What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand

Background: While many guidelines explain how to conduct Health Impact Assessments (HIAs), less is known about the factors that determine the extent to which HIAs affect health considerations in the decision making process. We investigated which factors are associated with increased or reduced effectiveness of HIAs in changing decisions and in the implementation of policies, programs or projects. This study builds on and tests the Harris and Harris-Roxas' conceptual framework for evaluating HIA effectiveness, which emphasises context, process and output as key domains. Methods: We reviewed 55 HIA reports in Australia and New Zealand from 2005 to 2009 and conducted surveys and interviews for 48 of these HIAs. Eleven detailed case studies were undertaken using document review and stakeholder interviews. Case study participants were selected through purposeful and snowball sampling. The data were analysed by thematic content analysis. Findings were synthesised and mapped against the conceptual framework. A stakeholder forum was utilised to test face validity and practical adequacy of the findings. Results: We found that some features of HIA are essential, such as the stepwise but flexible process, and evidence based approach. Non-essential features that can enhance the impact of HIAs include capacity and experience; 'right person right level'; involvement of decision-makers and communities; and relationships and partnerships. There are contextual factors outside of HIA such as fit with planning and decision making context, broader global context and unanticipated events, and shared values and goals that may influence a HIA. Crosscutting factors include proactive positioning, and time and timeliness. These all operate within complex open systems, involving multiple decision-makers, levels of decision-making, and points of influence. The Harris and Harris-Roxas framework was generally supported. Conclusion: We have confirmed previously identified factors influencing effectiveness of HIA and identified new factors such as proactive positioning. Our findings challenge some presumptions about 'right' timing for HIA and the rationality and linearity of decision-making processes. The influence of right timing on decision making needs to be seen within the context of other factors such as proactive positioning. This research can help HIA practitioners and researchers understand and identify what can be enhanced within the HIA process. Practitioners can adapt the flexible HIA process to accommodate the external contextual factors identified in this report

What do antenatal care providers understand and do about oral health care during pregnancy: a cross-sectional survey in New South Wales, Australia

BACKGROUND: There is mounting evidence to support the lack of awareness among pregnant women about health consequences and long term risks associated with poor oral hygiene during pregnancy. A recognised and important point of influence is their interaction with health professionals, particularly when receiving Antenatal Care. However, there is limited evidence about the perceptions of ANC providers in Australia toward the provision of perinatal oral healthcare. This study was undertaken to explore the knowledge, attitudes and practices of Antenatal Care (ANC) providers in New South Wales (NSW), Australia providing perinatal oral healthcare and to identify barriers to and predictors of their practices in this area. METHODS: A cross sectional survey was undertaken of ANC providers (general practitioners, obstetricians/gynaecologists and midwives) practising in NSW, Australia. Participants were recruited through their professional organisations via email, postal mail, and networking at conferences. The survey addressed the domains of knowledge, attitude, barriers and practices towards oral healthcare, along with demographics. Data was entered into SPSS software and analysed using descriptive and inferential statistics. RESULTS: A total of 393 surveys (17.6% response rate) were completed comprising 124 general practitioners, 74 obstetricians/gynaecologists and 195 midwives. The results showed limited knowledge among ANC providers regarding the impact of poor maternal oral health on pregnancy/infant outcomes. Most (99%) participants agreed that maternal oral health was important yet few were discussing the importance of oral health or advising women to visit a dentist (16.4–21.5%). Further, less than a third felt they had the skills to provide oral health advice during pregnancy. ANC providers who were more knowledgeable about maternal oral health, had training and information in this area and greater experience, were more likely to engage in practices addressing the oral health of pregnant women. CONCLUSION: The findings suggest that ANC providers in NSW are not focussing on oral health with pregnant women. ANC providers seem willing to discuss oral health if they have appropriate education/training and information in this area. Further research at a national level is required to confirm whether these findings are similar in all Australian states

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Treatment in the home setting with intermittent pneumatic compression for a woman with chronic leg ulcers: a case report

