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This paper describes the follow-up evaluation of a school-based scalds prevention programme designed to teach children about scalds hazards and encourage safe family practices. It involved two classroom sessions and a homework exercise that targeted five safety practices. The programme was taught to 28 classes in 14 schools in Waitakere City, New Zealand by Public Health Nurses (PHNs). Children (n = 116) aged 10-11 years from three of the schools in ethnically diverse, low/middle-income areas were assessed for their knowledge of scalds hazards 1 year after the programme. They recalled a mean of 7.46 out of 10 hazards, which was almost equivalent to children in an earlier evaluation who recalled 7.62 hazards immediately after the teaching. Altogether, 65-79% of children reported that each of the four safety items provided were at least temporarily used as intended, with 29-55% reporting that they were still in use 1 year later. Interviews with children's parents (n = 18) indicated that the majority of their hot water practices were not optimally safe prior to the programme and that many had adopted the suggested practices. While the PHNs were positive about the programme, they suggested teachers could deliver it as part of the school curriculum. (Contains 5 tables and 1 figure.)

Objective: To investigate the impact of workplace factors on psychological distress in New Zealand registered nurses. Background: Nurses are often faced with challenging work environments, with long work hours, high patient ratios, and emotionally charged situations that cause stress. Despite the well-established links between the nurse work environment and well-being, there remains a gap in the literature around the role of workplace factors on psychological distress in nurses. Study design and methods: A cross-sectional survey was conducted with registered nurses in New Zealand. Depression, anxiety, and stress were self-reported using the DASS-21, while difficult practice environments and negative workplace acts were self-reported using PES-NWI and NAQ-R. Descriptive and inferential statistics were undertaken using SPSS. STROBE guidelines were used to report the study. Results: 480 RNs completed the survey. On average, depression, anxiety, and stress scores were 6.08 (SD=7.06, Normal), 4.87 (SD=6.05, Normal), and 9.50 (SD=7.30, Normal), respectively. The Average PESNWI score was 2.70 (SD=0.54), while the average total NAQ-R score was 34.27 (SD=12.67). Depression, anxiety, and stress scores were positively associated with NAQ-R scores, and negatively associated with PES-NWI scores (p-values <0.05). PES-NWI score was negatively associated with NAQ-R score (p<0.05). PES-NWI and NAQ-R explained 28.8%, 15.6%, and 26.1% of the variation in depression, anxiety, and stress, respectively. Depression, anxiety, and stress were significantly associated with intention to leave (p-values <0.05). Depression and anxiety were significantly associated with ethnicity (p-values <0.05). Age was negatively associated with anxiety and stress (p-values <0.05). Years employed as a nurse were also negatively associated with anxiety (p<0.05). Discussion: This study addresses a knowledge gap by demonstrating that workplace factors are associated with psychological distress in nurses. Conclusion: Psychological distress in nurses is significantly associated with the work environment and with intention to leave the profession. Given that most countries are facing nurse shortages and are actively recruiting nurses from diverse countries and ethnic backgrounds, targeted and individualised support needs to be provided to preserve nurses' mental health and subsequent retention in the workforce. Implications for research, policy, and practice: Healthcare providers must prioritise modifying the work environment to address the factors contributing to nurses' psychological distress. This includes providing culturally tailored mental health resources and support for nurses with diverse backgrounds and experiences. Future research should examine how organisational-level strategies can reduce psychological distress in nurses. What is already known about the topic? * Psychological distress is common in nurses. * Indicators of psychological distress include non-specific symptoms of stress, anxiety, and depression. * Psychological distress is associated with challenging working conditions. What this paper adds: * Vulnerable groups, such as nurses from specific ethnic backgrounds and less experience, report higher levels of psychological distress, such as anxiety and depression. * The quality of the practice environment is associated with psychological distress in registered nurses. * Negative acts in the workplace (i.e., bullying and harassment) are positively associated with psychological distress in registered nurses. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pegasus Health Charitable Ltd, a Christchurch Primary Health Organisation, is contracted by the Canterbury District Health Board to provide continuing professional development for primary care practitioners in the region. Rurally located health practitioners have largely been unable to participate because of the travel time and distances involved. AIM: The initiative reported in this paper aimed to fill this gap by developing an accessible and high-quality multidisciplinary model of professional development for general practitioners, nurse practitioners, practice nurses and community pharmacists in rural areas of North Canterbury, New Zealand. METHODS: A survey was conducted to learn from the experiences of 14 health professionals in an existing multidisciplinary group, which had developed as a local initiative in one rural community. RESULTS: The survey had an 86% response rate. All respondents believed the multidisciplinary format worked well, had improved collaborative working and increased the consistency of patient care. Access to professional development had improved and the meetings provided a useful forum for the mostly part-time staff to interact as a group. The main caution noted was the potential to become inward looking without being exposed to fresh ideas from other practices. DISCUSSION: The multidisciplinary model was considered workable and valuable by the survey respondents. Based on our findings, the multidisciplinary model has been formalised by the Pegasus team responsible, and three new groups are now operating successfully in rural areas of North Canterbury. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The health sector is facing considerable challenges to meet the health needs of rural communities. Nurse practitioners (NPs) deliver primary health care (PHC) services similar to general practitioner (GP) services, within a health equity and social justice paradigm. Despite GP workforce deficits, New Zealand has been slow to effectively utilise NPs. AIM: From a larger study exploring the establishment of NP services, this paper reports on the barriers and facilitators to becoming a NP in rural PHC. METHODS: Overall, 13 NPs and 4 NP candidates participated in individual or group interviews. Participants were employed in a variety of PHC settings from six district health boards across New Zealand. Using a scaffold map constructed to show the stages of the pathway from nurse to NP, data were analysed to identify experiences and events that facilitated or were barriers to progress. RESULTS: Experiences varied considerably between participants. Commitment to the development of the NP role in their local areas, including support, advanced clinical opportunities, supervision, funding and NP job opportunities, were critical to progression and success. Existing GP shortages and the desire to improve health outcomes for communities drove nurses to become NPs. DISCUSSION: Implementation of the NP workforce across New Zealand remains ad hoc and inconsistent. While there are pockets of great progress, overall, the health sector has failed to embrace the contribution that NPs can make to PHC service delivery. A national approach is required to develop the NP workforce as a mainstream PHC provider. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The Medicines (Standing Order) Amendment Regulations 2011 allow medicines to be supplied or administered to a patient by a nurse in the absence of a medical practitioner and without a prescription. Regulations have been in place since 2002, but no substantive research has occurred in New Zealand concerning their use. AIM: This paper reports a survey of registered nurses (RNs) who work in primary health care (PHC) settings and explores aspects of their practice relating to their use of standing orders. METHODS: A self-reported survey using a non-probability sample of RNs working in PHC who use standing orders in their practice (n=231). Data were analysed descriptively. RESULTS: The sample were experienced RNs (mean 24 years since registration) and 53% have a post-graduate qualification. Some nurses' understanding of a standing order included provision of a prescription to a patient. Standing orders were used frequently (42% reported use 1 to >5 times/day) for a wide variety of conditions. There is a significant relationship between undertaking the stated professional development requirements and confidence in the clinical decisions made (p=0.025). Over half (52%) would like to use standing orders more often. DISCUSSION: Standing orders are used extensively in PHC settings. The conditions nurses are involved in treating are usually already differentiated or have a high degree of diagnostic certainty. Nurses can effectively provide medicines under standing orders when doctors support their use, issue evidence-based orders, and have confidence in nurses with advanced skills. Doctors need to meet their responsibilities under the Regulations. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pastoral care is recognised as an important aspect of a mature primary care network. Pegasus Health is now in its 25th year and has had a formal Pastoral Care Programme for doctors since 2009. AIM: This study aimed to collect local data on the self-care of Canterbury (Christchurch, New Zealand) general practitioners (GPs), nurse practitioners (NPs), practice nurses (PNs) and community pharmacists (CPs). METHODS: The survey was open to all participants in the Pegasus Small Group Education Programme in Canterbury. From a survey circulated to approximately 1100 primary care professionals, 504 responses were collected either electronically or as hard copies. RESULTS: The themes that emerged were similar among all the health professional groups. A significant proportion of health professionals took minimal annual leave and even more worked while ill. CPs were the group with the highest rates in both these areas. Reasons given for this focused largely on a lack of locum cover. DISCUSSION: Locum cover is a significant issue in Canterbury for all health professional groups in the study. The issue of locums is now being reviewed in Canterbury partly as a result of this study. Consideration is also being given to how the Pastoral Care Programme can be made more widely available. [ABSTRACT FROM AUTHOR]

