Julia Morphet

Research-based theatre (RbT) integrates research findings with performing arts to deliver a performance that informs, translates, and engages learners or audiences. Although not a new concept, RbT is growing in popularity within health professions education (HPE). A scoping review was conducted to map available literature regarding the methods used to inform RbT in HPE activities, as well as how they are used within education, training or curricula. The review followed Arksey and O’Malley’s six-stage framework and the Joanna Briggs Institute methodology. Studies that report on the use of RbT (concept) as an educational intervention (context) among health professionals or students (participants) were included. Multiple databases were searched (CINAHL, MeDLINE, PsycINFO, AMED, ERIC, Scopus, EMBASE, International bibliography of theatre and dance, and Web of Science). A total of 286 studies were retrieved. Following title and abstract screening, 71 studies were retrieved for full text review and 31 were included in the final review. Results were analysed and synthesised narratively. Most RbT interventions were aimed at qualified health professionals (HP) across 13 different professions. Performances were delivered to diverse audiences, including HP students, the public, and were often accompanied by post-performance discussion. Educational impact was widely reported, including increased awareness, empathy, and critical reflection, though learning measurement approaches varied. Research-based theatre has significant potential as an innovative tool for HPE, translating research findings into accessible, engaging educational formats. However, implementation is often obstructed by ambiguous terminology and a lack of transparent methodology available to HP researchers. Addressing these challenges by highlighting sustainable strategies, such as consistent terminology, opportunities for digital dissemination and collaborative design, is vital to maximizing reach and educational impact.

Background: Quality improvement activities targeting low‐value care are important to ensure that scarce healthcare resources are used responsibly. However, there has been little systematic research into what diagnostic testing is considered by emergency department (ED) clinicians to be at risk of unwarranted variation or potentially low value.Objectives: This study aimed to determine the views of ED clinicians on which diagnostic tests are highest risk for variation and/or low‐value care.Methods: A voluntary electronic survey was distributed to emergency clinicians across Australia and Aotearoa New Zealand. Respondents were asked to identify which investigations were high risk for unwarranted variation and/or low value.Results: There were 184 responses (75 doctors, 82 nurses, and 27 other) analysed. Investigations identified included D‐dimer (42%), venous blood gas (VBG) (39%), C‐reactive protein (CRP) (35%), and plain x‐rays of the abdomen (35%). Compared to nursing staff, medical staff perceived CRP (51% vs. 24%), urine drug screening (55% vs. 21%), clotting profile (48% vs. 24%), salicylate level (29% vs. 7%), erythrocyte sedimentation rate (41% vs. 10%), and abdominal x‐ray (67% vs. 16%) at higher risk. D‐dimer and VBG were seen to be high risk by both groups. Routinely ordered tests (e.g., full blood examination) were considered relatively low risk.Conclusions: Several commonly used investigations are perceived to be at high risk of unwarranted variation or low‐value care. These risks are perceived differently by different groups of emergency clinicians. Potential future directions include understanding the reasons for variation and efforts to reduce variation, including audit and feedback.

Introduction Over one billion adults attend emergency departments (EDs) internationally every year, including 6.6 million in Australia. Up to half of these patients have a peripheral intravenous catheter (PIVC) inserted. Although healthcare workers believe that placing a cannula is helpful (‘just in case’), PIVCs often remain idle. PIVC insertion is painful for patients, takes clinicians’ attention away from other care, has adverse outcomes and causes major economic and environmental burden. Our aim is to codesign an implementation toolkit to reduce unnecessary PIVC insertions and improve other national quality indicators using an implementation science framework. Methods and analysis A stepped-wedge cluster-controlled trial will be conducted in nine ED sites (clusters) across Australia. The interventions will be codesigned with and adapted to sites based on local context. The interventions are evidence-based multimodal intervention (MMI) and aligned to the 2021 Australian Commission for Safety and Quality in Health Care National PIVC Clinical Care Standard. The Consolidated Framework for Implementation Research and Learning Health System will be used to guide implementation. Interventions will be phased across three steps (three sites per step), and each site will collect control and postintervention data using mainly routinely collected clinical data. Each site will be allocated to receive the intervention at one of three study steps. Implementation strategies will tailor broad clinician and consumer engagement, policy changes, education, audit and feedback and clinical champions, along with environment and equipment changes, to each site. The primary objective is to reduce the proportion of adult patients who have a PIVC inserted by 10%. We will evaluate the clinical, implementation and cost-effectiveness of the intervention. Study findings will be used to conduct a health economic analysis, develop an implementation toolkit and inform a sustainable roadmap for national roll-out. This will meet the needs of a diverse range of EDs nationally and internationally. Ethics and dissemination The protocol was approved by the Monash Health Human Research Ethics Committee (HREC Reference Number: HREC/100808/MonH-2023-390692(v3)). The outcomes of this trial will be disseminated through peer-reviewed publications, conference presentations and communication with study partners and stakeholders including professional colleges and the Australian Commission for Safety and Quality in Health Care. Trial registration number Australian New Zealand Clinical Trials Registry registration number: ACTRN12623001248651. Date of registration: 1 December 2023. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386256&showOriginal=true&isReview=true

