OBJECTIVE: To conduct a comprehensive review of Undergraduate Nursing and Midwifery Curricula leading to registration in Ireland.
METHODS: A mixed methods approach using a curriculum evaluation framework that was underpinned by the philosophy and principles of appreciative inquiry.
METHODS: Five separate workstreams completed an evaluation of national policy documents and international curriculum documents, a literature review and two phases of stakeholder engagement including a graduate survey and peer-grouped stakeholder focus groups. The workstreams were emulated for the professions of nursing and midwifery.
RESULTS: National policy indicates a significant shift in healthcare delivery to the community environment, with a strong focus on the social determinants of health and a flexible interprofessional workforce. International curricula review revealed that nursing and midwifery education was split equally between academia and clinical practice at bachelor\'s degree level. Graduates were assessed for clinical competence with a variance of four to seven domains of competence evident for nurses and five principles for midwives. Direct entry midwifery was not widely available. The graduate survey identified that students were satisfied with the academic components of the curriculum; however, significant challenges in clinical placement were reported. Stakeholder focus groups reported a need for a learner-focused approach to the curricula, increased access to education, a deeper understanding and appreciation of the various roles required to educate nurses and midwives and a recognition of midwifery as a separate profession.
CONCLUSIONS: There is a need for a significant revision of the current nursing and midwifery curricula to meet the future healthcare needs of the diverse patient population with a community-focused delivery.
UNASSIGNED: The good reporting of a mixed methods study was used to guide the development of this manuscript.
UNASSIGNED: An Expert Advisory Group (EAG) was appointed to oversee the conduct of the research project and advise the research team as requested. There were five service user representatives included in the membership of the EAG. This included one representative from each of the divisions of the nursing and midwifery register in Ireland. A separate stakeholder engagement focus group was also conducted for the research upon the request from the service users.

OBJECTIVE: To explore the impact of COVID-19 on students\' lives and their online learning experience.
METHODS: A cross-sectional survey design was used in this study.
METHODS: A total of 44 nursing students who were enrolled in an undergraduate programme at a Canadian University participated in the study. The students were asked to fill out a 35-item survey that was developed by the European Students\' Union and that was circulated across Europe in April 2020.
RESULTS: The COVID-19 pandemic and subsequent lockdown affected students mentally, and emotionally. Findings also revealed that whilst most students had the privilege to study from home, many students did not have a desk, or a quiet place to study in their home and some had problems with Internet connectivity. Online lectures were delivered according to students\' preferences; however, students were dissatisfied with the way their practice was organized.
CONCLUSIONS: The similarities between this study and the European study provide common grounds for academics around the world to connect, collaborate and work on the challenges in providing nurse education in emergencies such as national disasters or pandemics to ensure preparedness for such future events.
UNASSIGNED: No Patient or Public Contribution.
CONCLUSIONS: The commonalities experienced in nursing education across the globe should act as an impetus for globalized nursing action. Educators need to prepare and reinvent a role for students in the clinical area in the event of future disasters/pandemics. Policy makers and administrators need to ensure when switching to online education no student is underprivileged or marginalized in the process.

OBJECTIVE: A discussion of the challenges of recruiting participants from harder-to-reach populations for quantitative survey studies and potential avenues for tailored strategies to address these challenges.
METHODS: Discussion paper.
METHODS: The search was conducted on August 2, 2021, in the CINAHL and PubMed databases, and in Google scholar. The initial search identified 5880 articles, and the final analysis included 44 articles that met the inclusion criteria. Articles were retained if they addressed methodological challenges or strategies for recruitment and concerned research with harder-to-reach populations.
CONCLUSIONS: This article draws on the literature regarding the challenges of recruiting research participants from harder-to-reach populations and known strategies for overcoming them. These strategies include, for example, establishing a trusting relationship between the researcher and the participant community and gaining in-depth knowledge of the target population. These challenges and strategies for recruiting participants from these populations are discussed specifically in the context of quantitative survey research.
CONCLUSIONS: Nurse researchers conducting quantitative survey studies with participants from harder-to-reach populations must tailor their recruitment strategies to the target population and, most importantly, be flexible and creative in their recruitment methods.
CONCLUSIONS: The article discusses the challenges of recruiting participants from harder-to-reach populations and strategies to overcome them in quantitative survey studies. Successful recruitment requires researchers to develop a thorough understanding of the harder-to-reach population, develop partnerships to locate and access potential participants, build trust with the community, tailor their language, minimize participation risk and resource constraints, recognize the cognitive and physical demands required, and be flexible and creative in developing recruitment strategies. This knowledge can enable the inclusion of more people from harder-to-reach populations in survey studies and provide evidence that can inform research and practice to provide healthcare tailored to their needs and ultimately help improve their health and well-being.

