 of the study, evidenced by reports of being welcomed, feeling a sense of belonging and intending to remain in the organisation as graduates. Conclusion: The findings provide insights into student perceptions of their experience in a Fellowship Program that uses a collaborative course delivery model. Overall, students reported a very positive experience in the Fellowship Program. They indicated positive perceptions of their learning environment – both for the theoretical and practical components of the Bachelor or Nursing.

POSTER 2

Intentional rounding as a model of care: A cross sectional study into patients and nurses experiences in a rural hospital

Ms Di Targett1, Mr Hamish Yeates1, Dr Leah East2

1Hunter New England Health, Armidale Australia, 2University of New England, Armidale, Australia

Background: Intentional rounding, often referred to as hourly rounding, is the process by which nurses and other health professionals regularly check on patients to ensure they are comfortable, and that fundamental needs such as pain assessment and control, and environmental needs are met (Flowers et al.,2016). Despite the practice of intentional rounding across the globe, there is paucity in the literature focused on patient experiences of intentional rounding. Aim: To explore the experience and satisfaction of intentional rounding from both the nurse and patient’s perception and the utilisation of rounding as part of a proactive model of care. Methods: A Cross sectional study. Results: This presentation will discuss the challenges, strategies, and results of a cross-sectional study into both, the patient and nurses’ experience of intentional rounding and satisfaction of care provided in an Australian rural hospital. The presentation will highlight the practicalities of introducing a formal study, inclusive of staff engagement, through to a discussion of the findings and measures of satisfaction of delivery of care, and the translation of this research into a proactive model of care. Conclusion: Intentional rounding can be perceived as a proactive model of care within a rural hospital from both a nurse and patient perspective. However, level of nurse engagement as perceived by patients, in addition to the therapeutic relationship between the nurse and patient continues to be a predictor of patient satisfaction. References: Flowers, K., Wright, K., Langdon, R., McIIwrath, M., Wainwright, C, &Johnson,M.(2016). Intentional rounding: Facilitators, benefits and barriers, Journal of Clinical Nursing, 25(9-10),1346-1355, doi:10.111/jocn.13217