Introduction. The global prevalence of diabetes is a pressing public health concern. Over 400 million individuals live with the effects of the disease, predominantly in low- and middleincome countries. In Aotearoa New Zealand (NZ), over 300 000 people have diabetes, resulting in a population rate of 43.1 per 1000. Enabling nurses to prescribe diabetes medications enhances accessibility and improves health outcomes for large sections of the population. Aim. This rapid review was undertaken to investigate the influence of nurse prescribing on health care delivery for individuals with diabetes in NZ, Australia, the United Kingdom, and Canada, countries sharing comparable health care systems and multicultural backgrounds. Methods. The review protocol was published on PROSPERO. In November 2022, a search was conducted across multiple databases to locate relevant literature and resources constrained to the last decade (from January 2012 to November 2022). Utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, data extraction was systematically structured, while rigorous appraisal processes upheld selection quality. Results. Fifteen publications were identified as meeting predefined inclusion and exclusion criteria. The review of these articles revealed four main themes: the impact of nurse prescribing on clinical outcomes, levels of patient satisfaction, implications for health care service provisions, and identification of barriers and facilitators associated with nurse prescribing. Discussion. This report identifies outcomes of nurse prescribing, concluding it provides a potential avenue for enhancing access to and alleviating the burden on health care systems. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In 2013, the Nursing Council of New Zealand consulted on a proposal for introduction of registered nurse (RN) prescribing at two levels (specialist and community) within the designated class of prescriber. The proposal builds on the success of the diabetes nurse specialist prescribing project and the experience of other countries where RN prescribing is well established. AIM: To describe the views and intentions of nurses who work in primary health care (PHC) settings about the two levels of RN prescribing proposed. METHODS: The study involved a self-reported survey using a non-probability sample of RNs working in PHC settings (N=305). Quantitative and qualitative data were analysed descriptively. RESULTS: The respondents were experienced nurses. Overall, 82.3% expressed interest in becoming a community nurse prescriber, and 62.6% expressed interest in the specialist prescriber level. RN prescribing was expected to improve efficiency and access to medicines for high-needs populations, clarify accountability and improve nurses' autonomy. The education requirements for the specialist level were viewed as appropriate but too onerous for many. Requirements were viewed as inadequate for the community level. Concerns were raised about funding for education and support for RN prescribing roles. DISCUSSION: Nurses were positive about the proposals and see a potential to meet significant unmet health need. Nurses are already engaged in the provision of medicines to patients and prescribing authority would ensure they are suitably qualified to engage in these tasks. A clear policy platform will be needed if the proposed levels of RN prescribing are to be successfully implemented. [ABSTRACT FROM AUTHOR]

Objective: We aimed to estimate the cost-effectiveness of brief weight-loss counselling by dietitian-trained practice nurses, in a high-income-country case study.Design: A literature search of the impact of dietary counselling on BMI was performed to source the 'best' effect size for use in modelling. This was combined with multiple other input parameters (e.g. epidemiological and cost parameters for obesity-related diseases, likely uptake of counselling) in an established multistate life-table model with fourteen parallel BMI-related disease life tables using a 3 % discount rate.Setting: New Zealand (NZ).Participants: We calculated quality-adjusted life-years (QALY) gained and health-system costs over the remainder of the lifespan of the NZ population alive in 2011 (n 4·4 million).Results: Counselling was estimated to result in an increase of 250 QALY (95 % uncertainty interval -70, 560 QALY) over the population's lifetime. The incremental cost-effectiveness ratio was 2011 $NZ 138 200 per QALY gained (2018 $US 102 700). Per capita QALY gains were higher for Māori (Indigenous population) than for non-Māori, but were still not cost-effective. If willingness-to-pay was set to the level of gross domestic product per capita per QALY gained (i.e. 2011 $NZ 45 000 or 2018 $US 33 400), the probability that the intervention would be cost-effective was 2 %.Conclusions: The study provides modelling-level evidence that brief dietary counselling for weight loss in primary care generates relatively small health gains at the population level and is unlikely to be cost-effective. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic presented significant job engagement challenges for the nursing workforce with increased pressures and workplace changes. Nursing staff shortages have increased nurse anxiety, burnout, fear, low morale and intentions to leave the profession. Nursing care is inherently stressful and at times complex, with stress often due to work inconsistencies, a lack of role clarity, workloads and time pressures. This study explores nurses job engagement, by looking specifically at nurses social-emotional attributes – Occupational Commitment, Self-efficacy Beliefs, Collective Efficacy Beliefs, Resilience, Adaptability and Emotional Labour. This protocol describes a mixed methods convergent parallel study, incorporating a survey questionnaire. The survey comprised of quantitative and qualitative questions, with data collected simultaneously, analysed separately, and integrated in the final analysis step. The survey design used validated social-emotional items, sorting and ranking questions and short answer responses. Analysis will involve individual and comparative analysis of the two participants groups, they are: Australian nurses (n = 86) and New Zealand Nurses (n = 275). Data collection was conducted during two different time periods – Australian pilot (2020-21) and in New Zealand (2022–2023). Recruitment involved the use of professional and personal nursing networks, newsletters and social media communications. Ethics approval was obtained through participating universities in both countries. Results will be disseminated through peer-reviewed publications, conferences, blogs, newsletters and reports to nursing networks. The study will provide valuable insights into nurses' social-emotional attributes and the role they play in job engagement. [ABSTRACT FROM AUTHOR]

