Sir Charles Gairdner Osborne Park Health Care Group

AIMS: To review and synthesize available evidence exploring the impact of pandemics on direct healthcare providers' workloads in the acute care setting. DESIGN: Scoping review. DATA SOURCES: A review of English research articles published up to August 2022 that examined the impact of pandemics on healthcare providers' workloads was undertaken. Studies were identified by searching four electronic databases: Medline (EBSCO), CINAHL (EBSCO), Web of Science and PsychInfo (EBSCO). Fifty-five studies met the inclusion criteria. REVIEW METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Scoping Review checklist. RESULTS: Healthcare workers experience an increase in workload pressures during a pandemic. This included patients requiring more care, undertaking non-normal work activities, increase in work content including changes to documentation, increase in demand and skills required, an increase in overtime and hours of work per week and higher patient-to-nurse ratios. The review also highlighted changes to the work environment and worsened work environments, including staffing shortages. CONCLUSION: Focused efforts from health organizations to prioritize supportive conditions, policies focused on improved work environments, staffing adequacy and fair and reasonable workloads will enhance retention of the current workforce and future planning for pandemics. IMPACT: Understanding workload challenges faced by frontline health professionals during the pandemic can improve planning, including policies and procedures, and resource allocation for future pandemic or emergency situations. In addition, extended periods of high workloads can impact staff retention. As many countries return to life after COVID-19, it is important that healthcare organizations examine staff pressures and identify ways to support staff moving forward. This will be vital for the future sustainability of the workforce. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

In this “When I say…” article, the authors argue for a philosophical transformation in how medical education values different ways of thinking and learning: the neurodiversity paradigm.

A systematic review of the diagnostic accuracy of MRI in the staging of cervical cancer was conducted based on the literature from the last 5 years. A literature search was performed in the Cochrane Library, EMBASE, MEDLINE and PubMed databases using the MeSH terms "cervical cancer", "MRI" and "neoplasm staging". A total of 110 studies were identified, of which 8 fit the inclusion criteria. MRI showed adequate accuracy (74-95%) and high sensitivity (92-100%) in assessing stromal invasion. The data for MRI in terms of assessing vaginal and pelvic side wall involvement were wide ranging and inconclusive. In assessing lymph node metastasis, MRI showed an adequate accuracy (73-90%), specificity (75-91%) and NPV (71-96%) but poor sensitivity (52-75%) and PPV (52-75%). MRI showed high accuracy (95%), sensitivity (78-96%), specificity (87-94%), and NPV (98-100%) but poor PPV (27-42%) in detecting bladder involvement. There was a paucity of data on the use of MRI in assessing rectal involvement in cervical cancer. Overall, the literature was heterogenous in the definitions and language used, which reduced the comparability between articles. More research is required into the diagnostic accuracy of MRI in the staging of cervical cancer and there must be increased consistency in the definitions and language used in the literature.