Abstract Background Intermittent Pneumatic Compression (IPC) is shown to improve the healing rate of Venous Leg Ulcers (VLU) in the hospital setting. The current Australian “Gold Standard” treatment according to the Australian and New Zealand Wound Management Associations’ (AWMA) Prevention & Management of Venous Leg Ulcer guidelines is compression, generally in the form of bandaging then progressing to hosiery once wounds are healed to prevent recurrence. This is recommended in conjunction with other standards of wound management including; nutrition, exercise, client education and addressing underlying pathophysiology and psychosocial factors. Compression bandaging is predominantly attended by community nurses in the clients’ home. Barriers to delivery of this treatment include; client concordance and or suitability for bandaging including client habitus, (shape of legs), client lifestyle, clinician knowledge and clinicians physical ability to attend bandaging, in particular for obese clients with limited mobility who pose a manual handling risk to the clinician themselves. The use of IPC may assist in mitigating some of these concerns, therefore it would seem wise to explore the use of IPC within the home setting. Case presentation This paper will present an original case report on the successful treatment of a woman living with chronic bilateral lower leg ulcers using IPC as an adjunct treatment in her home. This paper supports recommendations to explore the use of IPC therapy in the home setting, for treatment of chronic leg ulcers requiring compression. Conclusion Use of IPC in the home is anticipated to improve client involvement, concordance, client outcomes and reduce risk to staff applying conventional compression bandaging systems, particularly for obese clients with limited mobility

Experiences of registered nurses from a refugee background: A scoping review

Aims and objectives: This scoping review presents an exploration of international literature on the factors that impact refugees’ personal and professional experiences during their journey to being registered nurses in a new host country. Background: Governments of host countries receiving refugees seek to develop strategies that facilitate the successful resettlement, employment and enculturation of refugees that arrive as skilled professionals. There is a scarcity of studies focussing on issues faced by refugees that are RNs or those pursuing nursing registration and employment in a new host country. This study is relevant for resettlement services, nursing registration authorities and education providers and informs the international nursing workforce. Design: Scoping review. Methods: Databases such as MEDLINE, EMBASE, Cochrane Library, CINAHL; Google Scholar; PubMed; Scopus and Web of Science were searched for qualitative studies published up to and including 2017. Articles that did not specify explicitly the participants as registered nurses and/or refugees were excluded. All eligible articles were analysed for collective findings, and impact factors were extracted, synthesised and illustrated diagrammatically. Results: This review explored six eligible articles and six impact factors were identified. The challenging impacts were as follows: loss of control; shock in a new environment and bleak employment prospects . Equally three impact factors: reconciling new reality; establishing a new identity and hope for the future , facilitate positive experiences for nurses in their successful transition into society and the nursing workplace. Conclusions: This scoping review reports the small number of international studies on the experiences of refugees seeking to become registered and employed as registered nurses. The six impact factors identified influence the lives of the nurse participants socio‐economically in and out of the workplace. Relevance to clinical practice: Policymakers, managers and educators providing resettlement, registration and employment services could develop strategies that enhance integration and transition experiences of refugees aspiring to be registered nurses

Shining a light on refugee nurses

[Extract] Conflict and war in countries across the world has driven the worst migration crises since WWII, with the number of refugees exceeding 25 million (Rother et al., 2016; United Nations High Commissioner for Refugees, 2016). Unlike “migrants” who are able to freely travel and return home, “refugees” are people who have “a well‐founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group” (UNHCR, 2017). Designation as a refugee is granted by the United Nations High Commissioner for Refugees (UNHCR) and some government authorities to individuals who meet certain assessment criteria. Internationally, under the UNHCR resettlement programme, only a few countries have agreed to resettle refugees worldwide (UNHCR, 2017). The reception, repatriation and adaptation of refugees to new host countries have led to ongoing widespread sociopolitical contention and discussion (Dumper, 2007; Geddes & Scholten, 2016)

