Culturally and linguistically diverse general practitioners\u27 utilisation of practice nurses

Background Practice nurses are primarily employed by general practitioners, however little is known about the barriers to practice nurse employment from the perspective of general practitioners (GPs). Aim This paper seeks to explore solo, culturally and linguistically diverse (CALD) general practitioners\u27 perceptions of the practice nurse role, and to identify the barriers and facilitators of these doctors employing nurses within their practice. Methods A descriptive study, using semi-structured interviews, was conducted from July to August 2010. Participants were CALD GPs working as solo practitioners who were members of a Division of General Practice in South Western Sydney. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using thematic analysis. Results The response rate was 51%, however no demographic differences were identified between responders and non-responders. The majority of participants (73%) agreed that practice nurses could perform vital sign measurements or spirometry. Fewer participants (52-63%) believed practice nurses could perform breast checks, pap smears, or assessment of medication regimes. Perceived barriers to employing a practice nurse included lack of space or equipment, legal implications, lack of a specific job description and language communication issues. Participants identified the need for greater financial rebates, assistance with training practice nurses and assistance with business modelling as facilitators to practice nurse employment. Conclusion The feasibility of practice nurse employment in practices with solo, culturally and linguistically diverse general practitioners remains a challenge that needs further exploration. Employment of practice nurses may be a viable option for younger practitioners who have a desire to work in collaborative multidisciplinary models

Unscrambling the egg: A muddled path to a holistic, coherent and integrated institution wide approach to first year student transition. A Practice Report

A Third Generation approach to the first year experience and transition is widely recognised as essential and current best practice. However the significant challenges to institutions in achieving such an approach is broadly acknowledged. This Practice Report outlines the beginning attempts of one institution to recognise such a goal, and is designed to seek input and insight from workshop participants on proven strategies to progress this goal.</em

Unscrambling the egg : a muddled path to a holistic, coherent and integrated institution-wide approach to first year student transition. A Practice Report

A Third Generation approach to the first year experience and transition is widely recognised as essential and current best practice. However the significant challenges to institutions in achieving such an approach is broadly acknowledged. This Practice Report outlines the beginning attempts of one institution to recognise such a goal, and is designed to seek input and insight from workshop participants on proven strategies to progress this goal

Design and rationale of the Western Sydney Clinical Frailty Registry: A prospective observational long-term clinical cohort study

Background: Frail older adults are frequently admitted to hospital with complex care needs, however little is known about their clinical profile, inpatient management or outcomes. Aims: (i) To establish a baseline clinical profile of patients with frailty; (ii) To obtain a representative cross-sectional view of patients with frailty and their acute inpatient clinical management; (iii) To determine the rate and clinical outcomes of frailty among hospitalised patients. Methods: The study will be conducted in a Western Sydney tertiary teaching hospital (Blacktown and Mount Druitt Hospital), serving a large socio-economically diverse, multi-cultural community. A long-term, prospective observational clinical cohort of patients who are admitted under Rehabilitation and Aged Care Services over the next 5-year period (2020–25) will be conducted. Frailty will be assessed using the Clinical Frailty Scale, and the FI-ED frailty instrument, performance will be assessed using the Australian-modified Karnofsky Performance Status (AKPS). Participants will be followed-up at 3, 6, and 12 months by telephone, following their index hospitalisation. Outcomes of interest include all-cause rehospitalisation (including emergency department presentation), mortality and admission to residential aged care service over the period of 12 months. Data Linkage endpoint assessment will be undertaken at 1, 2, and 5 years. Discussion: Frailty is an emergent area of clinical and research interest. It is an important prognostic indicator of mortality, rehospitalisation and institutionalisation. Conclusion: This study will provide longitudinal data to demonstrate short, mid, or long-term outcomes of hospitalised frail older adults. Data will be used to inform future studies and quality improvement activities. Impact: It is envisioned that the registry will act as a spine project for future multi-disciplinary research opportunities including interventional studies, data linkage studies and quality improvement projects, thus enabling robust medium – long term examination of outcomes of interest, such as mortality, rehospitalisation and admission to residential aged care within this area of growing concern. There are plans to engage more disciplines in the registry\u27s research capacity-building endeavours and we have identified the need for greater consumer engagement and public involvement. The sustainability of the registry needs to be considered within the context of ongoing research funding and making better use of these data for continuous quality improvement. Registry registration: The registry was registered with the Australian Register of Clinical Registries (Australian Commission on Safety and Quality in Healthcare) on 3rd August 2020.(Australian Commission on Safety and Quality in Healthcare, 2020) Reference ACSQHC-ARCR-095. Available via https://www.safetyandquality.gov.au/australian-register-clinical-registrie

