Objective: This case study describes the introduction and evaluation of a structured perioperative education program for novice nurses in the theatre setting to address ongoing retention and attrition rates of skilled perioperative nurses. Background: A proficient and dynamic workforce is essential for speciality areas, including surgical theatre environments. Whilst perioperative nurse education occurs at undergraduate and postgraduate universities, assimilation and further development of skills into the work environment takes time and requires a supportive workplace culture. Lack of support and exposure to clinical experience limits the competency and confidence of novice nurses, which negatively affects retention in specialty areas. Study Design: Twenty novice nurses underwent a three-month rotation across 14 perioperative speciality areas with an assigned nurse mentor between 2021 and 2024. An educational learning package was developed to track the knowledge, confidence, and capability of novice nurses. Focus group sessions were held every three months, and surveys were administered to assess the overall effectiveness of the program. Results: Nineteen novice nurses reported increased confidence in their knowledge and overall confidence in the clinical area. Findings demonstrated that the program’s structure was a strength, while organisational impacts were the main barrier, including a lack of staff and time pressures identified as barriers. Overall, workplace culture was improved for all staff with improvements in staff retention. Conclusion: The retention of skilled perioperative staff is essential for best patient outcomes, organisational efficiencies, and a positive work culture and environment. This project has been successful in bridging the theory-practice gap, promoting skill acquisition and professional confidence for NN, whilst enhancing positive workplace culture and staff retention within the study setting. There is a need to review the self-paced learning booklets to enhance the documentation and to show completion by all participants. Implications for practice: Attrition rates in speciality areas that require a high level of ability, such as the perioperative environment, remain a constant concern for healthcare. This study proves the importance of investing in skill development for novice perioperative nurses through a structured educational program in the clinical setting. Supportive frameworks enhance nurses’ knowledge and confidence, leading to retention in speciality areas.

Objective: To aid nurses’ understanding of effect size utilisation in clinical and research contexts. Design and data sources: Methodological discussion paper that is based on the author’s experiences as a clinician and researcher and is supported by literature. Primary arguments: Patient change is a key consideration for clinical nurses and nurse researchers. Nurses routinely use measurement instruments to identify and quantify such change informing intervention outcomes, clinical decision-making, and health research conclusions. Whether improvement or deterioration, patient change should be operationalised through the magnitude of change (i.e., effect size). Effect sizes relative to the context of change (clinical vs empirical) and the reliability of the instruments used are important considerations here. However, despite discourse on the utilisation of effect sizes in health, aspects of effect sizes can be poorly understood, misapplied or overlooked. Furthermore, nurse researchers may default to Cohen’s d for use in power analysis and results reporting where they should be considering an effect size derived from other methods in the first instance. In part, this is due to the literature surrounding aspects of effect size being inherently complex, impacting on nurse and nurse researchers’ capacity to acquire a thorough understanding of the topic. Conclusions: Effect size in health can be particularly complex. Nevertheless, nurses and nurse researchers should have some understanding about effect sizes and their role in measuring patient change in clinical and empirical contexts. They need to be aware of how measurement instruments detect, track and quantify patient change and the resultant magnitude of effect relative to the clinical significance of the change for the patient. This paper aids nurses to effect robust change based on informed decision making thus strengthening their evidence-based practice. What is already known about the topic? Patient change informs nurses clinical decision-making strategies; however, nurses may not consider the magnitude of change relative to the context of change and the reliability of the instruments used to identify and quantify the change Effect size is one of the four criteria needed for power analysis and is perhaps the most difficult to identify Underpowered studies result in imprecise estimation of the true effect, which could be an over- or an under-estimation What this paper adds: This paper dispenses with the inherently complicated and technical terminology on effect size often found in the literature that can impact understanding. Consequently, this paper equips nurses to critique research literature and apply this knowledge to their clinical practice Provides other methods for identifying a suitable effect size for use in power analysis and results reporting as opposed to defaulting to Cohen’s d Draws attention to the importance of reporting effect size and associated confidence interval with research results data

