Bringing trauma home : reflections on interviewing survivors of trauma while working from home

In response to the COVID-19 pandemic, working from home became the new normal for many professionals. While this was beneficial in managing the rapidly spreading virus, it had varying impacts on the mental health of those previously not accustomed to remote work. This paper provides a critical reflection of the researcher’s experience of conducting interviews with survivors of trauma while working from home. The research aimed to understand the experiences of significant others supporting patients with severe burn injury in the Intensive Care Unit (ICU). As an experienced ICU nurse, the researcher has well developed personal coping strategies for dealing with complex trauma and in working with significant others of patients with severe burn injury in hospital settings. Due to the pandemic, data collection moved from face-to-face in the hospital, as originally intended, to phone or videoconference interviews. 17 participants were recruited, with all participants given the option of videoconference (n = 3) or telephone interviews (n = 14). Interviews had an average length of 55 minutes. This paper discusses the strategies adopted to cope with the sharing of significant others’ experiences of trauma while in the home environment. Careful consideration was needed for the researcher, the participants and those within the homes of both researcher and participant, in terms of psychological safety, ethical considerations and rapport building

Giornale italiano di chirurgia vascolare : rivista di chirurgia vascolare ; with English translation

This paper reports a pilot study examining the feasibility, acceptability and sustainability of a multidisciplinary case conferencing model in residential aged care. The model was developed through a consultation process and then implemented in 31 case conferences over a 6-month period between May and October 2008. This paper explores the feasibility and acceptability of model implementation, the experience of the facility staff, general practitioners and residents/family carers and the perceived sustainability of the model in clinical practice. It shows that although there was a degree of confusion around the concept of multidisciplinary case conferencing, implementation of this partnership model significantly improved communication between health workers, facilitated interaction between staff and family carers, and provided a focus for reflecting on individual residents' health needs

Australian primary health care nurses most and least satisfying aspects of work

Aims and objectives: To identify the aspects of working in Australian primary health care that nurses rate as the most and least satisfying. Background: The nursing workforce in Australian primary health care has grown exponentially to meet the growing demand for health care. To maintain and further growth requires the recruitment and retention of nurses to this setting. Understanding the factors that nurses' rate as the most and least satisfying about their job will inform strategies to enhance nurse retention. Design: A cross-sectional online survey. Method: Nurses employed in primary health care settings across Australia were recruited (n = 1166) to participate in a survey which combined items related to the respondent, their job, type of work, clinical activities, job satisfaction and future intention, with two open-ended items about the most and least satisfying aspects of their work. Results: Patient interactions, respect, teamwork, collegiality and autonomy were identified as the most satisfying professional aspects of their role. Personal considerations such as family friendly work arrangements and a satisfactory work–life balance were also important, overriding negative components of the role. The least satisfying aspects were poor financial support and remuneration, lack of a career path, physical work environment and time constraints. National restructuring of the primary health care environment was seen as a barrier to role stability and ability to work to a full scope of practice. Conclusions: This study has identified a range of positive and negative professional and personal aspects of the primary health care nursing role, which may impact on staff recruitment and retention. Findings from the study should be considered by employers seeking to retain and maximise the skills of their primary health care workforce. Relevance to clinical practice: Understanding the factors that nurses perceive as being the most and least satisfying aspects of the work is can open up dialogue about how to improve the working experience of nurses in primary health care

Job satisfaction and career intention of Australian general practice nurses : a cross-sectional survey

Purpose: The nursing workforce in Australian general practice has increased exponentially in size over recent years to meet the growing demand for health care. Nurses are more likely to remain working if they are satisfied with their jobs. Satisfaction is impacted by a complex range of factors, including the environment, workplace relationships, and the nurses’ role. Therefore, satisfaction data cannot be generalized across disparate clinical settings. This study sought to investigate the job satisfaction and turnover intentions of nurses working in Australian general practice. Design and Methods: A cross-sectional online survey of nurses employed in general practices across Australia was conducted using convenience and snowball sampling techniques. The survey tool contained a 29-item job satisfaction scale and 8 items around turnover intention. Findings: 786 responses were included in the analysis. Respondents were most satisfied with the work nature aspects of their job and least satisfied with the pay items. While most participants intended to stay in nursing (86%) and general practice (77%) employment, a substantial group were undecided about their future (16%). Those who were dissatisfied with their job or neutral in their satisfaction were more likely to be intending to leave than those who were satisfied with their job. Conclusions: This is the first study of job satisfaction and turnover intention reported about nurses working in Australian general practice. It has highlighted that a substantial proportion of the workforce is undecided about their future. Therefore, strategies need to be developed to address the issues raised around job satisfaction to reduce the potential loss of these skilled nurses. Clinical Relevance: Those intending to leave general practice nursing are more likely to be dissatisfied in their jobs. Understanding the factors that impact job satisfaction is important to inform strategies that will facilitate retention of nurses in general practice employment