This paper explores the conduct of performance appraisals of nurses in a New Zealand hospital, and how fairness is perceived in such appraisals. In the health sector, performance appraisals of medical staff play a key role in implementing clinical governance, which, in turn, is critical to containing health care costs and ensuring quality patient care. Effective appraisals depend on employees perceiving their own appraisals to be fair both in terms of procedure and interaction with their respective appraiser. We examine qualitative data from interviews and focus groups, involving 22 nurses in a single department, to determine whether perceived injustices impact on the effective implementation of the appraisal system. Our results suggest that particular issues had been causing some sense of injustice, and most of these were procedural. Potential solutions focus on greater formalisation of the performance appraisal process, and more training for appraisers and appraisees. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Teamwork in primary health care has been encouraged in New Zealand and in the international literature. It may improve work satisfaction for staff, and satisfaction and outcomes for patients. Teamwork may be classified as being multi-, inter- or transdisciplinary and is likely to be influenced by the nature of the work and the organisational context. AIM: To describe and analyse teamwork between general practitioners and practice nurses in New Zealand. METHODS: Data were drawn from a survey of general practices and from interviews with primary health care staff and management. RESULTS: Doctors and nurses in general practice in New Zealand see themselves as a team. Evidence suggests that the nature of the work and the business context most often leads to a multidisciplinary style of teamwork. some providers have adopted a more intense teamwork approach, often when serving more disadvantaged populations or in caring for those with chronic illnesses. DISCUSSION: Concepts of teamwork differ. This article provides a classification of teams and suggests that most general practice teams are multidisciplinary. It is hoped that this will help personnel to communicate their expectations of a team and encourage progressive team development where it would be of value. [ABSTRACT FROM AUTHOR]

Introduction. Antimicrobial resistance is an infectious disease threat to public health globally, and antimicrobial stewardship among healthcare professionals is one key way to address this potential problem. Registered nurse designated prescribers are the newest group of health professionals to gain prescribing authority in Aotearoa New Zealand, yet little is known about their understanding of their antimicrobial stewardship role. Aim. The aim of this study was to explore registered nurse designated prescribers’ understanding of their antimicrobial stewardship role through their prescribing practices and approaches to clinical reasoning. Methods. This exploratory descriptive qualitative study used individual semi-structured interviews with six registered nurse designated prescribers. Thematic analysis was used to analyse the interviews. Results. Four themes were identified: antibiotic prescribing practices and antimicrobial resistance; clinical indicators for prescribing antibiotics, with the sub-themes of history taking, presence of infection and bacterial versus viral infection; patient education; and safety and monitoring. These themes provide insight into registered nurse designated prescribers’ understanding of their antimicrobial stewardship role and prescribing of antibiotics. Discussion. This research found that the registered nurse designated prescribers had an awareness of the importance of their antimicrobial stewardship role in relation to antibiotic prescribing and reducing antimicrobial resistance. Education about antimicrobial resistance and antimicrobial stewardship for this professional group can be effective, but further research is needed to understand their ongoing educational needs. [ABSTRACT FROM AUTHOR]

Introduction: The move from senior student to novice/advanced beginner registered nurse has been noted to be a stressful period. This longitudinal study follows the experiences of five cohorts of graduate New Zealand registered nurses throughout their first year of practice (n = 530). Methods: Data were collected via self-report survey using the Casey-Fink Graduate Nurse Experience Survey© at three points throughout the first year of practice. Results: Exploratory factor analysis (EFA) resulted in a 5-factor solution for 24 items from section two of the survey: professional support, professional role, professional concerns, professional communication and personal stress. Most respondents (93%) were female, New Zealand Europeans (80%) working in either surgical or medical clinical areas. Professional support from preceptors and exposure to positive role models contributed to a sense of being supported for 81% of the respondents. Satisfaction with choosing the professional role of nursing remained constant with over 90% agreeing or strongly agreeing they had made the right career choice. Across time, respondents reported few professional concerns and few concerns about professional communication. Concerns about personal stress were consistent, with 50% reporting stress related to issues such as finances, childcare and job performance. Conclusion: Contrary to other research, a honeymoon period was not evident (other than the initial high satisfaction with salary), rather the nurses' satisfaction with nursing remained high throughout the year. [ABSTRACT FROM AUTHOR]

Objective The main aim of this study was to explore any association between colorectal cancer (CRC) and rotating shift work in nurses and midwives. The secondary aim of this study was to identify risk factors for CRC in nurses and midwives who are rotating shift workers. Design Cross-sectional study. Setting Electronic survey of participants from Australia, New Zealand and the United Kingdom. Subjects A sample of 8,199 male and female nurses and midwives from Australia, New Zealand and the United Kingdom invited through their registration papers or newsletter advertisement. Main outcome measure Prevalence of CRC in participants who have worked rotating shifts for 1-14 years or ≥15 years compared to participants who have never worked rotating shifts. In addition, risk factors for CRC in the rotating shift work population were analysed in a multivariate logistic regression model in order to obtain odds ratio of CRC. Results No statistically significant difference was found in the prevalence of CRC between those who have never worked rotating shift work, worked 1-14 years and worked 15 or more years. Among rotating shift workers, diabetes was associated with a 123-fold (95% CI 39-392; p<0.001) increased odds of CRC, while Inflammatory Bowel Disease (IBD) was associated with a 190-fold (95%CI 68-526; p<0.001) increased odds of CRC. Screening colonoscopy or sigmoidoscopy for CRC was associated with a 10-fold (95% CI 3-35; p<0.001) increased odds of being diagnosed with CRC. Conclusion No significant association was found between rotating shift work and colorectal cancer in nurses and midwives. In nurses and midwives who are rotating shift workers, diabetes, IBD and CRC screening significantly increased the odds of CRC. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Medical Council of New Zealand requires graduating doctors to have community attachments within their first two years of practice by 2020. Counties Manukau Health has developed a programme where house officers (HOs) are attached to a general practice for three months. AIM: This study aimed to establish the value of four HO general practice attachments in Counties Manukau and describe how HOs are being used in these practices. METHODS: A mixed-methods design was used to evaluate three attachment runs. Two practices provided the number of patients seen by HOs. Fifty-eight patients were surveyed to assess patient perceptions of the HOs. Six HOs, four supervising general practitioners, two PHO senior staff and one practice manager participated in semi-structured interviews. Focus groups were held with nurses, doctors and administrative staff at all four practices. FINDINGS: HOs saw 300-600 patients in one practice and 800-1000 in the other during their attachment. Practices developed their own approach to mentoring and teaching HOs. Most patients reported positive perceptions of the HOs. Themes from interviews and focus groups were consistent among participants and included: improved HO confidence, clinical skills and understanding of general practice; extra capacity and improved quality of care and staff satisfaction among practices. CONCLUSION: HOs and practices viewed HO attachments in general practice positively. HOs developed clinical skills and understanding of primary health care. Practice teams enjoyed the energy and enthusiasm of the HOs, while providing clinical support to ensure quality patient care. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Nutrition care refers to practices conducted by health professionals to support patients to improve their dietary intake. General practitioners (GPs) are expected to provide nutrition care to patients for prevention and management of chronic disease. AIM: This study explores GPs' opinions regarding nutrition care provision to patients with chronic disease. METHODS: An interpretive descriptive approach to qualitative research using seven semistructured focus groups with 48 GPs in Auckland was used. Focus groups investigated how GPs felt about providing nutrition care; the perceived barriers to and support required for this care; the development of further nutrition knowledge and skills; and possible roles for Practice Nurses. Recorded interviews were transcribed verbatim and analysed using a thematic approach. RESULTS: GPs indicated routine provision of basic nutrition care to patients with chronic disease, but perceived their limited consultation time and nutrition competence constrained their capacity to provide nutrition care. GPs felt they needed further information to provide culturally, socially and economically sensitive nutrition care. GPs displayed variable opinions on the benefits of developing their nutrition knowledge and skills, and the idea of Practice Nurses providing nutrition care. CONCLUSIONS: Despite perceiving that nutrition care is important for patients with chronic disease and facing barriers to providing nutrition care, GPs appear reluctant to further develop their knowledge and skills and for Practice Nurses to provide this care. Strategies to enhance GPs' nutrition-related self-efficacy, nutrition cultural competence and attitudes towards further training care may be warranted. [ABSTRACT FROM AUTHOR]

