Guest Editorial

Nursing education in Ireland: the end of the beginning and the envy of others in Europe.

Nursing care of transgender persons: A systematic mapping study

Objective To develop and evaluate a best practice model of general hospital acute medical care for older people with cognitive impairment. Design Randomised controlled trial, adapted to take account of...

Insights into the experiences of nurse educators in end-of-life care: A qualitative study

Editorial: Nurse education: time to get it right

Case-based education has a long history in the disciplines of education, business, law and the health professions. Research suggests that students who learn via a case-based method have advanced critical thinking skills and a greater ability for application of knowledge in practice. In medical education, case-based methodology is widely used to facilitate knowledge transfer from theoretical knowledge to application in patient care. Nursing education has also adopted case-based methodology to enhance learner outcomes and critical thinking. The objectives of the study was to describe a decentralised nursing management education programme located in Durban, South Africa and describe the perceptions of nursing faculty facilitators regarding implementation of this teaching method. Data was collected through the use of one-on-one interviews and also focus groups amongst the fifteen facilitators who were using a case-based curriculum to teach the programme content. The average facilitator was female, between 41 and 50 years of age, working part-time, educated with a baccalaureate degree, working as a professional nurse for between 11 and 20 years; slightly more than half had worked as a facilitator for three or more years. The facilitators identified themes related to the student learners, the learning environment, and strengths and challenges of using facilitation to teach the content through cases. Decentralised nursing management educational programmes can meet the needs of nurses who are located in remote areas which are characterised by poor transportation patterns and limited resources and have great need for quality healthcare services. Nursing faculty facilitators need knowledgeable and accessible contact with centrally based full-time nursing faculty in order to promote high quality educational programmes.