The feasibility and acceptability of nurse-led chronic disease management interventions in primary care : an integrative review

Aims: To explore the feasibility and acceptability of nurse-led chronic disease management and lifestyle risk factor reduction interventions in primary care (general practice/family practice). Background: Growing international evidence suggests that interventions delivered by primary care nurses can assist in modifying lifestyle risk factors and managing chronic disease. To date, there has been limited exploration of the feasibility and acceptability of such interventions. Design: Integrative review guided by the work of Whittemore and Knafl (). Data Sources: Database search of CINAHL, Medline and Web of Science was conducted to identify relevant literature published between 2000–2015. Review Methods: Papers were assessed for methodological quality and data abstracted before thematic analysis was undertaken. Results: Eleven papers met the inclusion criteria. Analysis uncovered four themes: (1) facilitators of interventions; (2) barriers to interventions; (3) consumer satisfaction; and (4) primary care nurse role. Conclusion: Literature supports the feasibility and acceptability of nurse-led interventions in primary care for lifestyle risk factor modification. The ongoing sustainability of these interventions rests largely on organizational factors such as funding, educational pathways and professional support of the primary care nursing role. Further robust research around primary care nurse interventions is required to strengthen the evidence base

Local trends in older people presenting at an emergency department

Background Emergency Departments are increasingly reporting difficulties in managing their patient load within the available resources. Older people contribute significantly to the number of presentations seen in Emergency Departments. Understanding the nature of presentations can help to appreciate how they might be best managed to assist in effective resource utilisation and patient care. Aim This study aimed to explore presentations to an outer metropolitan Emergency Department by older people. Design Retrospective review of all Emergency Department presentations of individuals aged over 65 years. Participants 8469 older individuals who presented to an outer metropolitan Emergency Department between July 2013 and September 2014. Methods Medical record data items included demographics, triage category, presenting problem(s), disposition and length of stay. Findings 14,976 Emergency Department presentations were made by 8469 older people. High attenders (n = 405 older individuals) accounted for 18.7% (n = 2798) of the total presentations. Almost half of the presentations (48.9%) were triaged as Category 3 presentations, with a further 29% triaged as Category 4. Whilst overall the most frequent discharge diagnoses were chest pain (3.8%), fall (3.0%) or COPD (2.9%), for the high attenders the most frequent discharge diagnoses were COPD (6.4%), chest pain (4.0%) and fall (3.1%). Only 54.2% (n = 8124) of all presentations led to a hospital admission. Conclusion Our data demonstrated that a proportion of presentations to the Emergency Department by older people could be reduced as many individuals did not require hospital admission. This would alleviate burden on the Emergency Department and potentially improve continuity of care and outcomes. Further research needs to explore the reasons that older people present to Emergency Departments rather than using other services and explore how primary care services can better meet these health needs. Additionally, educational strategies need to be implemented to improve consumer decision making about which health services they access and empower consumers to better manage their health

Professional development needs of general practice nurses

The Australian general practice nurse workforce has grown exponentially in recent years as a consequence of supportive government policy and the increasing burden of chronic and complex disease in the community. This descriptive survey sought to identify the educational and professional development needs of NSW practice nurses. A total of 231 nurses employed within 12 NSW Divisions of General Practice completed the survey. The highest priority education sessions identifi ed by participants were updates in wound care, diabetes, immunisation, as well as legal and professional issues, cardiopulmonary resuscitation, triaging and fi rst aid. Most participants preferred education sessions to be delivered mid-week in the evening. Over half of participants indicated a desire to be involved in professional networking, many of whom would like this to be multidisciplinary and intersectorial. Implications arising from this study encourage revisiting the current models of providing education and exploring fl exible modes of course delivery, as well as opportunities for interprofessional education and taking time to regularly assess the perceived learning needs of clinical nurses