Introduction. In New Zealand, nurses visiting families postnatally use the Patient Health Questionnaire-3 (PHQ-3) to screen and detect postnatal depression. Exploring nurses' perception of the tool when using it with women across cultures is central to ensuring the PHQ-3 tool supports equitable screening and detection of postnatal depression, yet little is known about nurses' confidence with, and use of, the tool with people of differing cultures. Aim. The aim of this study was to understand nurses' confidence in using the PHQ-3 to screen for postnatal depression, particularly its use cross-culturally. Methods. Quantitative online survey research was carried out in 2019. Fifty-two percent of eligible registered nurses participated (n = 187), completing Likert scale responses and open questions about the use of the screening tool with specific groups, and barriers and facilitators to screening. Results. Ninety-five percent of participants were confident in their use of the PQH-3, 70% of nurses agreed the PHQ-3 supports the identification of postnatal depression, and most respondents (54.5%) disagreed that the PHQ-3 was a good screening tool cross-culturally. Discussion. Nurses were confident in their use of the PHQ-3, and it was relatively highly regarded in its ability to detect postnatal depression. However, less confidence in its use across cultures implies the PHQ-3 does not translate to evidence-based, cross-cultural care. To serve culturally diverse populations, consultation is needed on both languages used and cultural practices so that tools are appropriate, otherwise they cannot be validated for use cross-culturally. [ABSTRACT FROM AUTHOR]

Introduction: The Rural Inter-Professional Simulation Course (RiSC) in New Zealand is a 3-day immersive course that brings rural doctors and nurses together to practise emergency and trauma skills using workshops and a simulation-enhanced interprofessional experience (SEIPE). The course aims to increase practitioners' psychomotor skills, communication, teamwork and leadership skills through simulationbased learning and translate this into the management of trauma in rural settings. Methods: This study employed an exploratory, descriptive design to explore transfer of learning from RiSC into clinical practice 8 months post course participation. Six registered nurses who participated in RiSC took part in semi-structured interviews. The transcribed interviews were analysed using a general inductive approach. Results: The nurses valued the learning experience in RiSC and used the skills they learnt in clinical practice, however factors such as their perception of the authenticity of the scenario and performance anxiety impacted the SEIPE. The nurses also observed interprofessional dynamics playing out during the SEIPE. Conclusions: RiSC is effective for rural trauma team training, however some aspects of the use of simulation in interprofessional education could be further enhanced. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The New Zealand (NZ) Ministry of Health's Primary Health Care Strategy (2001) has an overall vision of better health for all and the reduction of health inequalities between different population groups. This goal can be achieved by comprehensive, integrated primary health care (PHC) service delivery. One useful approach is to place social workers within PHC practices. This study aimed to explore the perceptions about, and the experiences gained by, such integrated social workers regarding their contributions towards the PHC vision. METHODS: This qualitative study focused on three participant groups, namely social workers, PHC professionals and key informants. Overall, 18 one-to-one, semi-structured interviews were undertaken in various locations in NZ. Key themes were identified via a general inductive approach. FINDINGS: Three key themes emerged from the data: wider factors, organisational factors and social work factors. The last theme encompassed the social workers' professional understanding, knowledge and approaches. The organisational factors (a community needs focus and provision of a supportive work environment) and the wider factors identified (funding and issues experienced by communities) had variable impact on these social work positions. CONCLUSION: Participants viewed social workers as facilitating appropriate access to and engagement by people with services; enhancing ongoing, coordinated, safe service provision; and contributing to staff development. The potential of the social work profession within PHC practices was well recognised by non-social worker participants. This study provides initial insights into the unique contributions made by social workers towards achieving NZ Ministry of Health's PHC vision. [ABSTRACT FROM AUTHOR]

Background: Hospitalisation of a child is a unique opportunity for health staff to offer smoking cessation support; that is screening for carer smoking status, discussing cessation and providing interventions to carers who smoke. This has the potential to reduce the child's exposure to second-hand smoke, and in turn tobacco related illnesses in children. However, these interventions are not always offered in paediatric wards. The aim of this study was to explore the provision and prioritisation of smoking cessation support to patient carers in a paediatric ward with a high proportion of Aboriginal patients and carers in a regional area of Australia's Northern Territory. Methods: This is a qualitative descriptive study of data collected through semi-structured interviews with 19 health staff. The interviews were audio recorded and transcribed verbatim. Thematic analysis was performed on the transcripts. Results: We found low prioritisation of addressing carer smoking due to, a lack of systems and procedures to screen for smoking and provide quitting advice and unclear systems for providing more detailed cessation support to carers. Staff were demotivated by the lack of clear referral pathways. There were gaps in skills and knowledge, and health staff expressed a need for training opportunities in smoking cessation. Conclusion: Health staff perceived they would provide more cessation support if there was a systematic approach with evidence-based resources for smoking cessation. These resources would include guidelines and clinical record systems with screening tools, clear action plans and referral pathways to guide clinical practice. Health staff requested support to identify existing training opportunities on smoking cessation. [ABSTRACT FROM AUTHOR]