New technologies call for new strategies for patient education

For many, electronic devices and wearables are part of everyday life. With the recent launch of the Apple iPhone 12 Series, it is necessary to consider the impact of these new technologies on cardiovascular implantable electronic devices (CIED). There are emerging case reports describing the effect of everyday technologies such as smart-phones, smart-watches, laptops, and e-cigarettes on temporary inhibition of shock therapy due to the magnetic sensitivity of these devices.1–5 Cardiovascular nurses are a consistent provider of CIED education during the trajectory of care from diagnosis, implantation, routine aftercare, and ongoing monitoring during follow-up. As the largest group of the healthcare work force with the most patient contact, we are well positioned to provide leadership and education regarding the increased risk of unintentional magnet reversion from emerging household items

Culturally and linguistically diverse general practitioners’ utilisation of practice nurses

Background: Practice nurses are primarily employed by general practitioners, however little is known about the barriers to practice nurse employment from the perspective of general practitioners (GPs). Aim: This paper seeks to explore solo, culturally and linguistically diverse (CALD) general practitioners’ perceptions of the practice nurse role, and to identify the barriers and facilitators of these doctors employing nurses within their practice. Methods: A descriptive study, using semi-structured interviews, was conducted from July to August 2010. Participants were CALD GPs working as solo practitioners who were members of a Division of General Practice in South Western Sydney. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using thematic analysis. Results: The response rate was 51%, however no demographic differences were identified between responders and non-responders. The majority of participants (73%) agreed that practice nurses could perform vital sign measurements or spirometry. Fewer participants (52—63%) believed practice nurses could perform breast checks, pap smears, or assessment of medication regimes. Perceived barriers to employing a practice nurse included lack of space or equipment, legal implications, lack of a specific job description and language communication issues. Participants identified the need for greater financial rebates, assistance with training practice nurses and assistance with business modelling as facilitators to practice nurse employment. Conclusion: The feasibility of practice nurse employment in practices with solo, culturally and linguistically diverse general practitioners remains a challenge that needs further exploration. Employment of practice nurses may be a viable option for younger practitioners who have a desire to work in collaborative multidisciplinary models

Educational Needs of People Living with Atrial Fibrillation: A Qualitative Study

Background This study explored the educational and self‐management needs of adults living with atrial fibrillation (AF). Methods and Results This is a qualitative study of adults living with AF, clinicians, and expert key stakeholders. Interviews were conducted via a one‐to‐one semistructured videoconference or phone and transcribed verbatim for thematic analysis. A total of 34 participants were recruited and included in analyses (clinicians n=13; experts n=13, patients n=8). Interviews were on average 40 (range 20–70) minutes in duration. Three key themes were identified: (1) “Patient‐centered AF education”; (2) “Prioritizing AF education”; and (3) “Timing AF education.” The availability of credible information was perceived as highly variable. Information primarily focused on anticoagulation, or procedural information, as opposed to other aspects of management, such as risk factor reduction. Factors to optimize learning, such as multimedia, apps, case studies, or the use of visuals were perceived as important. Continuity of care, including engagement of caregivers, was important to help develop relationships, and facilitate understanding, while concurrently creating opportunities for timely targeted education. Clinicians described acute care as a suboptimal setting to deliver education. Competing interests aligned with the time‐pressured context of acute care were prioritized over patient education. In contrast, patients valued continuity of care. AF education strategies need to pivot from a “one size fits all” approach and modernize to implement a range of approaches. Conclusions There remain many unmet needs in the provision of quality AF education to support self‐management. Multimodal offerings and the ability to tailor to individual patient needs are important design considerations for new education programs