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AIMS: To explore and summarise the literature on the concept of 'clinical deterioration' as a nurse-sensitive indicator of quality of care in the out-of-hospital context. DESIGN: The scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review and the JBI best practice guidelines for scoping reviews. METHODS: Studies focusing on clinical deterioration, errors of omission, nurse sensitive indicators and the quality of nursing and midwifery care for all categories of registered, enrolled, or licensed practice nurses and midwives in the out-of-hospital context were included regardless of methodology. Text and opinion papers were also considered. Study protocols were excluded. DATA SOURCES: Data bases were searched from inception to June 2022 and included CINAHL, PsychINFO, MEDLINE, The Allied and Complementary Medicine Database, EmCare, Maternity and Infant Care Database, Australian Indigenous HealthInfoNet, Informit Health and Society Database, JSTOR, Nursing and Allied Health Database, RURAL, Cochrane Library and Joanna Briggs Institute. RESULTS: Thirty-four studies were included. Workloads, education and training opportunities, access to technology, home visits, clinical assessments and use of screening tools or guidelines impacted the ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting. CONCLUSIONS: Little is known about the work of nurses or midwives in out-of-hospital settings and their recognition, reaction to and relay of information about patient deterioration. The complex and subtle nature of non-acute deterioration creates challenges in defining and subsequently evaluating the role and impact of nurses in these settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Further research is needed to clarify outcome measures and nurse contribution to the care of the deteriorating patient in the out-of-hospital setting to reduce the rate of avoidable hospitalisation and articulate the contribution of nurses and midwives to patient care. IMPACT: What Problem Did the Study Address? Factors that impact a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting are not examined to date. What Were the Main Findings? A range of factors were identified that impacted a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting including workloads, education and training opportunities, access to technology, home visits, clinical assessments, use of screening tools or guidelines, and avoidable hospitalisation. Where and on whom will the research have an impact? Nurses and nursing management will benefit from understanding the factors that act as barriers and facilitators for effective recognition of, and responding to, a deteriorating patient in the out-of-hospital setting. This in turn will impact patient survival and satisfaction. REPORTING METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines guided this review. The PRISMA-Scr Checklist (Tricco et al., 2018) is included as (supplementary file 1).Data sharing is not applicable to this article as no new data were created or analysed in this study." NO PATIENT OR PUBLIC CONTRIBUTION: Not required as the Scoping Review used publicly available information.

INTRODUCTION: The Kimberley region of Western Australia (WA) is classified by the Modified Monash Model as MM6 & 7 ('Remote/Very Remote'). Many physiotherapists in the Kimberley are considered 'rural generalists' and require a diverse set of clinical and non-clinical skills to work successfully within this setting. OBJECTIVE: To understand physiotherapists' perspectives regarding job satisfaction within the Kimberley region a 'rural and remote' areas of Australia. DESIGN: An exploratory case study approach examined physiotherapists' job satisfaction in the Kimberley. Each participant completed a demographic survey and a one-on-one face-to-face interview lasting for approximately 60 minutes. Transcriptions were analysed and presented thematically. Eleven physiotherapists (nine women, two men, median age = 32 [27-60] years) participated in the study. Participants' median time working in the Kimberley was 2 (1-15) years; eight participants completed a rural placement, and eight participants had a rural background. FINDINGS AND DISCUSSION: Two overarching themes relating to job satisfaction emerged: 'personal factors' and 'workplace factors'. Furthermore, several sub-themes illustrated high levels of job satisfaction. Positive sub-themes relating to personal factors included 'belonging to the community and a rural lifestyle'. 'Diversity in caseloads' and 'workplace culture' were examples of positive workplace sub-themes. Subthemes that challenged the participants personally were 'family arrangements' including schooling, 'spousal employment and family separation' and the 'transiency and social issues' within these remote communities. Workplace challenges comprised of 'barriers to providing best practice' and the 'workforce and clinical experience' found within the Kimberley physiotherapy community and the wider health care workforce. The primary challenge of job satisfaction that encompassed both personal and workplace factors was 'accommodation', with 'cost', 'lack of availability', and 'perceived unsafe location' challenging physiotherapists' decisions to remain in the Kimberley. CONCLUSION: This study describes the many factors impacting job satisfaction among physiotherapists in a rural and remote location in WA Australia. These factors warrant consideration by organisations interested in improving recruitment and retention in this context. Improving recruitment and retention in physiotherapists in rural and remote Australia has the potential to positively influence health service provision, and therefore improve health outcomes for those living in rural and remote communities.

Neurological conditions produce considerable disease burden. To describe quality of life in patients with neurological conditions and informal caregivers receiving postdischarge generic community neurological nursing services, and caregiver burden. A descriptive cross-sectional design was used with researchers administering the WHOQOL-BREF Australian Version questionnaire and Zarit Burden Interview. Most patients and caregivers rated quality of life as 'Good'. The patients' physical, psychological and environment domain scores, and caregivers' physical domain scores, were below norms. Half of the caregivers experienced burden and 42% had risk for depression. A heterogeneous group of patients with neurological conditions had considerable care and support needs for fundamental functioning postdischarge. Quality of life and caregiver burden measures highlight the impact of their circumstances on their health and wellbeing. Research is warranted to determine a comprehensive set of generic needs to guide integrated community nursing services for building patient and caregiver self-management capacity.

