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Social prescribing, also known as “community referral”, is a means of referring individuals living in the community to existing local non-clinical health, welfare, and social support services. International evidence demonstrates that social prescribing improves biopsychosocial quality of life, and burden on health services. Australia’s first social prescribing pilot program for individuals with mental illness (mood and psychotic spectrum disorders) was implemented in Sydney in 2016/2017; this study evaluates that program. Participants included 13 adults who were assessed at baseline and six-month follow-up. Outcomes included self-perceived quality of life, welfare needs, health status, loneliness, social participation, and economic participation. Results indicate significant improvements in quality of life and health status. This pilot program demonstrates that social prescribing may improve participant outcomes. It fits well within Australian health policy and funding models which focus on bolstering community care, and may be scalable, particularly in geographically isolated communities.

Objective There is an urgent need to prepare the healthcare workforce for the implementation of artificial intelligence (AI) into the healthcare setting. Insights into workforce perception of AI could identify potential challenges that an organisation may face when implementing this new technology. The aim of this study was to psychometrically evaluate and pilot the Shinners Artificial Intelligence Perception (SHAIP) questionnaire that is designed to explore healthcare professionals’ perceptions of AI. Instrument validation was achieved through a cross-sectional study of healthcare professionals (n = 252) from a regional health district in Australia. Methods and Results Exploratory factor analysis was conducted and analysis yielded a two-factor solution consisting of 10 items and explained 51.7% of the total variance. Factor one represented perceptions of ‘Professional impact of AI’ (α = .832) and Factor two represented ‘Preparedness for AI’ (α = .632). An analysis of variance indicated that ‘use of AI’ had a significant effect on healthcare professionals’ perceptions of both factors. ‘Discipline’ had a significant effect on Allied Health professionals’ perception of Factor one and low mean scale score across all disciplines suggests that all disciplines perceive that they are not prepared for AI. Conclusions The results of this study provide preliminary support for the SHAIP tool and a two-factor solution that measures healthcare professionals’ perceptions of AI. Further testing is needed to establish the reliability or re-modelling of Factor 2 and the overall performance of the SHAIP tool as a global instrument.

Objective The aim of this study was to draw upon the collective knowledge of experts in the fields of health and technology to develop a questionnaire that measured healthcare professionals’ perceptions of Artificial Intelligence (AI). Methods The panel for this study were carefully selected participants who demonstrated an interest and/or involvement in AI from the fields of health or information technology. Recruitment was accomplished via email which invited the panel member to participate and included study and consent information. Data were collected from three rounds in the form of an online survey, an online group meeting and email communication. A 75% median threshold was used to define consensus. Results Between January and March 2019, five healthcare professionals and three IT experts participated in three rounds of study to reach consensus on the structure and content of the questionnaire. In Round 1 panel members identified issues about general understanding of AI and achieved consensus on nine draft questionnaire items. In Round 2 the panel achieved consensus on demographic questions and comprehensive group discussion resulted in the development of two further questionnaire items for inclusion. In a final e-Delphi round, a draft of the final questionnaire was distributed via email to the panel members for comment. No further amendments were put forward and 100% consensus was achieved. Conclusion A modified e-Delphi method was used to validate and develop a questionnaire to explore healthcare professionals’ perceptions of AI. The e-Delphi method was successful in achieving consensus from an interdisciplinary panel of experts from health and IT. Further research is recommended to test the reliability of this questionnaire.

Background Frailty is a well known and accepted term to clinicians working with older people. The study aim was to determine whether an intervention could reduce frailty and improve mobility. Methods We conducted a single center, randomized, controlled trial among older people who were frail in Sydney, Australia. One group received an intervention targeting the identified characteristics of frailty, whereas the comparison group received the usual health care and support services. Outcomes were assessed by raters masked to treatment allocation at 3 and 12 months after study entry. The primary outcomes were frailty as assessed by the Cardiovascular Health Study criteria, and mobility as assessed by the Short Physical Performance Battery. Secondary outcome measures included disability, depressive symptoms and health-related quality of life. Results A total of 216 participants (90%) completed the study. Overall, 68% of participants were women and the mean age was 83.3 years (standard deviation, 5.9). In the intention-to-treat analysis, the between-group difference in frailty was 14.7% at 12 months (95% confidence interval: 2.4%, 27.0%; P = 0.02). The score on the Short Physical Performance Battery, in which higher scores indicate better physical status, was stable in the intervention group and had declined in the control group; with the mean difference between groups being 1.44 (95% confidence interval, 0.80, 2.07; P < 0.001) at 12 months. There were no major differences between the groups with respect to secondary outcomes. The few adverse events that occurred were exercise-associated musculoskeletal symptoms. Conclusions Frailty and mobility disability can be successfully treated using an interdisciplinary multifaceted treatment program. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12608000250336