Educational Needs of People Living with Atrial Fibrillation: A Qualitative Study

Background This study explored the educational and self-management needs of adults living with atrial fibrillation (AF). Methods and Results This is a qualitative study of adults living with AF, clinicians, and expert key stakeholders. Interviews were conducted via a one-to-one semistructured videoconference or phone and transcribed verbatim for thematic analysis. A total of 34 participants were recruited and included in analyses (clinicians n=13; experts n=13, patients n=8). Interviews were on average 40 (range 20-70) minutes in duration. Three key themes were identified: (1) Patient-centered AF education ; (2) Prioritizing AF education ; and (3) Timing AF education. The availability of credible information was perceived as highly variable. Information primarily focused on anticoagulation, or procedural information, as opposed to other aspects of management, such as risk factor reduction. Factors to optimize learning, such as multimedia, apps, case studies, or the use of visuals were perceived as important. Continuity of care, including engagement of caregivers, was important to help develop relationships, and facilitate understanding, while concurrently creating opportunities for timely targeted education. Clinicians described acute care as a suboptimal setting to deliver education. Competing interests aligned with the time-pressured context of acute care were prioritized over patient education. In contrast, patients valued continuity of care. AF education strategies need to pivot from a one size fits all approach and modernize to implement a range of approaches. Conclusions There remain many unmet needs in the provision of quality AF education to support self-management. Multimodal offerings and the ability to tailor to individual patient needs are important design considerations for new education programs

[In Press] Bundle-of-care interventions to improve self-management of patients with urinary catheters : study protocol

Background: Community-based urinary catheter-associated complications contribute to avoidable, costly hospital presentations. To minimise catheter-associated complications and improve the quality of life of patients living in the community, it is essential to improve catheter self-management through increasing patients’ and caregivers’ knowledge and self-efficacy. Aim: To co-design, develop and evaluate a bundle-of-care intervention to improve catheter self-management, reduce catheter-associated complications, and improved quality of life. Design: Mixed methods design underpinned by the principles of Appreciative Inquiry, micro- and spaced-learning pedagogies. Methods: A co-designed care bundle will be developed, to support both patients and nurses in improving catheter care in both acute and community settings. Intervention bundles for patients will be delivered using “GoShare Healthcare” and for nurses, using QStream. The underpinning pedagogical approaches of these two digital platforms focus on increasing knowledge retention and improving patient health outcomes. A process evaluation of the intervention will be undertaken using data collected from surveys, electronic medical record audits, and participant interviews. The primary outcome is improved catheter self-management, and secondary outcomes are increased self-efficacy and patients’ knowledge of catheter self-management. Discussion: The IQ-IDC study applies a two-pronged approach to co-design a bundle-of-care intervention that addresses important gaps in current catheter management. This study will contribute to new knowledge on effective implementation strategies to optimise self-management in urinary catheter care

Nursing as first choice predicts nursing program completion

Background: Attrition from nursing programs is common, costly and burdensome to individuals, nursing faculties and the health care system. Increasingly, nursing faculties are requested to monitor attrition rates as a measure of performance, but little is known of the influence of career choice on program completion. Objectives: The aim of this study was to assess the impact of nursing as a first choice for study on attrition in a baccalaureate nursing program. Design, Setting and Participants: A longitudinal, cohort design was used in this study, which involved undergraduate nursing students enrolled at a university in Australia. Of the 357 participants who completed a baseline survey in 2004 at entry to their Bachelor of Nursing program, 352 were followed up over a six-year period to the end of 2009. Results: Students who selected nursing as their first choice for study were nearly twice as likely (OR: 1.99 95% CI: 1.07–3.68) to complete their nursing program compared to those who did not. These students were also more likely to be older (mean age: 26.8 vs 20.1 years, Pb0.001), and employed in nursing-related work (35% vs 2%, Pb0.001). In addition, the study revealed that male students (OR: 1.93 95% CI: 1.07–3.46) and those who worked more than 16 h per week during semester (OR: 1.80 95% CI: 1.09–2.99) were less likely to complete than their counterparts. Conclusions: These data assist in generating realistic projections of completion and entry to the workforce. Understanding patterns of attrition and individuals' motivations to be a nurse is important not only for supporting nursing students to help them complete their studies but also for developing more targeted strategies directed toward student recruitment and retention