BACKGROUND: Post-stroke lateropulsion is prevalent and associated with poor rehabilitation outcomes; however, data regarding long-term function associated with lateropulsion are lacking. OBJECTIVES: This study aimed to explore lateropulsion resolution and associations between lateropulsion, functional outcomes, and fall occurrence up to 12 months post-stroke. METHODS: Participants for this prospective, longitudinal cohort study were recruited from a Stroke Rehabilitation Unit (SRU). Assessments were conducted at SRU admission, at discharge, and at three, six, nine, and twelve months post-stroke. Outcomes included the Four-Point Pusher Score (4PPS), Functional Independence Measure (FIM), and fall occurrence. Longitudinal outcomes were modeled using generalized linear mixed-effects models. RESULTS: The final analyses included data from 144 participants. Eighty-two participants (56.9) had lateropulsion (4PPS ≥ 1) on admission. Odds of resolved lateropulsion (4PPS = 0) increased longitudinally from discharge for people who participated in rehabilitation physiotherapy (OR: 9.7, 28.1, 43.1, 81.3: <0.001 at three, six, nine, and twelve months respectively). The greatest FIM improvement among participants in all 4PPS categories occurred during the SRU inpatient phase. The probability of falls post-discharge was greatest among participants with 4PPS = 1 at three months, when compared with 4PPS = 0 (p= 0.022). CONCLUSIONS: This study showed that lateropulsion can continue to resolve up to one year post-stroke. Earlier lateropulsion resolution was associated with ongoing rehabilitation physiotherapy participation. Long-term functional gains were maintained among people discharged home, whereas functional status deteriorated after six months among those in residential care. Study findings will allow rehabilitation and service providers to better plan for and accommodate the long-term rehabilitation and care needs of people with post-stroke lateropulsion.

Importance: Informal caregivers who provide home-based care frequently experience stress and burden that adversely affect their health-related quality of life (HRQOL). Objective: To evaluate the efficacy of the Further Enabling Care at Home (FECH+) program for the HRQOL of caregivers of older adults discharged home from the hospital. Design, Setting, and Participants: This multicenter, parallel, 2-group randomized clinical trial, with blinded baseline and outcome measurements, was conducted at 3 hospitals in 2 states in Australia. Recruitment took place between August 2020 and July 2022, and follow-up was performed for 12 months after hospital discharge. Participants were dyads of caregivers and patients. Eligible caregivers were aged 18 years or older who provided informal home-based care at least weekly for a patient aged 70 years or older. Caregivers were enrolled when their patient was discharged from the hospital. Dyads were randomly assigned to either the intervention or control group. Data analysis followed an intention-to-treat approach. Intervention: Caregivers in the intervention group received the FECH+ program, structured nurse support of 6 telephone calls over 6 months after the patient's discharge plus usual discharge care. Caregivers in the control group received usual care alone. Main Outcomes and Measures: Primary outcome was caregivers' HRQOL 6 months after discharge, which was measured using the Assessment of Quality of Life 8-Dimension (AQOL-8D). Secondary outcomes were caregivers' HRQOL 12 months after discharge as well as preparedness to care (measured using the Preparedness for Caregiving Scale), self-efficacy (measured using the Caregiver Inventory), and levels of strain and distress (measured using the Family Appraisal of Caregiving Questionnaire) at 6 and 12 months after discharge. Baseline and outcome measurements were administered by telephone at 3, 6, and 12 months after discharge. Results: A total of 547 dyads (caregivers: 405 females [74.0%], mean [SD] age, 64.50 [12.82] years; patients: 296 females [54.1%], mean [SD] age, 83.16 [7.04] years for the intervention group and 83.45 [7.20] years for the control group) were included in the intention-to-treat analysis. There was no significant difference in caregivers' HRQOL between the 2 groups at the primary time point of 6 months (difference in AQOL-8D score, 0.01; 95% CI, -0.02 to 0.03; P = .62) after hospital discharge. Conclusions and Relevance: In this randomized clinical trial, the FECH+ program-a nurse telephone support intervention for caregivers of older adults after hospital discharge-did not significantly improve caregivers' HRQOL at 6 months after discharge compared with usual care. Additional examination is warranted into improving caregivers' HRQOL at the time of their patient's hospital discharge. Trial Registration: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12620000060943.