BACKGROUND: Scope of practice enactment is poorly understood in the primary care setting.
OBJECTIVE: The following research objectives were addressed: (1) to revise and adapt the Actual Scope of Practice (ASCOP) questionnaire for use in the primary care setting, and (2) to determine internal consistency, construct validity, and sensitivity of the modified instrument.
METHODS: To address the first objective, a narrative literature review and synthesis and an expert panel review was conducted. To address the second objective, a cross-sectional survey of 178 registered nurses who worked in primary care was conducted.
RESULTS: The ASCOP, with few modifications, addressed key attributes of nursing scope of practice in the primary care setting. The modified instrument yielded acceptable alpha coefficients ranging from 0.66 to 0.91. Total mean score of 4.8 (SD  =  .67) suggests that registered nurses within interprofessional primary care teams almost always engage in activities reflected in the modified instrument.
CONCLUSIONS: The modified instrument is the first instrument validated to measure nursing scope of practice enactment in the primary care setting. Findings from this study support the use of the modified ASCOP questionnaire as a reliable and valid measure of scope of practice enactment among primary care registered nurses.

To explore the view of health professionals on the form and frequency of aggressive behaviour of clients against health professionals in home care services.
An explorative cross-sectional survey was conducted.
We conducted a survey using the Survey of Violence Experienced by Staff German version Revised (SOVES-G-R) and the Impact of Patient Aggression on Carers Scale (IMPACS). A convenience sample of 852 healthcare professionals from German-speaking Switzerland participated. Data collection was conducted between July-October 2019. Data were analysed descriptively using IBM SPSS Statistics.
Of the health professionals, 78.9% (N = 672) experienced aggressive behaviour since they worked in home care services. The most frequent aggressive behaviour was verbal aggression (75.6%, N = 644), while the most common predisposing factor was restriction in cognitive ability (71.3%, N = 67). Fear, burden and impairment of nursing relationship were common consequences of aggressive behaviour.

OBJECTIVE: To describe the nursing student-patient relationship in terms of three types of relationships-mechanistic, authoritative and facilitative-and analyse the factors related to the type of relationship.
BACKGROUND: As future professionals, nursing students have a central role in facilitating patient autonomy while working in partnership with patients. Supporting student-patient relationship throughout the nursing education may result in positive outcomes for both students and patients.
METHODS: A cross-sectional study.
METHODS: The data were collected from a convenience sample of Finnish nursing students using a structured web survey. Statistical data analysis was performed using chi-square test, two-sample t test, one-way analysis of variance and multinomial logistic regression. The STROBE Statement - Checklist for cross-sectional studies was used (Appendix S1).
RESULTS: Students most often assessed their relationship with the patients as facilitative, followed by authoritative and mechanistic relationships. The results revealed three predictors for facilitative relationship: students\' older age, long enough contact time with the patient and higher competence in ensuring quality. In authoritative and facilitative relationships, students had significantly more positive perceptions of the contextual factors and consequences of the relationship and higher ratings of self-assessed competence levels than students in a mechanistic relationship.
CONCLUSIONS: It seems that the facilitative student-patient relationship is connected to the professional competence of nursing students, especially in the area of ensuring the quality of patient care. Therefore, sustaining clinical learning environments and pedagogical approaches that value and support facilitative relationships in students\' clinical learning should be enhanced.
CONCLUSIONS: Efforts aimed at contributing to facilitative student-patient relationships have a crucial role in shaping students\' competency and in promoting high-quality patient care. Thus, supervision of students organised around establishing mutual student-patient relationships with the preceptors acting as facilitators will benefit both students and patients.