Connecting care in the community : what works and what doesn't

As the burden of chronic and complex disease grows, there is an emphasis on programs that enhance the quality of care within primary care. The Connecting Care in the Community (CCC) program is an example of the implementation of care integration. This qualitative study sought to explore the experiences general practice staff face in managing clients with chronic and complex care issues, and their perceptions of the contribution of the CCC program to this care. Seventeen general practice staff from 11 practices throughout the Illawarra/Shoalhaven region participated in semistructured interviews. Five main themes emerged: (1) awareness of the CCC program; (2) varying program exposure and value placed on the program; (3) practice 'busyness' and role confusion; (4) communication and information sharing; and (5) the need for staff education and knowledge of local resources. If policymakers and healthcare organisations can gain a better understanding of the experiences of general practice staff, they will be able to design and implement programs that best meet the needs of the providers that they are attempting to integrate

Nurses' knowledge, attitudes and practices regarding influenza vaccination : an integrative review

Aims and objectives. To critically analyse the literature describing nurses’ knowledge, attitudes and practices regarding influenza vaccination. Background. Influenza is a serious illness that has significant impacts on productivity, health outcomes and healthcare costs. Despite the recommendations for nurses to be vaccinated annually against influenza, the vaccination rates remain suboptimal. Design. Integrative literature review. Methods. An integrative review was conducted as described by Whittemore and Knafl (2005). A search of CINAHL, Cochrane Library, ProQuest Central, ClinicalKey, ScienceDirect, Wiley Online Library, and Informit was undertaken to identify relevant papers. Given the heterogeneity of included studies, a narrative approach was used to analyse the data. Results. There was limited research available on this topic area, with only 10 papers identified as meeting the inclusion criteria. Five themes were identified: the relationship between knowledge and influenza vaccination, perception of risk, motivators for influenza vaccination, barriers to influenza vaccination and impact of demographics on vaccination. Conclusions. Despite the evidence for the protective effects of influenza vaccination, rates of vaccination among nurses remain sub-optimal. Nurses’ influenza vaccination practices likely relate to their level of knowledge and perception of risk; the greater nurses’ knowledge regarding influenza and influenza vaccination the higher their perception of risk and the more likely they are to be vaccinated. This also translates to the advice that they give patients with vaccinated nurses more inclined to recommend vaccination than those unvaccinated. Relevance to clinical practice. The practices of nurses related to influenza vaccination may translate to the advice that they give their patients. Understanding the knowledge levels, practices and attitudes of nurses can assist in developing strategies to enhance education of nurses

Health screening for women with physical disability in Australian general practice : a survey

Background: Early detection of gynaecological issues improves health outcomes and reduces mortality. Such early detection is best achieved via regular, proactive health screening. Like other disadvantaged groups, women with physical disability have much lower gynaecological screening rates than the general population. Aim: The aim of this paper is to explore the current role of general practice nurses in women's health screening for individuals with physical disability. Methods: A national online survey of Australian general practice nurses was conducted. Findings: One hundred and seventy-eight general practice nurses completed the survey. Sixty-one percent reported having experience in working with people with a physical disability. Around one third of participants reported having completed specific education about physical disability. Most general practices implemented strategies to facilitate physical access for those with disability. However, few general practices had a medical records system that enabled identification of physical disability. Thirty-seven participants reported providing women's health screening for 89 women with a physical disability in the 4 weeks prior to the survey. A range of strategies were used to support women during these screening procedures. These could be broadly classified into; a) providing practical assistance to facilitate screening, and b) modifying technique and positioning for comfort. Conclusions: The limited experience with disability amongst an experienced nursing cohort, and the difficulty inherent in identifying those with a disability within recall and reminder systems, adds complexity to the provision of screening for women with a disability. Whilst participants articulated some innovative and creative strategies to assist women with a disability during health screening, enhanced awareness amongst nurses and proactive strategies would likely enhance service accessibility in this vulnerable group