As disabled doctors, we welcome efforts by Australian professional bodies to actively include doctors with disability.1 This is needed. Stark employment disparities expose ableism in the medical workforce: one in six Australians has a disability, but the prevalence of disability in doctors is only 3%.2, 3 The discrimination driving this inequity is structural, embedded in institutions, systems and societal culture.2, 4

BACKGROUND: Post-stroke lateropulsion is prevalent and has been associated with varied lesion locations, but existing imaging studies are limited by small participant cohorts. Evidence to guide lateropulsion rehabilitation is also limited. Improved understanding of lesion localization associated with lateropulsion post-stroke may inform more targeted intervention approaches. OBJECTIVES: This study investigated the associations between stroke neuroimaging data and presence of lateropulsion at inpatient rehabilitation admission. METHODS: This prospective, observational study included participants aged ≥65 years, admitted for inpatient stroke rehabilitation. Using routinely collected clinical neuroimaging data, stroke type, location, and volume were reported, and their association with lateropulsion presence (Four-Point Pusher Score - 4PPS) at admission was explored. RESULTS: = 0.03) were associated with lateropulsion presence. When stratified by stroke type, no specific location was significantly associated with lateropulsion presence in hemorrhagic strokes. Among participants with ischemic stroke, involvement of the pre-central gyrus (OR = 2.45, 95%CI 1.05-5.76), post-central gyrus (OR = 2.76, 95%CI 1.15-6.60), inferior parietal cortex (OR = 3.95, 95%CI 1.43-10.90), and supramarginal gyrus (OR = 3.73, 95%CI 1.25-11.13) were associated with lateropulsion presence. The stroke laterality and size were not significantly associated with lateropulsion presence. CONCLUSIONS: The findings indicate a role of network disconnection in the post-stroke lateropulsion presence. Future, larger-cohort lesion-network mapping studies are recommended.

Nursing can be a stressful occupation with many nurses struggling to cope with stress on a day-to-day basis. Considerable evidence suggests that positive coping strategies can be an effective part of stress management education programs. This article describes the theoretical rationale for a cognitive framework for stress management that was developed as part of a well-being educational program for cancer nurses. This framework included an associated mnemonic (www.pst) to assist in the recall and utilization of positive coping strategies. The stress management framework was intended to increase nurses' perceptions of personal control which is central to stress management. The academic coping literature is complex, jargon laden and often conceptually abstract, and may not easily be understood by a nonacademic audience. The cognitive framework described here is an evidence-based, user-friendly tool that could be used and evaluated by counsellors, educators, and researchers in different settings.