Milestones in the journey : The story of refugees becoming registered nurses in Australia

Aims To explore the experiences of refugees who became registered nurses after arriving to Australia. Design Qualitative description using a naturalistic inquiry framework. Methods Between February 2018 and September 2019, the lead author conducted semi-structured interviews with employed registered nurses (RNs) that are former refugees and English-speaking. Interviews were 45–90 min' duration and digitally recorded. Participants provided voluntary informed consent and were sent questions beforehand. Data were collected and coded into themes. Rigor was achieved with multiple transcript readings by the research team to confirm common themes. Results Twelve participants discussed their story. Three major themes were identified: (1) Milestone of being a refugee; (2) Milestone of resettling in Australia; (3) Milestone of becoming a RN. Conclusion Each participant's story started at a place of disadvantage. They progressed successfully through the three milestones; despite living with traumatic experiences, they learned new skills, developed English literacy, became a RN and juggled the demands of life. This paper highlights the poorly understood pockets of the current Australian RN workforce. Impact statement The nuanced stories of RNs with refugee backgrounds in this study move beyond trauma and struggle and demonstrate the important journey this particular group of health professionals undertake. Increasing the contextual knowledge of the complex lives of former refugees turned nursing professionals will raise public awareness of the diversity of life experiences of RNs working in Australia

Peer buddy mentoring project for nurses' career development

Objective: The aim of the paper is to describe the implementation of a peer buddy mentoring model to support the career development of Registered Nurses (RNs) seeking Clinical Nurse Specialist (CNS) positions. Methods: A qualitative survey design was used to collect data during the workshops, with follow-up semi-structured telephone or face-to-face interviews. Data were also collected via the researchers’ notes. Results: A total of 32 participants attended the program and 31 completed the surveys. The participants’ reported needing more support when applying for a CNS position. Despite these issues, the participants recommend the use of peer buddy mentoring as a motivational, supportive and instructive model. Conclusions: Peer buddy mentoring, and facilitated workshops, is a relatively low cost and effective strategy to support nurses aspiring to advance their careers. Participants valued the development of the peer buddy relationship and the mutual support and motivation it engendered

Nurses as participants in research : an evaluation of recruitment techniques

Background: Recruitment and retention of participants, as well as response rates, can be challenging in nursing research. This can be because of the questions asked; the choice of methodology; the methods used to collect data; the characteristics of potential participants; the sample size required; and the duration of the study. Additionally, conducting research with nurses as participants presents several issues for them, including the time needed to participate in the research, the competing commitments for clinical practice, the political and environmental climate, and recruitment itself. Aim: To report on research studies conducted by the authors at a tertiary teaching hospital, to show the lessons learned when recruiting nurses to participate in nursing research. Discussion: The authors discuss factors that supported recruitment of nurses in these studies, including the use of the personal touch and multiple recruitment strategies in a single study. Conclusion: Videos and photography facilitate interdisciplinary research and can be a valuable means of non-verbal data collection, especially with participants affected by disabilities, and can support research methods, such as the use of questionnaires. Implications for practice: Recruiting nurses for research can be challenging. We suggest that researchers consider using more than one recruitment strategy when recruiting nurse participants. Recruitment is more successful if researchers align the aim(s) of the research with nurse’s concerns and contexts

"You take the private part of her body, ... you are taking a part of her life" : voices of circumcised African migrant women on female genital circumcision (FGC) in Australia

Western countries working toward eradication of female genital mutilation require better inclusion of women originally from countries where the practice is prevalent. However, few authors have examined the knowledge, attitudes, and experiences of circumcised African migrant women in western countries. Our findings from 40 responses from self-reported survey and five in-depth interviews show that the participating African migrant women know the reasons behind female genital circumcision (FGC), are living with the negative consequences of FGC, and have a zero tolerance attitude toward the practice. Circumcised women are in the best position to define their health needs and champion global efforts to eradicate FGC