Rural and remote pharmacists' perspectives of grey nomads with diabetes travelling in Australia.

OBJECTIVE: The objective of the research was to explore rural and remote pharmacists' experiences of encountering grey nomads with diabetes. DESIGN: A qualitative Interpretive Description design was used to explore and capture the experiences of rural and remote pharmacists interacting with grey nomads who had diabetes. Data from the interviews were analysed thematically. SETTING: The Pharmacy Guild of Australia was approached and through their membership rural and remote pharmacists were invited to participate in the research. PARTICIPANTS: Nine rural and remote pharmacists who had encounters and provided services to grey nomads with diabetes responded to be interviewed. RESULTS: The analysed findings established four major themes including: the influence of rural and remote locations on services; common problems encountered by the pharmacists; preparation for travel by grey nomads with diabetes; and pharmacists' preparedness to support grey nomads with diabetes. CONCLUSION: The findings of this study identified that pharmacists needed remuneration for services provided to grey nomads with diabetes. Also, further development of the My Health record and telehealth to include pharmacists would be advantageous for grey nomads who have diabetes. Pharmacists stated there was a need for further education and a continuing professional development module specifically designed for pharmacists on diabetes self-management that moved beyond medications. A pre-travel checklist for grey nomads with diabetes travelling in rural and remote Australia would benefit all stakeholders through better preparation of travellers with diabetes to self-manage, thereby reducing the demand for health services including pharmacies.

Understanding the planning and preparation for diabetes self-management of grey nomads when travelling in rural and remote Australia: An exploratory survey.

OBJECTIVE: Many older Australians with chronic health conditions, including diabetes, are taking to the road in a recreational vehicle following retirement and are colloquially known as grey nomads. This exploratory online survey aimed to ascertain the issues on the road for grey nomads with diabetes and their experiences of self-management of their diabetes whilst in rural and remote regions of Australia. METHODS: Following ethical approval and piloting, an online survey was distributed through social media sites used by grey nomads and those with diabetes. From the closed and open-ended responses from travelers with diabetes in rural and remote areas, the demographics of this cohort were explored, as well as their self-management of diabetes. RESULTS: A total of 103 grey nomads with diabetes responded and 81 completed all survey questions. There was wide variation in the respondents' answers in regard to their self-management including their preparation for travel; their knowledge of diabetes and accessing health-care services; their management of illness; and their experiences whilst travelling including the effects of COVID-19. It was identified that there was a need for an increase in preparation prior to travel, and several important checks were identified for this planning specific to rural and remote areas of Australia, including the expectations of health services in these regions. CONCLUSIONS: A pretravel checklist for travellers with diabetes is recommended to contribute to better self-management of grey nomads with diabetes on the road in order to alleviate the issues identified.

Grey nomads with diabetes self-management on the road - a scoping review.

INTRODUCTION: This scoping literature review explored the characteristics and behaviours of a subset of Australia's older population: 'grey nomads', many who live and travel with type 1 or 2 diabetes mellitus. Grey nomads are people aged more than 55 years, who travel in caravans or motorhomes for extended periods of time around rural and remote areas of Australia. Grey nomads are challenging the established view of ageing in Australia by their lifestyle choices, which include social and economic contribution, independence and furthering of personal fulfilment. However, some evidence suggests that grey nomads experience health issues while in rural locations, which exerts a significant burden on already under-resourced Australian rural health services. This review seeks knowledge on grey nomads' self-management of diabetes while travelling, with the aim of understanding their experiences and identifying support services and strategies that would facilitate improved self-management. Furthermore, this review seeks knowledge of how Australia's rural and remote health services support the nomads with diabetes and the influence of this burgeoning population on such services. METHODS: A scoping review methodology provided the methods to map the current evidence concerned with this broad and complex topic. A systematic six-step framework was adopted: identifying the research question; identifying relevant literature; selecting studies; charting the findings; collating, summarising and reporting results; and a final consultation. RESULTS: The grey nomads in this review travelled long distances through the often-harsh Australian countryside where they sought, privacy, isolation, self-sufficiency and a closeness with nature. Although their motivations included life- and health-enhancing experiences, most grey nomads travelled with at least one chronic health condition, which they did not consider as a barrier to adopting a grey nomad lifestyle. However, many were under-prepared for their health needs when in rural or remote Australia. Specific literature concerning grey nomads and self-management of diabetes was not found but salient aspects of diabetes self-management were identified and included a well-developed relationship with their diabetes healthcare provider; a relationship that relied on ongoing communication and support. When travelling, the ability to form or sustain supportive relationships with local health care providers was limited due to sparseness of rural services and the perceived transient nature of the relationship. Increasingly, grey nomads utilised digital technology via telemedicine or social media sites for information and advice on health issues. The local pharmacies in rural and remote locations were also identified as sources of support and services. CONCLUSION: The literature showed that the grey nomad population had a similar distribution of chronic illness, including diabetes, to that of the general Australian population, but very little was published about how they self-manage conditions when in remote locations where healthcare services were limited. The emerging roles of digital technology and development opportunities for pharmacists offer new and innovative avenues to support grey nomads with diabetes while travelling in rural and remote Australia.