AIMS: To explore the impact of the COVID-19 pandemic on nurses' and junior doctors' workload, changes to direct care and the impact of workload on resource allocation. DESIGN: Mixed-method design was used. METHODS: Data were collected from direct observation, hospital administrative database and a survey. Nurses and junior doctors were observed on two COVID-19 wards and one non-COVID-19 ward using a semi-structured observation schedule. Survey data were collected from nurses and junior doctors that had worked on the COVID-19 ward during the pandemic. Patient data were collected from Web Patient Administration System during the period of March-August 2021 and compared to March-August 2022. RESULTS: The results of this study indicated that the workloads of nurses and junior doctors changed on the COVID-19 wards. Nurses on the COVID-19 ward spent less time on administration, communication and documentation compared to nurses working on the non-COVID-19 ward. For junior doctors, less time was being spent on direct care activities and administrative work compared to the non-COVID ward. On the COVID-19 wards, patients were older and had a shorter length of stay compared to the year before. Five themes were identified from the surveys, staffing shortages resulting in higher workloads and the need for overtime, unforeseen time to undertake tasks, lack of support and physical health and patient care compromised. CONCLUSION: The study highlights the need for systemic changes to staffing shortages and elevated workloads to improve the compromised mental and physical health caused during the pandemic and to retain the workforce for future sustainability. IMPLICATIONS: As we collectively reflect on the lessons learned from this unprecedented period, it is imperative to address the challenges experienced proactively, fostering a healthcare environment that prioritises the well-being of its front line heroes and, by extension, the quality of patient care. REPORTING METHOD: STROBE. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

BACKGROUND AND OBJECTIVES: Screening for elder abuse can improve detection, but many health providers lack the necessary skills and confidence. To address this, training for health providers on elder abuse screening was codesigned as part of a trial aimed at improving elder abuse detection and response. RESEARCH DESIGN AND METHODS: Between March and April 2023, 7 health providers and 10 older people and family carers participated in 2 national Australian online codesign workshops. Using the World Café method, discussions focused on what knowledge and skills health providers needed for screening; clinical and social issues affecting screening and referral; and support older people needed throughout the process. Data were thematically analyzed. RESULTS: Participants said health providers should take a trauma-informed, person-centered approach to screening, and explain the limits of confidentiality to older people. Clinical, social, and systemic issues such as dementia, ethnic diversity, and housing availability complicated screening and referrals. To facilitate disclosure, participants said health providers needed to reflect on whether they held ageist views. There were differing opinions on the length of the training and whether all health providers or only social workers should screen for abuse. DISCUSSION AND IMPLICATIONS: Participants' feedback on trauma-informed care, consent, and cognitive impairment concorded with evidence on best practice responses to elder abuse and were integrated into the training. Given operational constraints in health services, feedback from health providers about the training length and the inclusion of all health providers in screening were prioritized. The training is being evaluated in a national trial.

Background and hypothesis: A static predictive model relying solely on baseline clinicopathological data cannot capture the heterogeneity in predictor trajectories observed in the progression of chronic kidney disease (CKD). To address this, we developed and validated a dynamic survival prediction model using longitudinal clinicopathological data to predict end-stage kidney disease (ESKD), with death as a competing risk. Methods: We trained a sequence of random survival forests using a landmarking approach and optimized the model with a pre-specified prediction horizon of 5 years. The predicted cumulative incidence function (CIF) values were used to generate a personalized dynamic prediction plot. Results: The model was developed using baseline demographics and 13 longitudinal clinicopathological variables from 4,950 patients. Variable importance analysis for ESKD and death informed the creation of a sequence of reduced models that utilized six key variables: age, serum albumin, bicarbonate, chloride, eGFR, and hemoglobin. The models demonstrated robust predictive performance, with a median concordance index of 84.84% for ESKD and 84.1% for death. The median integrated Brier scores were 0.03 for ESKD and 0.038 for death across all landmark times. External validation with 8,729 patients confirmed these results. Conclusion: We successfully developed and validated a dynamic survival prediction model using common longitudinal clinicopathological data. This model predicts ESKD with death as a competing risk and aims to assist clinicians in dialysis planning for patients with CKD.