Background: To provide quality care at the end of life or for chronically sick patients, nurses must have good knowledge, attitude, and practice about palliative care. Lack of knowledge about palliative care, negative attitudes towards it, as well as gaps in evidence-based practice among nurses, are some of the most common obstacles to quality palliative care. Methods: To collect data, a cross-sectional questionnaire was administered to 565 nurses working in primary health care organisations in Astana, Kazakhstan. Data collection was completed from January 2022 to March 2023. The questionnaire contained demographic and professional characteristic questions, the Palliative Care Quiz for Nurses (PCQN), the Frommelt Attitudes Towards Care of the Dying (FATCOD), and the Evidence-based Practice Questionnaire (EBPQ). Descriptive statistics, independent t-tests, and one-way ANOVAs were used for analysis. Results: The sample size was 565 nurses. Nurses’ palliative care knowledge level was low (mean score: 9.06±2.93). The largest number of the correct answers on the PCQN questionnaire was received in the category "Management and control of pain and other symptoms" (49.95%). The majority of nurses (93%) have a neutral or negative attitude towards caring for dying patients (mean score: 94.50±12.41). Only 6.7% of respondents had a positive attitude. The obtained score (4.39 ± 1.05) on the EBPQ scale indicates an average level of competence in evidence-based practice. Age, work experience, educational level, attendance at palliative care training, and good competencies in evidence-based practice are statistically significant factors that affect knowledge of palliative care. The aspect of knowledge/skills in EBP is the most significant (β=0.122; p=0.005). Conclusions: An insufficient level of nurses' knowledge about palliative care and a neutral or negative attitude towards caring for dying patients was revealed. Health care providers are encouraged to expand palliative care-related training programs, which together can improve the quality of palliative care nursing services for patients. The results also indicate that much attention, and resources should be directed to improving the level of knowledge of nurses in the field of evidence-based practice, because this aspect significantly affects the level of knowledge on palliative care. Implications for research, policy, and practice: Further research is needed to identify the factors contributing to nurses' inadequate knowledge of palliative care, including gaps in training and cultural or systemic barriers. Policymakers should develop national frameworks for palliative care training and certification, while healthcare institutions should regularly assess and enhance nurses' knowledge through continuous professional development. What is already known about the topic Most nurses do not receive training in palliative care. The benefits of using evidence-based medicine in palliative care are described. The most common barriers to providing quality palliative care have been described many times. What this paper adds Primary care nurses have insufficient knowledge of palliative care. Primary care nurses have a negative or neutral attitude towards palliative care. The use of evidence-based medicine by nurses contributes to the formation of a high level of knowledge about palliative care and a positive attitude towards it.

Objective: This study aims to explore the reasons for hospital discharge-delay in an acute surgical unit (ASU) and the ways in which discharge-delays can be minimised. Background: Discharge-delay, the period of continued hospital stay after a patient is deemed medically fit to leave hospital, is one of the most significant barriers to optimal patient flow within the hospital system. Discharge-delay retains non-acute patients in the acute environment unnecessarily, while preventing acutely presenting patients from accessing services in a timely manner. It results in overcrowded emergency departments (ED) with delayed admissions, slowed theatre schedules, and bed blocking in critical care, as well as negatively impacting patient experience. Methods: A two phased, mixed methods design was employed in this research. Phase one obtained qualitative data through semi-structured interviews with nine staff members occupying different roles within the health care team. Themes derived from phase one informed the development of an audit and survey form utilised in phase two, which involved collecting quantitative data through its completion by registered nurses working in the ASU during the study period. This audit recorded the time a patient was cleared for discharge, and the time they left the ward, from which the amount of discharge-delay could be calculated. The survey recorded delaying factors that occurred for each patient discharged from the ward during the audit period. Results: Thematic analysis of the interview transcriptions revealed three core themes: (i) It takes a village to discharge a patient; (ii) Preparation, clearance, home; and (iii) Challenges and solutions to discharge-delay. The survey was completed by Registered Nurses regarding 40 discharging patients who they provided care for. Analysis revealed a mean patient discharge-delay of 225 minutes across the 40 patients. The most frequently recorded delay factors were ‘waiting for paperwork’ (55%) and ‘waiting for transport’ (40%). Conclusions: This study found that to reduce discharge-delay system-wide optimisation across the entire patient journey, with particular focus on reducing paperwork related delay, is required. Introducing a ‘discharge-focused clinician’ and improving the utilisation of transit lounge will especially help to reduce discharge-delay. What is already known about the topic? Unnecessarily long hospital admissions negatively impact patient experience and outcomes. Slow acute discharges effects patient flow organisation wide, including EDs, critical care, and theatre. What this paper adds? This paper focuses on the time between a patient being medically cleared and physically leaving the acute ward environment, allowing the specific period of discharge-delay to be quantified, understood and addressed. It clearly identifies specific discharge-delay causing factors in the context of an ASU and proposes solutions to optimise the discharge process.