INTRODUCTION: A Continuity of Cancer Care pilot project was established in two urban general practices, with the goal of improving cancer care and patient access to services. Practice nurses were engaged as coordinators to implement a model of care and patient navigation to offer continued and consistent care, and to assist the patient to navigate their cancer experience. AIM: The aim was to evaluate the effectiveness of the Continuity of Cancer Care pilot project. METHODS: Patients enrolled in the pilot project were invited to participate. Each participant completed a Patient Satisfaction Questionnaire and SF-12 Health Survey, and was then invited to take part in an interview. The evaluation framework utilised concepts of informational, management and relational continuity. RESULTS: The SF-12 subcategories of physical functioning, role physical, bodily pain and role emotional were lower than other results from cancer patients in the literature. The Patient Satisfaction Questionnaire and interviews indicated patients were satisfied with the relational continuity components of the project, but that gaps existed within the management and informational continuity aspects of care. DISCUSSION: Overall, the participants were satisfied with the Continuity of Cancer Care programme and valued the support, clarification and listening aspects of the programme. However, when evaluated in relation to a more comprehensive definition of continuity of care, there were distinct gaps. While the relational aspects of continuity of care were mostly achieved, the management and informational aspects appeared to be limited primarily to nurses acting to interpret hospital and general practitioner comments for patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The Auckland chlamydia pilot was one of three pilots funded by the Ministry of Health to trial implementation of the 2008 Chlamydia Management Guidelines prior to national roll-out. AIM: To assess what elements in the testing programme pilot worked best for staff and to determine how an opportunistic testing programme could be better configured to meet staff needs and preferences. METHODS: A staff survey listed key chlamydia testing tasks in chronological order, and service interventions supporting these tasks. Staff were asked to rate each task on its difficulty prior to the pilot, and then on the difference the pilot had made to each task. They were also asked to rate service interventions on their usefulness during the pilot implementation. RESULTS: The survey had a response rate of 94%. The testing tasks posing the greatest difficulties to staff were those involving patient interactions (41%) and management of follow-up (52%). About 70% of staff felt tasks were improved by the pilot. Staff considered the three most useful service interventions to be a chlamydia-specific template created for the practice management system, provision of printed patient resources, and regular team discussions with other staff. DISCUSSION: A significant proportion of staff reported difficulties with routine tasks required for opportunistic testing for chlamydia, highlighting the need to involve staff during programme design. Practice nurse-led approaches to future opportunistic testing programmes should be considered as nurses had a more positive response to the pilot and nurse-led approaches have been shown to be successful overseas. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Despite more than 10 years of the diabetes annual review (DAR) programme, ensuring the annual return of diabetic patients for review remains a challenge for primary care. Regardless of future arrangements for diabetes review programmes, regular review of patients remains clinically important. AIM: To investigate the effect of patient and practice characteristics on the retention of patients continuously enrolled with the same practice in the DAR programme. METHODS: We undertook a retrospective, observational study of a cohort of enrolled diabetic patients who had a DAR in the July 2006 - June 2007 reporting year and remained enrolled with the same practice for the following three years. Controlling for death and migration, retention rates were calculated for age, gender, ethnicity, rurality, practice fundingtype and practice nurse (PN) to general practitioner (GP) ratio. RESULTS: The study included data from 78 practices and 6610 patients with Type 2 diabetes. Non-Maori and those aged 60 years and over were more likely to be retained in the programme. For practice factors, those with a higher PN to GP ratio had a significant retention advantage. Rurality and funding type was not shown to have a significant role in retention. DISCUSSION: Results support the view that both patient and practice factors influence a patient's retention within the DAR programme. The PN to GP ratio may be an important factor in the retention of patients in a DAR programme and warrants further research and consideration when planning future primary care models. [ABSTRACT FROM AUTHOR]

INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice set- ting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 2006-2008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Effective workforce development is a key investment in producing quality health care. service delivery stakeholders often assume that workforce development is best achieved through short clinical topic training or extended postgraduate courses; however, the views and preferences of primary health care (PHC) nurses have not routinely been sought. This study explores the workforce development needs of experienced PHC nurses in a provincial area of New Zealand. METHODS: In addition to a literature scan, two focus group interviews were held with nurses representing a broad range of PHC subspecialities. Participants also completed a brief survey regarding their own and colleagues' education needs. Nurse leaders in three District Health Boards (DHBs) and one Primary Health Organisation (PHO) were asked for comments on workforce strategies. Datasets were analysed separately then triangulated for overall themes. FINDINGS: Thirty-one PHC nurses attended the two focus groups. Participants noted changes to their roles in the last three years, including new areas of clinical and workforce development. Participants in both focus groups largely focused on structural and organisational barriers to PHC workforce development. CONCLUSIONS: PHC nurses have priorities for workforce development that may differ from stakeholders, and offering clinical education opportunities alone may not be enough. Providing leadership education as well as career mentoring appears to be as important as clinical education and should happen in conjunction with other workforce development opportunities. This research demonstrates a need for a nationally agreed education strategy for the PHC nursing workforce. [ABSTRACT FROM AUTHOR]

The establishment in 1903 of a professional district nursing service in Wellington, New Zealand’s capital city, was a philanthropic response to the need for skilled care for the sick poor in their own homes, as hospital and charitable aid boards believed chronic patients drained their resources. This paper argues that it was the timely combination of the individual philanthropy of Sarah Ann Rhodes, the organisational philanthropy of the St John Ambulance Association and the new professional standing and availability of registered nurses such as Annie Holgate that ensured its successful foundation. It also argues that district nursing services blurred spatial, social, and public–private boundaries in new ways. Finally, it considers the district nurse’s role as the philanthropist’s proxy, the means for realising the philanthropist’s desire to help the sick poor [ABSTRACT FROM AUTHOR]

Objective: This paper surveys current literature related to medication administration errors, the role of nurses in such errors, and current initiatives that are underway within New Zealand to address this aspect of patient safety. Setting: The literature review focused on research that primarily addresses the issues related to medications that arise in tertiary care facilities. Primary argument: Medication administration errors are reported to occur in one in five medication dosages. Such events have long been scrutinised, with the primary focus being the practice of nurses and their role in medication error. Analysis of such events frequently identifies the nurse as the deliverer of unsafe practice. However, over the past few years a shift in how medication errors are understood has led to the identification of systems-related issues that contribute to medication errors. Conclusion: Initiatives such as the 'Quality and Safe Use of Medicines' raise the opportunity to address some of the safety related issues with a view to enhancing patient safety. A call for nurses to pre-emptively drive and contribute to these initiatives, along with the development of nursing led research, is offered. [ABSTRACT FROM AUTHOR]

