The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease

Background. Nutrition is important for the management of chronic diseases. While practice nurses have numerous roles in primary care, the expectations on practice nurses to provide nutrition care for chronic disease management are increasing. The self-perceived knowledge, skills and attitudes of practice nurses in providing nutrition care has not been widely investigated

The breadth of primary care: a systematic literature review of its core dimensions

Background: Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods: A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results: Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions: A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health

The Australian nursing and midwifery academic workforce: A cross-sectional study.

AIM: To explore the demographics, employment characteristics, job satisfaction and career intentions of the Australian nursing and midwifery academic workforce. BACKGROUND: The academic workforce is crucial in preparing the next generation of nurses and midwives. Thus, understanding current satisfaction, challenges, opportunities and intentions is important for recruitment and succession planning. DESIGN: Cross-sectional online Australian academic nursing and midwifery survey. METHOD: Respondents were invited to complete an online survey via social media platforms, advertisements on professional websites and circulation via professional associations. Descriptive and inferential statistics were used to analyse the data. RESULTS: Of the 250 respondents, most were Registered Nurses (n=212), female (n=222), held tenured teaching and research positions (n=126) and were over the age of 50 (n=130). Almost half of respondents held a PhD (n=98), with 55 (43.7 %) of those without a Doctoral qualification indicating no intention in undertaking doctoral studies. Over 85 % (n=213) of respondents indicated working regular unpaid hours. Female respondents had a significantly higher mean annual teaching allocation compared with males who had higher research workload allocations (p=0.033). Job satisfaction and intention to leave academia were linked with workload and perceived value. Job satisfaction was significantly higher among teaching-only and research-only academics (p=0.005). CONCLUSION: The sustainability of the Australian nursing and midwifery workforce is at risk due to an ageing workforce and some academics' lack of intention in pursuing doctoral studies. Gender inequities emerged as a finding in this study. Workforce strategies are required to address gender disparities and workload imbalances that have an impact on job satisfaction

Sustained Leadership Practices and Behaviours Following Postgraduate Leadership Education: A Qualitative Study.

AIM: To explore how postgraduate leadership education is translated into practice and how leadership practices and behaviours are sustained following completion of a leadership program. DESIGN: A qualitative exploratory study using an appreciative inquiry approach. METHODS: A single Health District, partnered with a regional university, offering a 12-month leadership program, the Effective Leadership in Health Program. Four semi-structured group interviews were undertaken with 11 registered nurses (RNs) and allied health professionals. Data were audio-recorded and transcribed before being analysed using thematic analysis. RESULTS: Four themes were revealed relating to how the learning was translated and sustained in clinical practice, namely, within (1) self, (2) others, (3) relationships and (4) sustained leadership. All participants agreed that their participation in the leadership program impacted on their subsequent approach to leadership in multiple contexts, relationships and interactions

Living on: an exploration of healthful cancer survivorship among grey nomads

Aim: To explore the experiences of grey nomads living with a diagnosis of cancer. Background: Cancer is primarily both a life-limiting and a chronic condition of ageing and older people. Older people, however, are not a homogeneous group; there are several generations and many different groups to be considered. Grey nomads are one such group and are characterised as being retired and travelling domestically for extended periods of time, usually in a caravan or motorhome. Design: Prospective qualitative phase of a larger, sequential, explanatory, mixed-methods project. Methods: A series of 14 semi-structured, in-depth interviews were conducted over six months in 2016 with 14 self-identified grey nomads living with a diagnosis of cancer. Interviews were analysed using thematic analysis. Results/Findings: Participants travelled despite of, and because of, their cancer diagnosis. These two key themes, with their associated sub-themes, explain how older people incorporated their cancer-related work, that is to say, managing their cancer-related follow-up and treatment health needs into their travelling life; how they normalised it; and how they developed strategies for healthful survivorship. Conclusion: Participants were living healthfully in that they were living a lifestyle that promoted their well-being. Participants developed strategies in response to their changed environment and thus created new capacity to support what they wanted to do. Despite being cancer survivors — some of whom were undergoing active treatment — participants gained ‘healthfulness’ through their chosen nomadic lifestyle.This study was funded by the University of Wollongong, School of Nursing Research Fund.http://www.cambridgepublishing.com.au/19

Aberrations of anterior insular cortex functional connectivity in nontreatment-seeking alcoholics

An emergent literature suggests that resting state functional magnetic resonance imaging (rsfMRI) functional connectivity (FC) patterns are aberrant in alcohol use disorder (AUD) populations. The salience network (SAL) is an established set of brain regions prominent in salience attribution and valuation, and includes the anterior insular cortex (AIC). The SAL is thought to play a role in AUD through directing increased attention to interoceptive cues of intoxication. There is very little information on the salience network (SAL) in AUD, and, in particular, there are no data on SAL FC in currently drinking, nontreatment seeking individuals with AUD (NTS). rsfMRI data from 16 NTS and 21 social drinkers (SD) were compared using FC correlation maps from ten seed regions of interest in the bilateral AIC. As anticipated, SD subjects demonstrated greater insular FC with frontal and parietal regions. We also found that, compared to SD, NTS had higher insular FC with hippocampal and medial orbitofrontal regions. The apparent overactivity in brain networks involved in salience, learning, and behavioral control in NTS suggests possible mechanisms in the development and maintenance of AUD