Link worker social prescribing programs are gaining recognition in Australia for addressing health and social needs outside routine medical care. The evaluation of these programs is essential for informing future social prescribing programs, research and evolving policy. However, diverse outcome evaluation measures present challenges for benchmarking across link worker social prescribing programs. An integrative review was conducted to identify and describe outcome domains and measures, and the methodological approaches and evaluation designs of link worker social prescribing programs in Australia. Comprehensive searches of the literature on link worker social prescribing programs in Australia were conducted across 14 electronic databases. In order to reduce the risk of bias, study selection and data extraction were conducted independently by multiple authors, and included studies underwent quality and risk of bias assessment using the standardised Mixed Methods Appraisal Tool. Six studies met the inclusion criteria. Outcome domains were categorised into ‘person-level’, ‘system-level’ and ‘program implementation’ domains. Despite the variation in participant groups, the ‘person-level’ domains of global well-being and social well-being were consistently evaluated. While measurement tools varied significantly, the WHO Quality of Life Brief Assessment and short-form UCLA Loneliness Scale were most commonly applied. At the system level, health service utilisation was primarily evaluated. This integrative review reports on the current state of evidence in Australia, with the potential to track changes and trends over time. Developing a core outcome set, incorporating stakeholder and consumer contributions for benchmarking aligned with the healthcare landscape is recommended. The findings may guide the refining of social prescribing initiatives and future research, ensuring methodological robustness and alignment with individual and community needs.

Background Loneliness and decreased quality of life are associated with decreased life expectancy and are regarded as serious health concerns. Understanding the impact of the pandemic on older adults living alone is essential for informing strategies to decrease loneliness and improve quality of life following the COVID-19 pandemic and in future crises. This integrative review aimed to synthesise the qualitative and quantitative evidence on the factors of the pandemic that influenced loneliness and quality of life of older adults living alone, and examine associated interventions to support this population. Methods An integrative review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases (CINAHL Plus, MEDLINE with Full Text, APA PSYCArticles, Psychology & Behavioral Sciences Collection, Academic Search Premier and Proquest Coronavirus Research Database) were searched in February 2024 for peer-reviewed studies on community-dwelling older adults (60+) living alone during COVID-19. Screening and selection were completed in Covidence. The review included 53 articles (39 quantitative, 11 qualitative, and three mixed-methods) published between 2020 and 2023. Study quality was appraised using the Mixed Methods Appraisal Tool. Data were extracted into Excel and synthesised narratively across quantitative, qualitative, and mixed-methods studies to identify factors influencing loneliness, quality of life, and related interventions. Results Most studies were based on cross-sectional data and represented a broad international experience. Most studies reported increased loneliness and worsened quality of life during the pandemic. Loneliness was associated with isolation, intolerance of uncertainty and anxiety, however being accustomed to isolation, unity through adherence to pandemic measures, and socialising with neighbours were protective factors. Worsened quality of life was associated with poor sleep patterns, stigmatisation from being labelled as an ‘at risk’ population and feeling imprisoned at home. Protective factors included an appreciation for activities and connections, fostering creativity, engaging in hobbies and learning new skills. Lastly, interventions utilised technology via phone calls and socially assisted robots and were shown to help older adults. Conclusions Additional meaningful, engaging and accessible strategies are needed to support older adults who live alone during crises. This integrative review offers insight into global experiences of loneliness and quality of life among older adults living alone during the COVID-19 pandemic, with suggestions for effective intervention strategies.