BACKGROUND: Elder abuse often goes unreported and undetected. Older people may be ashamed, fearful, or otherwise reticent to disclose abuse, and many health providers are not confident in asking about it. In the No More Shame study, we will evaluate a co-designed, multi-component intervention that aims to improve health providers' recognition, response, and referral of elder abuse. METHODS: This is a single-blinded, pragmatic, cluster randomised controlled trial. Ten subacute hospital sites (i.e. clusters) across Australia will be allocated 1:1, stratified by state to a multi-component intervention comprising a training programme for health providers, implementation of a screening tool and use of site champions, or no additional training or support. Outcomes will be collected at baseline, 4 and 9 months. Our co-primary outcomes are change in health providers' knowledge of responding to elder abuse and older people's sense of safety and quality of life. We will include all inpatients at participating sites, aged 65 + (or aged 50 + if Aboriginal or Torres Strait Islander), who are able to provide informed consent and all unit staff who provide direct care to older people; a sample size of at least 92 health providers and 612 older people will provide sufficient power for primary analyses. DISCUSSION: This will be one of the first trials in the world to evaluate a multi-component elder abuse intervention. If successful, it will provide the most robust evidence base to date for health providers to draw on to create a safe environment for reporting, response, and referral. TRIAL REGISTRATION: ANZCTR, ACTRN12623000676617p . Registered 22 June 2023.

Guidelines for professionals practising in healthcare settings recommend that autistic people seeking care should receive neurodiversity-affirming support. However, education on neurodiversity is not widely included in health professional training in Australia. With a focus on health equity for autistic, neurodivergent people, we conducted a healthcare improvement initiative addressing the need for neurodiversity education in an Australian tertiary hospital through a change process. This project was conducted from May to November 2022, led by neurodivergent, disabled doctors who developed neurodiversity education for two hospital departments, refined through Plan-Do-Study-Act cycles and feedback surveys. The feedback survey, which included an opportunity to provide comments, was completed by 29 of 44 attendees, a response rate of 66%. Respondents agreed the education was relevant to their work (97%, n = 28), and reported more confidence (83%, n = 24) and acceptance (90%, n = 26) of autistic patients and colleagues. Themes identified in the analysis of the open-ended questions included reducing negative attitudes (biases), recognizing unmet neurodiversity learning needs, and a shift in perspective. Neurodivergent doctors led this healthcare improvement project to educate hospital clinicians about neurodiversity. The theme of reducing bias emerged from the open-ended responses, highlighting the importance of this work, given bias contributes significantly to health inequity. Lay abstract Barriers to autistic people accessing healthcare include health professionals with negative attitudes (biases). This study created training for hospital doctors and nurses about reducing healthcare barriers so autistic people can be included. We taught about neurodiversity affirming support, which means accepting and valuing neurodivergent people because they belong in our diverse society. The team included two neurodivergent, disabled doctors, and two research experts. The training was based on guidelines about quality hospital care, supporting autistic people, and the experiences of neurodivergent doctors. Meetings were held with hospital education leaders to find out what kinds of training doctors and nurses preferred. A feedback survey was created to find out about experiences within the training. Three groups received the training. First was Junior Medical Officers in the Emergency Department, who are qualified doctors training to become specialists. The second was specialists and doctors in the final stage of training before becoming specialists in the Geriatric Medicine department. The third was nurses in the Emergency Department. The majority of the survey responses said the training was relevant and made them feel more confident in supporting and more accepting of autistic people. Themes from the open-response questions were “bias,” “neurodiversity knowledge” and “perspective shifts.” These describe becoming aware of biases and stigma and having these challenged; wanting to know more about supporting neurodivergent people; and changing their point of view to understand neurodivergent people. These findings can support other hospitals to train staff about neurodiversity-affirming support.

BACKGROUND: The aim of the International Stroke Recovery and Rehabilitation Alliance is to create a world where worldwide collaboration brings major breakthroughs for the millions of people living with stroke. A key pillar of this work is to define globally relevant criteria for centers that aspire to deliver excellent clinical rehabilitation and generate exceptional outcomes for patients. OBJECTIVES: This paper presents consensus work conducted with an international group of expert stroke recovery and rehabilitation researchers, clinicians, and people living with stroke to identify and define criteria and measurable indicators for Centers of Clinical Excellence (CoCE) in stroke recovery and rehabilitation. These were intentionally developed to be ambitious and internationally relevant, regardless of a country's development or income status, to drive global improvement in stroke services. METHODS: Criteria and specific measurable indicators for CoCE were collaboratively developed by an international panel of stroke recovery and rehabilitation experts from 10 countries and consumer groups from 5 countries. RESULTS: The criteria and associated indicators, ranked in order of importance, focused upon (i) optimal outcome, (ii) research culture, (iii) working collaboratively with people living with stroke, (iv) knowledge exchange, (v) leadership, (vi) education, and (vii) advocacy. Work is currently underway to user-test the criteria and indicators in 14 rehabilitation centers in 10 different countries. CONCLUSIONS: We anticipate that use of the criteria and indicators could support individual organizations to further develop their services and, more widely, provide a mechanism by which clinical excellence can be articulated and shared to generate global improvements in stroke care.