Grey nomads with diabetes: the experience of rural and remote diabetes educators in South Australia.

The phenomenon of grey nomads travelling in rural and remote regions of Australia is on the increase, and as this cohort is an older age group, they are often travelling with chronic conditions, such as diabetes. Seven rural and remote diabetes educators were interviewed about their experiences of grey nomad travellers with diabetes, to whom they provided services. The findings revealed problems associated with grey nomads with diabetes, including maintenance of equipment, medications, self-management, glycaemic control and unpredictable events. The problems highlighted by the participants were exacerbated when travelling long distances for extended periods, often with changes to their usual regime of self-management. The isolation and remoteness of some areas was a factor for the travellers who were often not prepared and often turned to pharmacists for help. The participants were able to enhance the care and self-management of the travellers with diabetes and identified several pathways travellers may undertake if they needed services related to their diabetes. The diabetes educators' capacity to provide services for travellers was stretched at times; however, this was viewed as positive in that it added diversity to their normal practice. Recommendations included a preparation checklist and information for travellers with diabetes and further education for pharmacists.

Exploring the Prevalence of Undiagnosed Prediabetes, Type 2 Diabetes Mellitus, and Risk Factors in Adolescents: A Systematic Review.

PROBLEM: The prevalence of prediabetes and type 2 diabetes (T2D) is increasing in adolescents worldwide. Most studies have focused on the clinical features, treatment, and complications for adolescents and so the need to generate insight into the risk factors and prevalence of undiagnosed prediabetes and T2D in adolescents across the globe remains. ELIGIBILITY CRITERIA: Relevant articles that were published from 2007 up to and including January 2017 were identified through electronic searches of CINAHL, Cochrane, Medline, PsycInfo, PubMed, Scopus, Web of Science, and Sociological Abstracts (Proquest). Four independent researchers examined the articles for eligibility. SAMPLE: Sixteen studies were included that investigated the risk and prevalence of undiagnosed prediabetes and T2D in adolescents aged 12-19. RESULTS: The most commonly measured risk factors included obesity/overweight, family history, and ethnicity. Other studies measured risk factors associated with insulin resistance, including hypertension, acanthosis nigricans, and dyslipidemia. Prevalence of undiagnosed prediabetes and T2D varied among regions globally with rates ranging from 3.3 to 14.3% and 0.1 to 2.2%, respectively. CONCLUSIONS: Undiagnosed prediabetes and T2D and the associated risk factors are prevalent in many regions in countries worldwide, significantly impacting adolescents and their families. IMPLICATIONS: Future research is required to inform interventions aimed at preventative measures for early screening and detection of prediabetes and T2D in adolescents, as well as the development of multi-disciplinary teams that include pediatric nurses and the specialized care they provide.

Assessing levels of student nurse learning in community based health placement with vulnerable families: Knowledge development for future clinical practice.