Background: Urinary catheters are useful among hospital patients for allowing urinary flows and preparing patients for surgery. However, urinary infections associated with catheters cause significant patient discomfort and burden hospital resources. A nurse led intervention aiming to reduce inpatient catheterisation rates was recently trialled among adult overnight patients in four New South Wales hospitals. It included: 'train-the trainer' workshops, site champions, compliance audits and promotional materials. This study is the 'in-trial' cost-effectiveness analysis, conducted from the perspective of the New South Wales Ministry of Health.Methods: The primary outcome variable was catheterisation rates. Catheterisation and procedure/treatment data were collected in three point prevalence patient surveys: pre-intervention (n = 1630), 4-months (n = 1677), and 9-months post-intervention (n = 1551). Intervention costs were based on trial records while labour costs were gathered from wage awards. Incremental cost effectiveness ratios were calculated for 4- and 9-months post-intervention and tested with non-parametric bootstrapping. Sensitivity scenarios recalculated results after adjusting costs and parameters.Results: The trial found reductions in catheterisations across the four hospitals between preintervention (12.0 % (10.4 - 13.5 %), n = 195) and the 4- (9.9 % (8.5 - 11.3 %), n = 166 ) and 9- months (10.2 % (8.7 - 11.7 %) n = 158) post-intervention points. The trend was statistically non-significant (p = 0.1). Only one diagnosed CAUTI case was observed across the surveys. However, statistically and clinically significant decreases in catheterisation rates occurred for medical and critical care wards, and among female patients and short-term catheterisations. Incremental cost effectiveness ratios at 4-months and 9-months post-intervention were $188 and $264. Bootstrapping found reductions in catheterisations at positive costs over at least 72 % of iterations. Sensitivity scenarios showed that cost effectiveness was most responsive to changes in catheterisation rates.Conclusions: Analysis showed that the association between the intervention and changes in catheterisation rates was not statistically significant. However, the intervention resulted in statistically significant reductions for subgroups including among short-term catheterisations and female patients. Cost-effectiveness analysis showed that reductions in catheterisations were most likely achieved at positive cost.Trial Registration: Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000090314). First hospital enrolment, 15/11/2016; last hospital enrolment, 8/12/2016. [ABSTRACT FROM AUTHOR]

Background: A growing body of international literature concurs that comprehensive and complex Advance Care Planning (ACP) programs involving specially qualified or trained healthcare professionals are effective in increasing documentation of Advance Care Directives (ACDs), improving compliance with patients' wishes and satisfaction with care, and quality of care for patients and their families. Economic analyses of ACDs and ACP have been more sporadic and inconclusive. This study aimed to contribute to the evidence on resource use associated with implementation of ACP and to inform key decision-makers of the resource implications through the conduct of a cost-consequence analysis of the Normalised Advance Care Planning (NACP) trial.Methods: The outcomes for the economic evaluation included the number of completed "legally binding" ACDs and the number of completed Conversation Cards (CC). The cost analysis assessed the incremental difference in resource utilisation between Usual Practice and the Intervention. Costs have been categorised into: 1) Contract staff costs; 2) Costs associated with the development of the intervention; 3) Implementation costs; 4) Intervention (delivery) costs; and 5) Research costs.Results: The cost incurred for each completed ACD was A$13,980 in the hospital setting and A$1248 in the community setting. The cost incurred for each completed Conversation Card was A$7528 in the hospital setting and A$910 in the community setting.Conclusions: The cost-consequence analysis does not support generalisation of the specified intervention within the hospital setting. The trial realised an estimated incremental cost per completed ACD of $1248, within the community setting. This estimate provides an additional benchmark against which decision-makers can assess the value of either 1) this approach towards the realisation of additional completed ACDs; and/or 2) the value of ACP and ACDs more broadly, when this estimate is positioned within the potential health outcomes and downstream health service implications that may arise for people with or without a completed ACD.Trial Registration: The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246 ). The URL of the trial registry record. [ABSTRACT FROM AUTHOR]

Aim: To explore the health workforce responses to COVID‐19. Design: Analysis of job advertisements. Methods: We collected advertisements for healthcare jobs which were caused by and in response to COVID‐19 between 4 March–17 April 2020 for the United States, Canada, United Kingdom, Australia and New Zealand. We collected information on the date of the advertisement, position advertised and location. We categorized job positions into three categories: frontline, coordination and decision support. Results: We found 952 job advertisements, 72% of which were from the United States. There was a lag period between reported COVID‐19‐confirmed cases and job advertisements by several weeks. Nurses were the most advertised position in every country. Frontline workers were substantially more demanded than coordination or decision‐support roles. Job advertisements are a novel data source which leverages a readily available information about how workforces respond to a pandemic. The initial phases of the response emphasise the importance of frontline workers, especially nurses. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Childhood obesity is a major health concern in New Zealand. Primary care nurses have been charged with body mass index (BMI) screening and initiating education or referral of 4-year-old children during the Before School Check (B4SC). Asking nurses about their BMI screening experiences when reporting is mandated by the Ministry of Health reveals valuable knowledge to inform the work of health professionals in this area. AIM: To explore the experience of nurses performing the B4SC since the inclusion of the Raising Healthy Kids targets into the wellchild check. METHODS: Five focus group discussions across New Zealand were conducted using the Nominal Group Technique. Nurses individually recorded their answers to the research question, 'What is your perception of performing the B4SC since the inclusion of the Raising Healthy Kids target in July 2016?'. Group discussion and establishing priorities followed. Researchers collated and analysed data. Results were obtained by adding up scores across groups to provide the final overall themes of: (i) communication; (ii) BMI as a measurement; (iii) cultural norms and socioeconomic situations; (iv) parenting and family structure; and (v) education. RESULTS: Communication was the common theme across groups, but other priorities were more specific to the sociodemographic and cultural profile of the areas of practice. Mandatory reporting appears to have had the positive outcome of encouraging nurses to use positive and holistic discussion on health to families rather than concentrating on BMI. Nurses reported using tools to educate parents without implying judgement of their parenting and lifestyle. DISCUSSION: Nurses worked hard to maintain relationships with families as they recognised the long-term value of keeping families engaged with health professionals. Where tools were useful, such as the BMI calculator, nurses used these to assist with positive communication. The mandatory nature of the BMI referral had enhanced their skills with difficult conversations. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) is a common sexually transmitted infection that is implicated in 99.7% of cervical cancers and several other cancers that affect both men and women. Despite the role that HPV plays in an estimated 5% of all cancers and the evolving role of HPV vaccination and testing in protecting the public against these cancers, preliminary research in New Zealand health professionals suggest knowledge about HPV may not be sufficient. Methods: A total of 230 practice nurses, smear takers and other clinical and laboratory staff who attended a range of training events completed a cross-sectional survey between April 2016 and July 2017. The survey explored four broad areas: demographics and level of experience, HPV knowledge (general HPV knowledge, HPV triage and test of cure (TOC) knowledge and HPV vaccine knowledge), attitudes towards the HPV vaccine and self-perceived adequacy of HPV knowledge. Results: The mean score on the general HPV knowledge questions was 13.2 out of 15, with only 25.2% of respondents scoring 100%. In response to an additional question, 12.7% thought (or were unsure) that HPV causes HIV/AIDS. The mean score on the HPV Triage and TOC knowledge questions was 7.4 out of 10, with only 9.1% scoring 100%. The mean score on the HPV vaccine knowledge questions was 6.0 out of 7 and 44.3% scored 100%. Only 63.7% of respondents agreed or strongly agreed that they were adequately informed about HPV, although 73.3% agreed or strongly agreed that they could confidently answer HPV-related questions asked by patients. Multivariate analyses revealed that knowledge in each domain predicted confidence in responding to patient questions. Furthermore, the number of years since training predicted both HPV knowledge and Triage and TOC knowledge. Discussion: Although overall level of knowledge was adequate, there were significant gaps in knowledge, particularly about the role of HPV testing in the New Zealand National Cervical Screening Programme. More education is required to ensure that misinformation and stigma do not inadvertently result from interactions between health professionals and the public. [ABSTRACT FROM AUTHOR]