Aim: To explore the pathway of care for people post hip fracture and define what is important for person‐centred recovery. Design: Qualitative design using interpretive descriptive methodology, guided by the Health Empowerment theoretical framework. Methods: Semi–structured interviews were conducted from March to October 2021, focussed on the lived experience of recovery post hip fracture. Thirteen participants were interviewed. Five people post hip fracture; four advanced practice nurses and four practice nurses. Data were analysed using thematic analysis. Results: Fragments of hip fracture care was a major theme describing a disconnected pathway following discharge from hospital, and exposed the gap between recommendations for follow up and implementation. Gaps highlighted the need for a key contact clinician to support care coordination, use of individualised care plans, clinical pathways for practice nurses, and follow up post hip fracture. Conclusion: A disconnected recovery pathway was found from the lived experience of hip fracture. Findings highlight opportunities to develop integrated person‐centred models of care that empower patients to self‐manage their recovery. Implementation of an empowered coordinated pathway with a shared care approach integrates consistent care across the whole patient journey. Implications for the Profession and/or Patient Care: Identified gaps from a fractured recovery formed key components to support a connected care pathway post hip fracture. Linked by the overarching construct of Health Empowerment, policy and practice development embedding a connected pathway within nurse‐led models of care should be considered. Reporting Method: Consolidated Criteria for Reporting Qualitative Research. Patient or Public Contribution: No Patient or Public Involvement. Impact: This study explored what was important for recovery post‐hip fracture. A fragmented recovery pathway was identified that highlighted key components for improvement. Research supports policy and practice development for nurse‐led models of care with an empowered approach post hip fracture.

Aim: To develop and psychometrically test two newly developed Cancer Nurse Self‐Assessment Tools for early and metastatic breast cancer (CaN‐SAT‐eBC and CAN‐SAT‐mBC).Design: Instrument development and psychometric testing of content validity, reliability and construct validity.Methods: A three‐phase procedure was conducted. Phase 1: An expert working group was formed to design and develop each tool using Benner's Model of Clinical Competence. Phase 2: The Content Validation Index (CVI) was used to assess the relevance and clarity of each item on the tools with breast cancer nurse experts and nursing educators. A CVI ≥ 0.78 was required for an item to be included in each tool. Phase 3: The tools were tested for internal consistency using Cronbach's alpha and construct validity using principal component analysis (PCA). The Guidelines for Reporting Reliability and Agreement Studies were followed in reporting this study.Results: Each tool underwent two rounds of content validation. Ten experts were involved in the content validation for the CaN‐SAT‐eBC and 12 experts involved for CaN‐SAT‐mBC. The final versions comprised 18 (CAN‐SAT‐eBC) and 22 elements (CaN‐SAT‐mBC). All items obtained a satisfactory CVI of 0.83–1.0. Data from 159 and 126 nurses were analysed to evaluate reliability for CaN‐SAT‐eBC and CaN‐SAT‐mBC, respectively. The Cronbach's alpha coefficients for all elements were between 0.83 and 0.98. The PCA supported that each element was unidimensional and composed of internally correlated items, with the exception of the ‘Diagnostics’ element of practice which has a two‐component structure measuring basic and advanced diagnostic tasks.Conclusions: The two CaN‐SATs are comprehensive, valid and reliable. They can be used for self‐assessment by nurses in relation to breast cancer care and for identifying learning needs for long‐term professional development. The self‐assessment tools can also be used to develop education initiatives for specialised breast cancer nurses.Patient or Public Contribution: No patient or public contribution.

Background: Registered nurses (RNs) play an important role in providing primary healthcare (PHC) services. Longitudinal evidence on how the RN scope of practice in these settings has evolved over the years is currently missing and is critical in understanding how Australian government health policies have shaped the reality of nursing practice. Aim: To explore the scope of practice of RNs in Australian PHC workplace in both metropolitan and rural areas and among those with and without postgraduate qualifications during 2015–2019. Methods: Longitudinal survey data were retrospectively retrieved, collated and analysed using variate and bivariate analyses in SPSS Version 27.0. Composite items were used to combine survey items into seven key areas of nursing practice. Results: Majority of the 3882 participants were female ( n = 3782, n = 97.4%), worked in general practice ( n = 2916, 75.1%) and in metropolitan areas ( n = 2145, 55.3%) and had completed a short course ( n = 2470, 63.6%). A total of 904 participants (23.3%) completed at least one postgraduate degree. There was no significant and substantial difference in the frequency, and preference for frequency, of seven PHC practice areas by participants in different workplace localities, with or without a formal postgraduate degree as well as throughout the 5‐year survey period. Conclusion: The findings on the scope of practice by the RN participants might be explained by the interplay of interprofessional, organisational and institutional factors (more than individual factors). Implications for Nursing Management: Multilayer strategies targeting interprofessional, organisational, institutional and individual factors should be in place to enable RNs to work to their full capacity and advanced level of education. RNs also need to be included in major policy‐ and decision‐making that affects them to ensure their job satisfaction, retention in practice and contribution to patient health outcomes in PHC are sustained.

Aim: To explore the experiences of emergency nurses providing end‐of‐life care during the COVID‐19 pandemic. Design: A qualitative descriptive study. Methods: Data were collected between May and August 2023. Individual, semi‐structured interviews were conducted face to face or by videoconferencing with a purposive and snowballed sample of 11 emergency nurses. Data were analysed using thematic analysis. Results: There were four main themes identified: (1) Isolation and loneliness that emergency nurses felt when providing end‐of‐life care throughout COVID‐19. (2) Comparison of Care Relating to Communication; whereby emergency nurses compared the provision of end‐of‐life care before COVID‐19 to end‐of‐life care provided during the pandemic. (3) Frustration and guilt: emergency nurses felt when providing end‐of‐life care. (4) Teamwork: participants interviewed explored the meaning of having a supportive team when providing end‐of‐life care. Conclusions: This study explores in‐depth experiences of emergency nurses providing care to those who were dying during the COVID‐19 pandemic. This study identified that emergency nurses were impacted emotionally by providing end‐of‐life care during the pandemic, and ongoing support is likely to be needed. This study also reinforced the strength of teamwork amongst emergency nurses. Patient or Public Contribution: No patient or public contribution.