BACKGROUND: Globally, new nurse practitioner roles have been introduced into interdisciplinary teams. Research indicates that agreement among the different healthcare providers regarding one another\'s role and scope of practice is important for establishing interdisciplinary teamwork. Lack of agreement regarding a new nurse practitioner\'s scope of practice may hinder collaboration.
OBJECTIVE: To investigate the level of agreement among advanced geriatric nurses (AGNs), their colleagues and their leaders regarding which activities related to direct and indirect care, teaching/supervision, coordination and research and development work are perceived as appropriate for AGNs.
METHODS: A cross-sectional descriptive survey.
METHODS: The total population of AGNs in Norway (n = 26) and a sample of their colleagues, including leaders (n = 465), were invited to answer an online questionnaire. Twenty-three (88.5%) AGNs and 195 (42%) colleagues answered the questionnaires. A series of cross-tabulations were conducted to identify the respondents reporting on the appropriateness of different activities.
RESULTS: The respondents identified all of the activities related to coordination, teaching/supervision and research and development work as appropriate for AGNs. Although the respondents considered several of the direct and indirect care activities as appropriate, there were conflicting views on the activities that traditionally fall within the medical field vs. those that traditionally fall within the nursing field. The AGNs saw most of the nursing and medical activities as appropriate, but their colleagues and leaders saw only some of the nursing activities as appropriate. The results also showed that there was high disagreement among the leaders regarding appropriate activities.
CONCLUSIONS: The results indicate that healthcare providers agree on which activities related to teaching/supervision, coordination, and research and development work are appropriate to include in AGNs\' scope of practice, but that there are conflicting views regarding activities related to direct and indirect care.

WHAT IS KNOWN ON THE SUBJECT?: Supportive observations is the practice of closely monitoring patients who are acutely unwell in order to keep them safe. There are no formal guidelines for nursing staff on what to observe during observations. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: A consensus of expert opinion suggests that the clinically meaningful behaviours in supportive observations focus on six factors: agitation, self-harm and suicide, violence, negative influence, disengagement and positive behaviour. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These aspects of patient presentation should be a part of the decision-making discussions about observations. The Mersey Care Supportive Observations Recording Tool that emerged from this consensus may assist with recording the relevant information. Abstract Introduction Supportive observations are common in mental health care but there are no guidelines on best practice or what should be documented in observations records. Aim To develop expert consensus on the important aspects of patient presentation that inform clinical decision-making about observations and to develop a recording tool from this consensus. Method A Delphi methodology was used to consult an expert panel of mental health clinicians and academics to agree on what aspects of patient presentation during constant observations are important in informing clinical decisions. Thematic analysis was applied to the agreed item set to extract common aspects of presentation and behaviour. Results The panel considered 118 individual items across three rounds of consultation and agreed that 51 items were important to clinical decisions about observations. Thematic analysis found six man themes: agitation, self-harm and suicide, violence, negative influence, disengagement and positive behaviour. Subthemes were used to create the MerseyCare Supportive Observations Recording Tool (MSORT). Discussion These data represent the first expert consensus on the aspects of patient presentation that are important to clinical decisions. Implications for practice Consensus items should be recorded in observations records and be considered in decision-making about observations. The MSORT may aid observations recording.

Dialysis is a lifelong treatment required by end stage renal disease patients who are not able to undergo renal transplantation. Dialysis impacts the patients\' quality of life drastically, increasing the risk of mortality. Depression and anxiety are commonly reported among dialysis patients, but their prevalence and correlates vary by sociocultural context.
The aim of this study is to examine the prevalence of anxiety and depression and associated factors among patients receiving hemodialysis at a major tertiary referral medical center in Lebanon that receives patients from all over the country.
A cross-sectional, descriptive design was used.
Ninety patients receiving hemodialysis were targeted using convenience sampling, with a final sample size of 83 patients. The patients were interviewed while undergoing their dialysis session using the Hospital Anxiety and Depression Scale, and asked demographic and clinical questions.
The majority of participants were married men over 60 years of age; 48% achieved high school education. Depression was prevalent in 40.8% and anxiety in 39.6%, with 20 patients (24.1%) having both conditions. Although 24.1% self-reported anxiety symptoms, only 2.4% were taking anxiolytics. Illiterate patients had significantly higher depression scores than those with higher levels of education (p = 0.021). Patients who were living with their family had higher anxiety scores than those living alone (p = 0.014).
Anxiety and depression are underdiagnosed and undertreated in Lebanese dialysis patients. Screening and appropriate referral to mental health specialists are needed.

OBJECTIVE: To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers.
BACKGROUND: Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives\' work environment and scope of practice.
METHODS: Mixed methods research utilising prospective descriptive survey and interview.
METHODS: An online survey was administered to nurse-midwives practicing in the state of Texas (N = 449) with a subset (n = 10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed.
RESULTS: The survey was completed by 141 midwives with eight interviewed. Most were older, Caucasian and held a master\'s degree. A majority worked full-time, were in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was most commonly provided for Hispanic and White women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organisation or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5 years.
CONCLUSIONS: An ageing midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilised with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice.
CONCLUSIONS: Robust midwifery workforce data are needed as well as a midwifery board which tracks availability and accessibility of midwives. Educators should consider training models promoting long-term service in underserved areas, and development of skills crucial for impacting health policy change.