Objective: To describe the impact that electronic medical record (EMR) documentation has on nurses’ and midwives’ practice. Background: Although both advantages and disadvantages of a digitised health system have been documented, nurses and midwives continue to express concerns about the effect EMRs and computers have on their practice and patient relationships. Study design and methods: A cross-sectional survey design was used. An anonymous questionnaire was distributed in electronic and paper formats to identify nurses’ and midwives’ opinions of the impact of EMRs and computers on their practice and patient relationships in a regional tertiary-level hospital. Quantitative data was analysed descriptively; free-text responses were analysed thematically. Results: Nurses (n=31) and midwives (n=49) responded. Both respondent groups disagreed that the EMR had improved teamwork with other health professionals. Overwhelmingly, midwives disagreed that EMRs had improved the quality of care (n=43, 87.8%). Nurses agreed EMRs had improved documentation standards (n=24, 77.4%) and patient safety (n=22, 71%). However, midwives responded that EMRs had not improved women’s safety (n=31, 63%). Three themes emerged from the data: computers affect my productivity; computers affect my relationship with the patient/woman; the EMR increases my frustration and stress levels. Nurses and midwives felt the heavy documentation load and lack of integration across the EMR platform reduced efficiency, discouraged teamwork, and further excluded patients/women from participating in their care. Discussion: Although nurses and midwives agreed that the accessibility of EMRs to all health care staff is advantageous, the documentation demands of each clinical area are vastly different. The hybrid system of paper and electronic documentation increases documentation workload. Generally, midwives were more critical of the impact of EMRs on their practice. Conclusion: Nurses and midwives identified current challenges of EMRs with respect to productivity, relationships with patients and colleagues, and user wellbeing aligning with results of other published studies. As primary users of EMRs, nurses and midwives can offer valuable feedback to health services to help deliver digitised healthcare that is user-friendly, and patient/woman centred. Implications for research, policy, and practice: Organisations need to enact policies and procedures that facilitate nurses and midwives identifying areas of potential improvement to increase the usability and operability of the EMR. Such processes should lessen the negative impacts of EMR (such as documentation burden) on nursing/midwifery practice, with the aim of enhancing clinical and safety outcomes. It is suggested that ethnographic research studies be undertaken to gain a deeper understanding of the EMRs on nurse/midwife productivity, wellbeing, job satisfaction and patient safety concerns. What is already known about the topic: Positive and negative EMR outcomes for patients and clinicians have been documented. Involving clinicians (especially nurses and midwives) in the development of digital systems prior to implementation has been shown to reduce negative attitudes towards them. Ongoing user analysis is recommended in human-centred design to improve usability and user wellbeing. What this paper adds: Description of the differing experiences and challenges faced by nurses and midwives using the EMR program and computers in the same hospital. Positive and negative effects of the current EMR program and computers have been identified. This paper verifies the results of other national studies about the effects of EMRs and computers on nurses’ and midwives’ productivity, relationships, and wellbeing.

Objective: We aimed to develop and test the feasibility of a nurse-led, telehealth transitional care intervention for people with multimorbidity. Design and methods: A feasibility study, using quantitative and qualitative methods was conducted at an 800-bed acute metropolitan hospital from March 2021 to January 2022. Eligible participants were adult inpatients with multimorbidity. The intervention involved three stages: (1) baseline risk of readmission assessment and collaborative development of a Transition Action Plan; (2) transitional care coordination following hospital discharge, and (3) handover to the primary healthcare provider. A Transition Coordinator delivered the intervention with the aim of determining the intervention’s feasibility in a practice environment. Acceptability to patients was assessed using a feedback survey. Acceptability to staff was noted through recorded interactions, collaboration, and feedback. Results: Twenty-one adults with a mean age of 78 years participated in the intervention. Participants had 3-10 comorbid chronic conditions, and the most common were hypertension (71%), other cardiovascular (66%), renal (52%), and diabetes (47%). Most patients (52%) were at medium risk of readmission and 38% were at high risk, however, only 24% of patients were readmitted. The study identified there is no routine risk of re-admission screening for patients with multimorbidity, and the intervention was found to be acceptable and feasible to patients, ward staff, and the multidisciplinary team. Conclusion: The results indicated feasibility of a transitional care intervention for people with multimorbidity, and the need for routine risk of readmission screening for people with multimorbidity. Further research is required to determine if the intervention is cost-effective and associated with reduced rates of hospital readmission. What is already known about the topic? People with multimorbidity often receive fragmented health services, which may increase their risk of hospital readmission. Internationally, Transitional Care Model interventions improve the transition experience from acute hospital care to the community and reduce short-term readmission rates, for people with multimorbidity. Transitional Care Model interventions have shown improved health and economic benefits for older adults. However, these benefits have not been evaluated in Australia. What this paper adds This study provides evidence regarding the feasibility and acceptability of a low-cost, nurse-led, transitional care intervention to support people with multimorbidity transitioning from acute hospital care to home/community, in the Australian context. The study identified high support needs of participants upon transition and provides preliminary evidence in favour of a fundamental shift from discharge planning to stratified transition planning for patients with multimorbidity. Presently, on hospital admission, there is no systematic risk of readmission assessment or transition care planning and implementation for people with multimorbidity. This is a notable service gap requiring redress across South Australian Local Health Networks.