Background: Nurse-led models of comprehensive geriatric assessment and care coordination can improve health management as well as reduce hospitalisations for high risk community dwelling older people. This study investigated the effect on healthcare utilisation of systematic case finding to identify high risk older people in the community with a subsequent comprehensive assessment and care coordination intervention by a Gerontology Nurse Specialist based in primary care.Methods: This was a controlled before-after study design located within primary healthcare practices in Auckland, New Zealand. An intervention model was initiated within two primary healthcare practices and involved a screening tool to identify high risk older people with succeeding gerontology nurse specialist assessment and care coordination. The comparison group included older people who received usual care at three comparable primary healthcare practices. The primary outcome measure was acute hospital admissions. Secondary outcomes included hospital re-admissions, length of stay, emergency department presentations, residential care admissions, and community contacts.Results: A total of 579 older people were posted the screening tool in the intervention group, with 517 completed screens (89% response rate) formulating the intervention group. A total of 101 older people were identified as high risk from these screens (20%). The comparison group comprised 883 older people. Comparing the intervention and comparison group, no statistical differences were found for hospital admissions, emergency department presentations, hospital re-admissions, length of stay, or residential care admission. Community physiotherapy showed a statistically significant increase for the intervention compared to the comparison group (p = 0.03). Non-significant findings revealed decreased risk of entering residential care and fewer frequent hospital re-admissions for the intervention group when compared with the comparison group.Conclusions: This specialist nurse-led intervention involving comprehensive assessment and care coordination care did not appear superior to usual care, however, there is benefit to exploring a more robust randomised controlled trial design.Trial Registration: Retrospectively registered on 18/09/2017 with the Australian New Zealand Clinical Trials Registry (ANZCTR). Registration number ACTRN12617001332314. [ABSTRACT FROM AUTHOR]

Background: Primary care nurse-led prediabetes interventions are seldom reported. We examined the implementation and feasibility of a 6-month multilevel primary care nurse-led prediabetes lifestyle intervention compared with current practice in patients with prediabetes, with weight and glycated haemoglobin (HbA1c) as outcomes. Methods: This study used a convergent mixed methods design involving a 6-month pragmatic non-randomised pilot study with a qualitative process evaluation, and was conducted in two neighbouring provincial cities in New Zealand, with indigenous Maori populations comprising 18.2% and 23.0%, respectively. Participants were non-pregnant adults aged ≤ 70 years with newly diagnosed prediabetes (HbA1c 41-49 mmol/mol), body mass index (BMI) ≥ 25 kg/m² and not prescribed Metformin. A structured dietary intervention tool delivered by primary care nurses with visits at baseline, 2-3 weeks, 3 months and 6 months was implemented in four intervention practices. Four control practices continued to provide usual care. Primary quantitative outcome measures were weight and HbA1c. Linear and quantile regression models were used to compare each outcome between the two groups at follow-up. Qualitative data included: observations of nurse training sessions and steering group meetings; document review; semi-structured interviews with a purposive sample of key informants (n = 17) and intervention patients (n = 20). Thematic analysis was used. Results: One hundred fifty-seven patients with prediabetes enrolled (85 intervention, 72 control), 47.8% female and 31.2% Maori. Co-morbidities were common, particularly hypertension (49.7%), dyslipidaemia (40.1%) and gout (15.9%). Baseline and 6 month measures were available for 91% control and 79% intervention participants. After adjustment, the intervention group lost a mean 1.3 kg more than the control group (p < 0.001). Mean HbA1c, BMI and waist circumference decreased in the intervention group and increased in the control group, but differences were not statistically significant. Implementation fidelity was high, and it was feasible to implement the intervention in busy general practice settings. The intervention was highly acceptable to both patients and key stakeholders, especially primary care nurses. Conclusions: Study findings confirm the feasibility and acceptability of primary care nurses providing structured dietary advice to patients with prediabetes in busy general practice settings. The small but potentially beneficial mean weight loss among the intervention group supports further investigation. Trial Registration: ANZCTR ACTRN12615000806561. Registered 3 August 2015 (Retrospectively registered). [ABSTRACT FROM AUTHOR]

INTRODUCTION: Domestic violence in its myriad shapes and forms is a crime affecting every level of society. Gaining a true understanding of intimate partner violence (IPV) victimology allows for the meaningful provision of intervention services. AIM: To explore the prevalence of IPV disclosure during routine screening in a large general practice in provincial New Zealand. METHODS: Data were collected from 13 October 2008 to 30 June 2014 from 6827 individuals screened for IPV on 10 062 occasions and were analysed relative to age, ethnicity, gender, screening outcome, screener and health centre enrolled status. RESULTS: Analysis indicated an overall ever-positive disclosure rate of IPV of 11.1%, lower than New Zealand studies that place ever-positive prevalence as high as 78%. Maori women disclosed an ever-positive rate of 21.6%, Pacific women 13.2%, compared to 8.9% for NZ European/Other women. Casual patients positively disclosed in 13.7% of instances as opposed to enrolled patients in 10.5%. Disclosure of past abuse was made 1.3 times more often than that of a current abusive situation. Those aged between 16 and 65 years disclosed an ever-positive rate >10%. While nurses screened 5.5 times more patients than doctors, the doctors facilitated a higher percentage of positive disclosures than the nurses. DISCUSSION: Disclosure rates from a general practice setting do not mirror those of population studies or administrative datasets due to differences in samples and data collection methods. Routine annual screening is effective, with both doctors and nurses providing support for approximately equal numbers of patients in immediate danger. [ABSTRACT FROM AUTHOR]

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INTRODUCTION: The increasing prevalence of diabetes has led to expanded roles for primary health care nurses in diabetes management. AIM: To describe and compare anthropometric and glycaemic characteristics of patients with diabetes and their management by practice nurses, district nurses and specialist nurses. METHODS: Primary health care nurses in Auckland randomly sampled in a cross-sectional survey, completed a postal self-administered questionnaire (n=284) and telephone interview (n=287) between 2006 and 2008. Biographical and diabetes management details were collected for 265 (86%) of the total 308 patients with diabetes seen by participants on a randomly selected day. RESULTS: Nurses were able to access key clinical information for only a proportion of their patients: weight for 68%; BMI for 16%; HbA1c for 76% and serum glucose levels for 34% (for either measure 82%); although most (96%) records were available about whether patients self-monitored blood glucose levels. Most nursing management activities focused on giving advice on dietary intake (70%) and physical activity (66%), weighing patients (58%), and testing or discussing blood glucose levels (42% and 43%, respectively). These proportions varied by nurse group (p<0.05), generally being highest for specialist nurses and lowest for district nurses. DISCUSSION: Most practice and specialist nurses could access patients' weight and HbA1c levels and focused their clinical management on health education to decrease these if indicated. Communication and organisational systems and contracts that allow district nurses to work across both primary and secondary health services are necessary to improve community-based nursing services for patients with diabetes. [ABSTRACT FROM AUTHOR]

