Defibrillation beliefs of rural nurses: focus group discussions guided by the Theory of Planned Behaviour.

INTRODUCTION: The endorsement of the chain of survival concept and early defibrillation has challenged health professionals to reconsider their beliefs about how they respond to in-hospital resuscitation. In the rural context, where 24 hour coverage is not available nurse-initiated defibrillation is expected. Despite literature and policy change in Australia to allow nurses to initiate defibrillation, there is no current research that uses a systemic theoretical approach to investigate the specific beliefs of nurses and their use of defibrillators. The purpose of this study was to elicit a beginning understanding of the defibrillation beliefs of rural nurses. METHODS: This research used focus groups within the framework of the Theory of Planned Behavior to describe the defibrillation beliefs of rural registered nurses. The sites selected for this study were two acute care hospitals in rural Australia (RRMA Classification). Each of these hospitals was in located 'other rural areas' (RRMA Classification) in separate towns and had 25 and 30 beds. The study sample consisted of 10 females and two males. Focus group questions were designed to elicit salient beliefs within the theoretical framework. Three constructs of behavioral, normative and control beliefs guided the development of the question and analysis of the discussions. In accordance with the authors of the theoretical framework, content analysis was used to analyse the data from the study. RESULTS: Two behavioral beliefs, four control beliefs and four normative belief categories were elicited. Two behavioral beliefs categories emerged from the open-ended question: 'What, if any are the advantages of you being able to use a defibrillator?' Participants were congruent when discussing the advantages of nurses initiating defibrillation. The two categories were 'quicker response times' (15 responses) and 'increased success with resuscitation' (8 responses). Participants were asked to identify any events that might influence their decision to use or not use a defibrillator if there was a cardiac arrest on their ward on that day. The categories of control beliefs elicited were 'rhythm recognition' (22 responses), 'litigation' (15 responses), 'fear of harm to patient or self' (11 responses), and 'roles' (4 responses). To identify the normative referents, participants were asked to identify who would approve or not approve of them being responsible for the use of defibrillators in their clinical area. Four normative beliefs represent 100% of the responses, these were: patients; nurses; doctors; and the nursing registration body, the Queensland Nursing Council. CONCLUSIONS: The central issues for these participating nurses were related to the consequences for the patient, support and confidence with rhythm recognition. Understanding rural nurses beliefs as they pertain to nurse-initiated defibrillation may provide educators with some insight as to what changes are needed to increase nurse-initiated defibrillation.

Occupational physical activity across occupational categories.

This study investigated the amount of physical activity that occurs during normal working hours, highlighting the occupational differences in physical activity by occupational category. Data were collected by means of a self-administered questionnaire (Tecumseh Occupational Physical Activity Questionnaire [TOQ]), which measures past year Occupational Physical Activity (OPA) and by a motion-sensing device (Yamax DigiWalker Pedometer SW - 700). Ninety male and female participants aged 18-62 years participated in the study. Participants were stratified by occupational category according to the Australian Standard Classification of Occupations (ASCO), which was then condensed into professional, white-collar and blue-collar workers. The results showed significant (p < .05) increases in OPA from the professional category (least active) through to the blue-collar workers (most active) in terms of walking activity. Mean daily step counts were 2,835, 3,616 and 8,757 for professional, white-collar and blue-collar respectively. Occupational Physical Activity Scores and Work Activity Units (WAU) in MET - min x wk(-1) from the TOQ showed similar patterns, with blue collar reporting significantly (p < .05) more past year OPA than their white-collar and professional workers. Significant correlations were also shown between the pedometer (step-count data) and the TOQ (r = .38 - .74, p < .01).

Test-retest reliability of four physical activity measures used in population surveys.

Accurate monitoring of prevalence and trends in population levels of physical activity (PA) is a fundamental public health need. Test-retest reliability (repeatability) was assessed in population samples for four self-report PA measures: the Active Australia survey (AA, N=356), the short International Physical Activity Questionnaire (IPAQ, N=104), the physical activity items in the Behavioral Risk Factor Surveillance System (BRFSS, N=127) and in the Australian National Health Survey (NHS, N=122). Percent agreement and Kappa statistics were used to assess reliability of classification of activity status as 'active', 'insufficiently active' or 'sedentary'. Intraclass correlations (ICCs) were used to assess agreement on minutes of activity reported for each item of each survey and for total minutes. Percent agreement scores for activity status were very good on all four instruments, ranging from 60% for the NHS to 79% for the IPAQ. Corresponding Kappa statistics ranged from 0.40 (NHS) to 0.52 (AA). For individual items, ICCs were highest for walking (0.45 to 0.78) and vigorous activity (0.22 to 0.64) and lowest for the moderate questions (0.16 to 0.44). All four measures provide acceptable levels of test-retest reliability for assessing both activity status and sedentariness, and moderate reliability for assessing total minutes of activity.

Identifying bone mass and muscular changes.

The aim of this investigation was to examine the impact of a six-month high intensity strength-training program on lumbar bone mineral density (BMD), trunk and lower limb strength in a population of Australian women aged 50 years and over. A subject pool of 44 women were recruited and randomly allocated into either strength training (n = 19) or active control (n = 25) groups. All subjects trained twice weekly in either a 50 minute supervised strength training session that progressed from 60% one repetition maximum (1RM) to 90% 1RM or a 50 minute group walk session. Measurements included a lumbar (L2-L4) BMD scan: peak isokinetic trunk strength and a dynamic 1RM squat as a measure of lower body strength. No significant group differences in lumbar BMD were evident at the completion of training. However, a significant (p < 0.05) within group change was apparent for the active control group as lumbar BMD decreased 1.7% below baseline testing. A significant (p < 0.05) group difference was evident with the strength trained group increasing peak isokinetic trunk strength (19.3%) and 1RM squat strength (34.4%) above that of the active controls. It was concluded that strength training provides an effective means for increasing trunk and lower limb strength in women over 50 years. The impact of strength training on lumbar BMD was not conclusive in the present study.

Residential and nursing home care of elderly people with cognitive impairment: prevalence, mortality and costs.

Cognitive impairment among residents has considerable resource implications for both individuals and those responsible for publicly funded care. Two linked surveys were carried out in England: (1) a longitudinal study followed 2500 admissions to publicly funded care up to 42 months after admission; and (2) a cross-sectional survey of 618 homes collected information about 11,900 residents. Information was collected about cognitive impairment using the Minimum Data Set Cognitive Performance Scale. Cognitive impairment was associated with source of funding and type of home. Although level of cognitive impairment has some effect, fees and costs were most influenced by type of home. At the same level of impairment, self-funded residents were more likely to be located in relatively low-cost settings than publicly funded residents. In independent homes fees were lower for publicly funded than for self-funded residents. Overall median length of stay of publicly funded admissions was 18 months. For the most part length of stay was not associated with level of cognitive impairment on admission. It is concluded that more information is needed about the effect of quality of care on people with cognitive impairment in different settings. If the same quality of care can be achieved in residential and nursing homes, the evidence would suggest that changes in placement policies could result in potential savings to the public purse.