Transferable strategies and actions for increasing health assessments for people with an intellectual disability In Australia, people living with an intellectual disability comprise about 1–3% of the population and, compared with the general population, experience worse health outcomes.1 Poorer participation in primary health care of people with an intellectual disability contributes to high levels of undetected and unmanaged health issues and premature deaths from preventable causes.2 A positive development to address these inequities is the roll-out of a $6.5 million Primary Care Enhancement Program over 4 years (2020–2024). The Enhancement Program will be developed through four lead Primary Health Networks (PHNs), with a view to a national rollout across all PHNs. The aim of the Enhancement Program is to increase the skills and ability of general practitioners and other health care professionals to provide effective primary health care for people with intellectual disability.3 To achieve this aim, a key focus of the Enhancement Program is to increase the uptake of the existing Medicare Benefits Schedule (MBS) preventive health assessments to strengthen equity of primary health care access and to support the delivery of evidence-based preventive health to people with intellectual disability (Supporting Information).3 In Australia, there is some evidence to support the use of preventive health assessments for people with an intellectual disability.4 The evidence suggests that yearly preventive health assessments performed in the primary health care setting pick up on unmet health needs in the area of health screening, health promotion, and identification of unrecognised disease.4 Health assessments are a mechanism to support the delivery of evidence-based preventive health care. While people with intellectual disability might in general seem to share few characteristics with Aboriginal and Torres Strait Islander people (hereafter respectfully referred to as Indigenous), these groups have some common challenges when accessing primary health care. These include complexity of health needs, limitations on identification of being Indigenous or having an intellectual disability in clinical information systems, discrimination, clinical inertia, and communication barriers. For both groups, effective clinical practice requires attention to social determinants of health as well as specific medical needs.5, 6 As part of a long-standing Indigenous primary health care continuous quality improvement (CQI) research collaboration, we have knowledge of the barriers to and enablers of the uptake of preventive health assessments — specifically, the MBS item 715 for Indigenous people.7, 8 As such, we have identified some positive actions that may potentially be transferrable to people living with an intellectual disability, along with strategies to inform the effective roll-out of this new program. There is currently no dedicated MBS item on health assessments for people living with an intellectual disability. The 2009 Medicare review resulted in the merging of MBS items dedicated to health assessments for people with intellectual disability with four time-based MBS items (MBS 701, brief; 703, standard; 705, long; or 707, prolonged) for other target groups.9 With the collapse of different health assessments into the single newer MBS item, the ability to identify the extent to which health assessments are being provided to different target groups, such as people living with an intellectual disability, has been lost.9 Given this, PHNs now cannot track uptake or implementation of health assessments for people with an intellectual disability. It is impossible to extract the relevant data from administrative systems at the primary health care level or Department of Health level. Having a dedicated Indigenous-specific health assessment (MBS item 715) has enabled research and evaluation on barriers and enablers of implementation, and data about uptake have informed subsequent policy development.5 Reinstatement of a dedicated and adequately remunerated MBS item is vital to building the evidence base to inform health policy and the provision of health services for people with an intellectual disability through contributing to understanding of who is receiving health assessments and who is not. This will in turn enable development of targeted strategies for increasing uptake. The inability of existing primary health care electronic clinical information systems to systematically identify people living with an intellectual disability will limit the ability of primary health care to identify eligible patients and invite them for a health assessment. Therefore, we recommend that clinical information systems in primary health care are upgraded to enable the easy identification of people living with an intellectual disability, and that primary health care staff are appropriately trained to use these systems. Any patient identifier established in the primary health care setting should be able to be linked to other relevant data systems. Identifying people living with intellectual disability in data systems is particularly important for piloting the new Australian National Disability Data Asset, which will bring together data from multiple sources, including primary health care, to improve the ability to measure and improve outcomes for people with disability.10 A useful point of reference for Australian primary health care is the United Kingdom model, in which people with intellectual disability must be identified at primary health care services. This requirement is supported by a legislative framework and is part of a long term National Health Service plan for providing targeted health services.11 It has been observed that Indigenous health assessments do not necessarily reflect the health aspirations and goals of Indigenous people.12 This learning can be used to ensure that health assessments for people living with intellectual disability are evidence-based, developed with input from people with intellectual disability and carers, and reviewed regularly. Electronic templates can be developed for use in common general practice clinical information systems. With appropriate ethics approval and consent, the data collected can be used for CQI and research purposes to improve implementation of health assessments and ultimately health outcomes. Implementing CQI processes has been shown to be effective in improving the delivery of Indigenous-specific health assessments and evidence-based preventive health care.8 We therefore recommend supporting CQI activities to increase the uptake of health assessments for people living with an intellectual disability. This could include a target in the Practice Incentive Program Quality Improvement program (such as, proportion of people living with an intellectual disability who have had a health assessment), or supporting primary health care to develop locally relevant CQI processes. Although prevalence studies have identified that certain medical conditions and risk factors occur more frequently in people with intellectual disability, there are currently no national clinical guidelines for the delivery of best practice primary health care for people living with an intellectual disability.1 Furthermore, there have been recent calls for the inclusion of intellectual disability into standard clinical guidelines as a specific population that requires distinctive consideration.13 Such guidelines would be a reference point for assessing quality of care for improvement purposes and for building the capacity of GPs and other providers, similar to the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.14 Although there has been increased uptake of Indigenous-specific health assessments, there are continuing gaps in providing appropriate follow-up care, which is essential for ensuring benefit from health assessments.7, 8, 15 We recommend increasing awareness of relevant follow-up MBS items, in addition to health assessments. Investment in the Enhancement Program appears primarily targeted at improving skills and abilities of GPs to improve the quality of care for people with intellectual disability. Yet, there is clear evidence of the value of addressing both demand- and supply-related determinants to improve access to health assessments.5 For example, an effective strategy in increasing the uptake of Indigenous-specific health assessments has been marketing campaigns targeted at community members to increase their awareness of the importance and availability of the assessments. Therefore, we recommend a similar awareness campaign targeting community, carers and disability service providers about the availability of these health assessments for people living with intellectual disability. Naturally, not all learning from experience of Indigenous health assessments is transferable. For example, a preference for health assessments to be conducted by a clinician of the same culture or experience may not apply. While discrimination may be a common factor affecting health and wellbeing, it will be experienced and manifest in different forms to influence health assessment implementation. Australia lacks legislative, policy and regulatory frameworks required to support or enact improving health outcomes for people with intellectual disability. People living with disability are neglected, as a group with specific needs, in both the current draft of the 10-year National Preventive Health Strategy and Australia's Long Term National Health Plan.16, 17 Recognition in relevant frameworks would be a pivotal starting point for addressing the health needs of people living with an intellectual disability. In conclusion, we welcome this commitment to investing in improving access to primary health care and health outcomes for people living with an intellectual disability. We believe there is a unique opportunity to reflect on, and learn from, the experience of implementing Indigenous-specific health assessments, and to apply these learnings to the campaign for increased access to health assessments for this important group. Despite emerging evidence of the benefits of health assessments, there is a clear need to continue to evaluate their effectiveness in different contexts. Multifaceted strategies and action are required at the primary health care centre and service level, in the community, and at patient and policy levels to increase health assessments and follow-up for people living with an intellectual disability. The development of this manuscript would not have been possible without the active support, enthusiasm and commitment of staff in participating primary health care services, and members of the Centre for Research Excellence in Strengthening Systems for Indigenous Health Care Equity and the Centre for Research Excellence in Disability and Health. No relevant disclosures. Not commissioned; externally peer reviewed. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Nurses’ mental health care competence is vital for addressing the current mental health care crisis’ demand for quality in mental health care and services. These challenges also involve educational institutions. In the mental health course of the bachelor’s nursing curriculum, nurse educators face multiple tasks and challenges concerning preparing students for their clinical placement. This study aimed to explore and describe nurse educators’ pedagogical approaches across three universities. The study applied a qualitative and descriptive design, and data were collected from individual qualitative interviews with 13 experienced nurse educators. A content analysis approach in lines with Graneheim and Lundman was used to analyse the data. The content analysis resulted in one theme and three categories, and each category was characterised by three subcategories. The theme intentionally preparing student nurses for mental health care competence served as an overarching theme describing the educators’ overall reflections and descriptions. The three categories were: activating students for the mental health context; caring for students on a personal level; and supporting students in grasping the scope of nursing within the mental health context. These categories described the varieties and complexity of nurse educators’ pedagogical approaches addressing student nurses’ mental health care competence.