AIMS: To systematically summarise evidence related to the use of non-sterile gloves when preparing and administering intravenous antimicrobials. DESIGN: Scoping review. METHODS: A rigorous scoping review was undertaken following Arksey and O'Malley's (2005) framework and the modified Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review guidelines (2018). Five databases and grey literature were included in the search. Literature published between 2009 and 2024 was included. DATA SOURCES: Five databases (Medline, CINAHL, EMBASE, Scopus and Web of Science) and the grey literature were searched in February 2024. RESULTS: Three studies were included; however, none directly addressed correct non-sterile glove use during intravenous antimicrobial preparation or administration in clinical practice. CONCLUSION: We found no evidence to support the use of non-sterile gloves in intravenous antimicrobial preparation. There is an urgent need for rigorous research to inform the development of clear guidelines on non-sterile glove use to underpin evidence-based decision-making in nursing and other health professional education, improve patient outcomes, reduce healthcare costs and promote environmental sustainability in healthcare. IMPLICATIONS: Inappropriate use of non-sterile gloves for preparing and administering intravenous antimicrobials hinders correct hand hygiene practices and increases healthcare-associated infections, healthcare costs and waste. IMPACT: A critical gap in the existing evidence was a key finding of this review, highlighting the urgency for evidence-based guidelines to improve patient safety outcomes, reduce healthcare costs and promote environmental sustainability in healthcare. REPORTING METHOD: This scoping review adhered to the relevant EQUATOR guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting checklist. PATIENT OF PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct or reporting. TRIAL AND PROTOCOL REGISTRATION: The protocol was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/QY4J2).

The Australian Stroke Foundation guidelines recommend participation in at least 3 hours of physical and occupational therapy daily during stroke rehabilitation. The majority of services in Australia do not currently meet this guideline. This study explored the usefulness of activity diary implementation in increasing activity during inpatient stroke rehabilitation and identified barriers and enablers to activity level guideline adherence, as perceived by clinicians. Using a mixed-methods, longitudinal embedded-design study, two participant cohorts were recruited: people undergoing inpatient stroke rehabilitation and stroke rehabilitation clinicians. Behaviour mapping pre- and post-implementation of activity diaries measured inpatient activity levels. Clinician surveys assessed enablers and barriers to inpatient activity level guideline adherence, both pre- and post-implementation. Twelve adults undergoing inpatient stroke rehabilitation were included. Trends toward reduced time spent sedentary (d = –0.797, 95% confidence interval (CI) [–1.811, 0.217]), increased independent ADL practice (d = 0.861, 95% CI [–0.159, 1.88]), and lower limb active practice were noted after diary implementation (d = 0.778, 95% CI [–0.234, 1.791]). Sixteen clinicians completed 14 pre-diary implementation and nine post-implementation surveys. The main themes identified as clinician-perceived barriers to activity level guideline adherence included de-prioritisation of activity, staff shortages, caseload demands, lack of family and patient-friendly resources, and stroke-related factors. The facilitators included activity diaries, behaviour change, and multidisciplinary communication. Active time among people undergoing inpatient stroke rehabilitation increased after implementation of the diaries. Despite the identified institutional barriers to inpatient activity engagement, activity diaries may assist in promoting an increase in activity among people undergoing inpatient stroke rehabilitation.