BACKGROUND: Community services work with vulnerable families to assist them to link with health, education and welfare services. Community placements provide nursing students with understandings of the health impacts of social circumstances on broad population's. Nurses provide health care for vulnerable populations so it is important for students to gain experience in dealing with various population groups in a variety of settings. Community placements can increase student confidence to provide care for all people in the acute care setting. OBJECTIVES: The research project explored the use of a community placement to assist nursing students in applying psychosocial theories to practice; determining the affect of nursing students to the community service; and if the learning achieved in the placement was applicable to their future nursing practice were also objectives of the research. DESIGN: The mixed methods design used placement suitability focused questionnaires, and student, staff and clinical supervisor one-to-one interviews. SETTINGS: In 2015 a community based homelessness service which provides a home visiting service approached the School of Nursing and Midwifery to provide a community placement for nursing students. The urban homelessness service caters for 350 homeless clients per month. PARTICIPANTS: Eight second year nursing students and six fulltime homelessness staff, mainly social workers, participated in the surveys and interviews. METHODS: Nursing students were 'buddied' with a social worker and visited individuals and families recently placed in emergency housing. The student nurses (8) and homelessness staff (6) were surveyed and interviewed about their knowledge, skills and perceptions about the value of community based placements. RESULTS: Findings indicate student's recognition of the skills to be learned in a non-acute setting are applicable to all clinical settings and enhance student knowledge and potential future care. The staff in the homelessness service espouse the enhancement provided by the expertise of the nursing students working with vulnerable populations. This paper highlights the benefits as perceived by students on often undervalued community based placements. CONCLUSIONS: It is essential that universities collaborate with industry and consumers to ensure that the undergraduate programs offer a high standard of care and address current trends in the health care industry. There is a growing need for workforce development in primary healthcare and an increased understanding about how adversity can lead to ill health.

Parental Concern: Parents Discuss How They Support Their Adolescents Attending Schoolies Events in Australia.

Adolescents who have completed their high school studies converge on coastal areas of Australia annually to celebrate their freedom in events known as "Schoolies." The current body of research in relation to Schoolies demonstrates that adolescents consume alcohol and other drugs and engage in sexual activity during these events. Exactly how parents support adolescents in attending these events and how they perceive the Schoolies experience represent major gaps in the literature. To undertake this research, 7 parents were interviewed using a semi-structured approach. Interview transcripts were analyzed using Braun and Clarke's thematic analysis, with 4 main themes identified: communication, consuming alcohol, peer support, and helping parents to support their adolescents in attending Schoolies. Communication was the main strategy used by parents to talk about Schoolies with their adolescent, with the majority encouraging open communication around drinking alcohol, staying with friends, and instilling correct or moral values into their adolescents in relation to respectful behavior. Parents saw the consumption of alcohol as inevitable and as something they could not control. However, the ramifications of alcohol consumption were the primary concerns for these parents. This study provides a number of insights into the perceptions that parents have about Schoolies events and how they support their adolescent to attend. Parents sought guidance in supporting their adolescent child via educational media and talking to other parents.

Perinatal addiction: providing compassionate and competent care.

Perinatal addiction is being seen with increasing frequency and is a complex issue. It involves the patient, her environment, partner, prenatal care, labor, delivery, and neonatal time periods. There are no quick solutions. These patients do require compassionate and competent care regardless of how their care provider may feel about their particular situation. This article can assist the clinicians in managing and trying to understand the conditions of the patient who has been identified with addiction issues and needs help and support after delivery. The aim of the clinician must be to provide competent care with compassion and patience and to formulate a plan of care that will support and benefit the mother and her neonate.

Muslim person's experiences of diabetes during Ramadan: information for health professionals.

This phenomenological study provides an in-depth understanding of the lived experiences of Muslim persons with diabetes during Ramadan. The findings facilitate health professionals' knowledge of the unique needs of these clients during this time. van Manen's (1990) and Hycner's (1985) analytical methods assisted in producing the themes: knowing and understanding - being in harmony with the body, knowing its capabilities and limitations and its response to change; controlling - being in charge of diabetes during Ramadan; accepting and recognising - acknowledging diabetes and its impact on fasting during Ramadan; and faith and belief - the courage of conviction.

Support and counseling after maternal death.

Teamwork, communication, critical incident debriefing, and grief counseling surrounding the events of an unexpected maternal death are important continuing education and practice topics for health care employees working with pregnant women. Social technologies have impacted health care institutions and systems. Ethical dilemmas have been created in hospitals as they develop policies and procedures regarding electronic communications and social networking Web sites.