Insights on leadership from early career nurse academics: Findings from a mixed methods study

© 2016 John Wiley & Sons Ltd. Aim: To explore the perceptions of early career nursing academics on leadership in academia. Background: There is growing emphasis on leadership capacity building across all domains of nursing. However, there is limited evidence on leadership capacity in early career academics. This study tested an intervention to develop leadership capacity amongst early career nursing academics in two Australian universities. Methods: A sequential mixed methods design, using online surveys and semi-structured interviews, was used to collect data. Results: Twenty-three early career nursing academics participated. Most had experience of formal leadership roles and were aware of its importance to them as they developed their academic careers. Participants were able to discuss their own views of themselves as leaders; their perceptions of their own needs for leadership development, and ways in which they could seek to develop further as leaders. Conclusion: There is a need to provide initial and ongoing opportunities for leadership development amongst nurse academics. These opportunities should be contextualised and recognise factors such as gender, and the effects of structural oppression. Implications for nursing management: Nurse academics are involved in the preparation of the next generation of clinical leaders and it is imperative that they are able to articulate a clear view of leadership

Rational use of antibiotics by community health workers and caregivers for children with suspected pneumonia in Zambia: A cross-sectional mixed methods study

Background: Antibiotic resistance is an issue of growing global concern. One key strategy to minimise further development of resistance is the rational use of antibiotics, by providers and patients alike. Through integrated community case management (iCCM), children diagnosed with suspected pneumonia are treated with antibiotics; one component of an essential package to reduce child mortality and increase access to health care for remote populations. Through the use of clinical algorithms, supportive supervision and training, iCCM also offers the opportunity to improve the rational use of antibiotics and limit the spread of resistance in resource-poor contexts. This study provides evidence on antibiotic use by community health workers (CHWs) and caregivers to inform iCCM programmes, safeguarding current treatments whilst maximising access to care. Methods: 1497 CHW consultations were directly observed by non-clinical researchers, with measurement of respiratory rate by CHWs recorded by video. Videos were used to conduct a retrospective reference standard assessment of respiratory rate by experts. Fifty-five caregivers whose children were prescribed a 5-day course of antibiotics for suspected pneumonia were followed up on day six to assess adherence through structured interviews and pill counts. Six focus group discussions and nine in depth interviews were conducted with CHWs and caregivers to supplement quantitative findings. Results: The findings indicate that CHWs adhered to treatment guidelines for 92 % of children seen, prescribing treatment corresponding to their assessment. However, only 65 % of antibiotics prescribed were given for children with experts' confirmed fast breathing pneumonia. Qualitative data indicates that CHWs have a good understanding of pneumonia diagnosis, and although caregivers sometimes applied pressure to receive drugs, CHWs stated that treatment decisions were not influenced. 46 % of caregivers were fully adherent and gave their child the full 5-day course of dispersible amoxicillin. If caregivers who gave treatment for 3 to 5 days were considered, adherence increased to 76 %. Conclusions: CHWs are capable of prescribing treatment corresponding to their assessment of respiratory rate. However, rational use of antibiotics could be strengthened through improved respiratory rate assessment, and better diagnostic tools. Furthermore, a shorter course of dispersible amoxicillin could potentially improve caregiver adherence, reducing risk of resistance and cost

Differences in White Matter Microstructure and Connectivity in Nontreatment‐Seeking Individuals with Alcohol Use Disorder

Background Diffusion‐weighted imaging (DWI) has been widely used to investigate the integrity of white matter (WM; indexed by fractional anisotropy [FA]) in alcohol dependence and cigarette smoking. These disorders are highly comorbid, yet cigarette use has often not been adequately controlled in neuroimaging studies of alcohol‐dependent populations. In addition, information on WM deficits in currently drinking, nontreatment‐seeking (NTS) individuals with alcohol dependence is limited. Therefore, the aim of this work was to investigate WM microstructural integrity in alcohol use disorder by comparing matched samples of cigarette smoking NTS and social drinkers (SD). Methods Thirty‐eight smoking NTS and 19 smoking SD subjects underwent DWI as well as structural magnetic resonance imaging. After an in‐house preprocessing of the DWI data, FA images were analyzed with tract‐based spatial statistics (TBSS). FA obtained from the TBSS skeleton was tested for correlation with recent alcohol consumption. Results Smoking NTS had lower FA relative to smoking SD, predominantly in the left hemisphere (p < 0.05, family‐wise error rate corrected across FA skeleton). Across the full sample, FA and number of drinks per week were negatively related (ρ = −0.348, p = 0.008). Qualitative analyses of the structural connections through compromised WM as identified by TBSS showed differential connectivity of gray matter in NTS compared to SD subjects of left frontal, temporal, and parietal regions. Conclusions NTS subjects had lower WM FA than SD, indicating compromised WM integrity in the NTS population. The inverse relationship of entire WM skeleton FA with self‐reported alcohol consumption supports previous evidence of a continuum of detrimental effects of alcohol consumption on WM. These results provide additional evidence that alcohol dependence is associated with reduced WM integrity in currently drinking NTS alcohol‐dependent individuals, after controlling for the key variable of cigarette smoking