Introduction: Increased human health concerns related to the natural environment and climate change are having a growing impact on nursing practice. This past year in Canada, for example, British Columbia reported the highest number of heat related deaths, followed by devastating forest fires in many provinces that have disproportionately impacted Indigenous Peoples. Nurses are well positioned to address the direct health impacts associated with climate change. As a result, nurses require an increased level of ecoliteracy to address the health impacts linked to climate change. The role of the nurse in addressing the health impacts of climate change are vast, ranging from direct patient care, education and advocacy, their role includes supporting individuals, communities, and populations to mitigate, adapt and build resiliency in the face of a changing climate. Background: Regulatory and professional associations support the professional emphasis on the significance of ecoliteracy yet there is insufficient understanding of the resistance to the content in nursing curricula. Although current literature supports an increased emphasis on the integration of ecosystem health concerns and the impact on human health within undergraduate nursing education, there is a paucity of empirical evidence regarding nursing educators’ perspectives on the subject. This study is a first step in gaining a greater understanding of the perspectives of nurse educators on ecoliteracy within undergraduate nursing education programs in one Canadian province. Methods: This qualitative research study included 13 nurse educators from three diverse academic settings. Data were collected using semi-structured, open-ended interview questions, followed by content analysis of the data. Results: Data analysis revealed five key themes: a) importance of ecoliteracy in undergraduate nursing programs; b) current integration of ecoliteracy concepts in curricula; c) future considerations for ecoliteracy content; d) barriers to the inclusion of content supportive of ecoliteracy in curricula; e) strategies to address barriers. While educators feel that ecoliteracy is important in undergraduate nursing, they noted that the current integration of climate content in the curriculum is uneven. Barriers and potential strategies to integrating this content are identified. Conclusion: The findings of this study can be used for curriculum revision and to stimulate innovation and research in nursing education. This study creates the opportunity for a larger scale replication study, pilot studies of the integration of concepts that would support ecoliteracy, and further research on the topic. This study identified that many complexities are involved in achieving ecoliteracy in nursing education and suggest that while threading of content can address the urgent need, further research is required to identify entry to practice requirements for undergraduate nursing programs.