Background Implementing evidence that changes practice in emergency departments (EDs) is notoriously difficult due to well-established barriers including high levels of uncertainty arising from undifferentiated nature of ED patients, resource shortages, workload unpredictability, high staff turnover, and a constantly changing environment. We developed and implemented a behaviour-change informed strategy to mitigate these barriers for a clinical trial to implement the evidence-based emergency nursing framework HIRAID ® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) to reduce clinical variation, and increase safety and quality of emergency nursing care. Aim To evaluate the behaviour-change-informed HIRAID ® implementation strategy on reach, effectiveness, adoption, quality (dose, fidelity) and maintenance (sustainability). Methods An effectiveness-implementation hybrid design including a step–wedge cluster randomised control trial (SW-cRCT) was used to implement HIRAID ® with 1300 + emergency nurses across 29 Australian rural, regional, and metropolitan EDs. Evaluation of our behaviour-change informed strategy was informed by the RE-AIM Scoring Instrument and measured using data from (i) a post HIRAID ® implementation emergency nurse survey, (ii) HIRAID ® Instructor surveys, and (iii) twelve-week and 6-month documentation audits. Quantitative data were analysed using descriptive statistics to determine the level of each component of RE-AIM achieved. Qualitative data were analysed using content analysis and used to understand the ‘how’ and ‘why’ of quantitative results. Results HIRAID ® was implemented in all 29 EDs, with 145 nurses undertaking instructor training and 1123 (82%) completing all four components of provider training at 12 weeks post-implementation. Modifications to the behaviour-change informed strategy were minimal. The strategy was largely used as intended with 100% dose and very high fidelity. We achieved extremely high individual sustainability (95% use of HIRAID ® documentation templates) at 6 months and 100% setting sustainability at 3 years. Conclusion The behaviour-change informed strategy for the emergency nursing framework HIRAID ® in rural, regional, and metropolitan Australia was highly successful with extremely high reach and adoption, dose, fidelity, individual and setting sustainability across substantially variable clinical contexts. Trial registration ANZCTR, ACTRN12621001456842 . Registered 25 October 2021.

Frailty is a common syndrome that is associated with vulnerability to poor health outcomes. Frail older people have increased risk of morbidity, institutionalization and death, resulting in burden to individuals, their families, health care services and society. Assessment and treatment of the frail individual provide many challenges to clinicians working with older people. Despite frailty being increasingly recognized in the literature, there is a paucity of direct evidence to guide interventions to reduce frailty. In this paper we review methods for identification of frailty in the clinical setting, propose a model for assessment of the frail older person and summarize the current best evidence for treating the frail older person. We provide an evidence-based framework that can be used to guide the diagnosis, assessment and treatment of frail older people.

Background Students must be prepared for the transference of medication administration (pharmacology knowledge and clinical skills) to clinical practice. The Preparedness for Medication Oral Administration questionnaire has been used in several studies and demonstrated strong internal reliability and consistency. The questionnaire has been revised to align with updated medication competencies. The factor structure or dimensionality of the questionnaires has not been examined. Aim To examine the psychometric properties of the Preparedness for Medication Administration (Revised) Questionnaire. Method Data from a previous study were used to determine the psychometric properties of the Preparedness for Medication Administration (Revised) Questionnaire. Three new items were added to the revised questionnaire, and the focus shifted from the oral route of medication administration. An exploratory factor analysis was conducted to assess the reliability and dimensionality of the revised questionnaire, using principal axis factoring and Oblique rotation on the 20 items. Results Two hundred fourteen final-year undergraduate nursing students completed the questionnaire; the Kaiser–Meyer–Olkin measure confirmed sampling adequacy (.96) and Bartlett's test of sphericity χ 2 (214) 3003.534 p  < .001 adequate sample size-to-variable ratio and inspection of the correlation matrix for loadings > 0.30. The 20 items produced a 2-factor solution, which was also confirmed by parallel analysis, with the deletion of 4 items not meeting item loadings of > 0.4. The final revised version of the questionnaire titled the Preparedness for Medication Administration Revision2 (PMAR2) contained 16 items loading onto one of the 2 factors titled Clinical Reasoning and Confidence to Practice Safely. Cronbach alpha coefficients for the factors were .89 to .95, respectively. Conclusion This research provides information for a psychometrically sound tool to assess students' preparedness for medication administration once they graduate and become independent practitioners.

Nursing workforce shortages and continuing pressures on healthcare systems require health services and education providers to work collaboratively to support student nurses' transition into practice, preparing and retaining a quality nursing workforce.