Background: Sick leave due to neck pain (NP-SL) is costly and negatively impacts the productivity of the nursing and midwifery workforce. Identification of modifiable risk indicators is necessary to inform preventive efforts. This study aimed to investigate the role of pain-related psychological features (pain catastrophizing, fear of movement, and pain coping) in NP-SL alongside other potential risk indicators. Methods: A cross-sectional analysis of a large cohort study of Australian and New Zealand nurses and midwives, established between 1st April 2006 to 30th March 2008, was undertaken. Recruitment procedures adopted within each Nursing Council jurisdiction were governed by the individual regulatory authorities and their willingness to engage with the study. Invitations directed potential participants to a purpose-built internet-based survey, where study information was provided and consent requested. Once consent was obtained, a range of standardized tools combined into one comprehensive electronic questionnaire was elicited. Exposure variables assessed included pain characteristics and a broad range of psychological, psychosocial, occupational, general health and demographic factors. Two-way interactions between age and gender and candidate exposures were also assessed. Binary logistic regression was performed using manual backward stepwise elimination of non-significant terms. Results: The cohort included 4,903 currently working nurses or midwives aged 18-65 years. Of these, 2,481 (50.6%) reported neck pain in the preceding 12 months. Our sample comprised of 1,854 working nurses and midwives with neck pain in the preceding year who supplied sick leave data. Of these, 343 (18.5%) reported taking sick leave in the preceding year due to their neck pain. The final most parsimonious multivariable model demonstrated neck pain severity (adjusted odds ratio, [aOR] = 1.59), passive pain coping (aOR = 1.08) and fear of movement (aOR = 1.06) increased the likelihood of NP-SL in the previous year. Interactions between demographic and general health factors exhibited both protective and risk relationships with NP-SL, and there was no association between pain catastrophizing and NP-SL. Conclusions: Findings demonstrate that sick leave due to neck pain was associated with pain severity, fear of movement and passive pain coping. In addition, there were complex interactions found between demographic and general health factors. These features represent potentially modifiable targets for preventive programs. [ABSTRACT FROM AUTHOR]

Background: An important consideration in health service delivery is ensuring that services meet consumer needs and that consumers are satisfied with service delivery. Patient satisfaction can impact on compliance with suggested treatments and therefore impact on health outcomes. Comparatively few studies have explored consumer satisfaction with nurses in general practice. Methods: A sub-group of 18 consumers from a larger quantitative evaluation of consumer satisfaction with New Zealand general practice nurses participated in semi-structured telephone interviews. Interview data was analysed using thematic analysis. Results: Four major themes emerged from the data. These themes highlighted that, despite confusion experienced by some consumers regarding the practice nurse role, consumers were happy with the level of care provided by them. Consumers felt valued by Practice Nurses and considered them competent and highly knowledgeable. Findings also convey that consumers appreciate the accessibility and financial benefits of utilising the services of practice nurses. Conclusions: Consumers are highly satisfied with practice nurse service delivery and value their relationships with these health professionals. Consumers revealed that greater clarity around the practice nurse role and their scope of practice may enhance their utilisation. Spreading the message of practice nurses being the right person to deliver care, within their scope of practice, at the right time may have the potential to provide more timely care within the primary care setting. [ABSTRACT FROM AUTHOR]

Background: Although primary health care, and in particular, general practice will be at the frontline in the response to pandemic influenza, there are no frameworks to guide systematic planning for this task or to appraise available plans for their relevance to general practice. We aimed to develop a framework that will facilitate planning for general practice, and used it to appraise pandemic plans from Australia, England, USA, New Zealand and Canada. Methodology/Principal Findings: We adapted the Haddon matrix to develop the framework, populating its cells through a multi-method study that incorporated the peer-reviewed and grey literature, interviews with general practitioners, practice nurses and senior decision-makers, and desktop simulation exercises. We used the framework to analyse 89 publiclyavailable jurisdictional plans at similar managerial levels in the five countries. The framework identifies four functional domains: clinical care for influenza and other needs, public health responsibilities, the internal environment and the macroenvironment of general practice. No plan addressed all four domains. Most plans either ignored or were sketchy about noninfluenza clinical needs, and about the contribution of general practice to public health beyond surveillance. Collaborations between general practices were addressed in few plans, and inter-relationships with the broader health system, even less frequently. Conclusions: This is the first study to provide a framework to guide general practice planning for pandemic influenza. The framework helped identify critical shortcomings in available plans. Engaging general practice effectively in planning is challenging, particularly where governance structures for primary health care are weak. We identify implications for practice and for research. [ABSTRACT FROM AUTHOR]

Background: ACP involving a facilitated conversation with a health or care professional is more effective than document completion alone. In policy, there is an expectation that health and care professionals will provide ACP support, commonly within their existing roles. However, the potential contributions of different professionals are outlined only broadly in policy and guidance. Research on opportunities and barriers for involving different professionals in providing ACP support, and feasible models for doing so, is currently lacking. Methods: We identified twelve healthcare organizations aiming to offer system-wide ACP support in the United States, Canada, Australia and New Zealand. In each, we conducted an average 13 in-depth interviews with senior managers, ACP leads, dedicated ACP facilitators, physicians, nurses, social workers and other clinical and non-clinical staff. Interviews were analyzed thematically using NVivo software. Results: Organizations emphasized leadership for ACP support, including strategic support from senior managers and intensive day-to-day support from ACP leads, to support staff to deliver ACP support within their existing roles. Over-reliance on dedicated facilitators was not considered sustainable or scalable. We found many professionals, from all backgrounds, providing ACP support. However, there remained barriers, particularly for facilitating ACP conversations. A significant barrier for all professionals was lack of time. Physicians sometimes had poor communication skills, misunderstood medico-legal aspects and tended to have conversations of limited scope late in the disease trajectory. However, they could also have concerns about the appropriateness of ACP conversations conducted by others. Social workers had good facilitation skills and understood legal aspects but needed more clinical support than nurses. While ACP support provided alongside and as part of other care was common, ACP conversations in this context could easily get squeezed out or become fragmented. Referrals to other professionals could be insecure. Team-based models involving a physician and a nurse or social worker were considered cost-effective and supportive of good quality care but could require some additional resource. Conclusions: Effective staffing of ACP support is likely to require intensive local leadership, attention to physician concerns while avoiding an entirely physician-led approach, some additional resource and team-based frameworks, including in evolving models of care for chronic illness and end of life. [ABSTRACT FROM AUTHOR]