United States: Overview of Cancer Pain and Palliative Care

Nurse educators perform a critical role and function impacting thousands of nursing students each year in the delivery of safe, evidence-based, high quality care of patients. When evaluating the impact of the educational activities, it is also critical that nurse educators have the knowledge, skills, and abilities to identify and measure the outcomes of the instruction delivered. Nurse educators must also have in-depth knowledge of teaching and learning styles, technology such as simulation, and the diversity that is present in the nursing school classroom. All of these factors impact curriculum development and delivery. Obtaining certification as a nurse educator indicates that a standard of excellence as a nurse educator has been achieved that sends a positive message to the public about the quality of instruction nursing students receive in nursing education programs.

Nurses' perceptions in caring for persons with diabetes have been little studied. To address this gap in the literature, a sample of nurses from a large Mid-western health care system were surveyed on nurses' perceptions of: (i) problems encountered in the care of patients with diabetes; (ii) problems encountered by patients and/or family member(s) in diabetes management; and (iii) nurses' suggested solutions. A randomly selected list of 200 registered nurses obtained from the health system's Department of Human Resources included inpatient, outpatient, emergency department, medical centre and home health care nurses. The sample was stratified to include 25% inpatient and 75% outpatient nurses. Of the 200 surveys mailed, 136 were returned (68% response rate). Twenty-four per cent of the 136 nurses reported they did not provide care for patients with diabetes. Of 103 nurses providing care to patients with diabetes, 98% were female, 91% were Caucasian, 76% were between the ages of 30 and 49 years, 57% worked in outpatient settings, 35% worked in primary care, and 42% had a bachelor's degree or higher. Of those with practice guidelines, 84% found the practice guidelines helpful. These nurses also perceived that they, as nurses, needed more education to improve their care of diabetes patients; few nurses believed it was within the scope of their practice to change treatment regimens. The perception of most nurse respondents was that acceptance of diabetes, knowledge deficits and non-compliance were primary patient problems in the management of diabetes. Nurses' perceptions of solutions to the problems centred on education of nurses and patients, and reinforcement of the importance of follow-up care.

Research during the past 40 years has reported negative attitudes toward older people by nurses and nursing students. To date, nurse educators' perceptions have not been specifically studied. Interview data from 14 baccalaureate nurse educators using a grounded theory approach described their personal perspectives related to long-term care settings. The study highlighted four major themes that clearly supported the view that these nurse educators harbored many of the same negative perspectives that nurses, nursing students, and other health care providers have about long-term care settings. One gerontology nurse specialist shed some positive perspectives on this topic. This study makes a recommendation for gerontology specialists to be directly involved in nurse education. Future research is needed with culturally diverse nurse educators in other national and international nursing programs.

Shared learning to improve the care for young people and mental health within nurse education (SHYNE). Improving attitudes, confidence and self-efficacy

The aim of this study is to examine post-graduate thesesin nursing in Turkey between 1980-2015 and to determine the distribution of theses according to years, research types and research topics. The study was carried out with documental analysis. Theses on the subject area were collected from National Theses Center of Turkish Council of Higher Education. When the research studies are analyzed, what draws attention is that nearly all of them are experimental or quasi-experimental studies. The researchers mostly examined organizational behaviors. Another topic examined in graduate theses was patient care. Most common third experienced subject in field of nursing was nursing education. According to our results 44,37% of postgraduate theses in nursing were conducted in 2007-2015, 34,46% in 2000-2006 and the others before 2000. While 33,33% of postgraduate theses in nursing focused on patient care in 2000-2006 this proportion increased to 44,18% in 2007-2015. 258 (38,16%) of 676 theses focused on patient care, 303 (44,82%) on organizational behavior and 115(17,01%) on nursing education. When distribution of research designs used in postgraduatetheses in nursing was analyzed 32,69% of theses were designed experimental, 18,78% quasi-experimental and 39,49 non-experimental. 6,80% of postgraduate theses were descriptive.