Integrating General Practice Into the Australian COVID-19 Response: A Description of the General Practitioner Respiratory Clinic Program in Australia.

Integrating primary care with the health response is key to managing pandemics and other health emergencies. In recognition of this, the Australian Government established a network of respiratory clinics led by general practitioners in response to the coronavirus disease 2019 (COVID-19) pandemic as part of broader measures aimed at supporting primary care. General practitioner (GP) respiratory clinics provide holistic face-to-face assessment and treatment to those with respiratory symptoms in an environment with strict protocols for infection prevention and control. This ensures that these patients are able to access high quality primary care while protecting the general practice workforce and other patients. The GP respiratory clinic model was developed and operationalized 10 days after the policy was announced, with the first 2 respiratory clinics opening on March 21, 2020. Subsequently a total of 150 respiratory clinics were opened and served over 800,000 patients within more than 99% of Australia's postcodes. These clinics used a standardized data collection tool that has provided the largest and most complete primary care surveillance database of respiratory illness in Australia. The success of the GP respiratory clinic model was made possible due to strong partnerships with Primary Health Networks and individual general practices that rapidly shifted operations to embrace this new approach. This article describes the development and early implementation of this model.

Ensuring the continuation of routine primary care during the COVID-19 pandemic: a review of the international literature.

BACKGROUND: The COVID-19 pandemic has resulted in the diversion of health resources away from routine primary care delivery. This disruption of health services has necessitated new approaches to providing care to ensure continuity. OBJECTIVES: To summarize changes to the provision of routine primary care services during the pandemic. METHODS: Rapid literature review using PubMed/MEDLINE, SCOPUS, and Cochrane. Eligible studies were based in primary care and described practice-level changes in the provision of routine care in response to COVID-19. Relevant data addressing changes to routine primary care delivery, impact on primary care functions and challenges experienced in adjusting to new approaches to providing care, were obtained from included studies. A narrative summary was guided by Burns et al.'s framework for primary care provision in disasters. RESULTS: Seventeen of 1,699 identified papers were included. Studies reported on telehealth use and public health measures to maintain safe access to routine primary care, including providing COVID-19 screening, and establishing dedicated care pathways for non-COVID and COVID-related issues. Acute and urgent care were prioritized, causing disruptions to chronic disease management and preventive care. Challenges included telehealth use including disparities in access and practical difficulties in assessing patients, personal protective equipment shortages, and financial solvency of medical practices. CONCLUSIONS: Substantial disruptions to routine primary care occurred due to the COVID-19 pandemic. Primary care practices' rapid adaptation, often with limited resources and support, demonstrates agility and innovative capacity. Findings underscore the need for timely guidance and support from authorities to optimize the provision of comprehensive routine care during pandemics.

The COVID-19 pandemic has resulted in considerable disruption to health services including regular primary care. As a consequence, primary care practices have had to adopt new ways of providing care to ensure ongoing availability of services. However, little is known about the type of measures taken by care providers and challenges encountered in reorganizing services. The aim of this research was to provide a detailed understanding of changes in the way primary care was delivered and to identify difficulties experienced by patients and providers in adjusting to new approaches. The 17 studies included in the review indicate that primary care providers quickly put in place strategies including telehealth (e.g. telephone and video consultations) and infection control measures to ensure safe access to care. Furthermore, urgent and short-term care were prioritized resulting in interruptions to other services, including management of preexisting or long-term illnesses. Challenges included barriers to accessing telehealth such as inadequate internet connection and practical difficulties in examining patients, personal protective equipment shortages, and financial losses by practices. Adequate support from authorities is needed to enhance the provision of comprehensive primary care during pandemics.

A framework for involving coproduction partners in research about young people with type 1 diabetes.

BACKGROUND: Involvement of end-users in research can enhance its quality, relevance, credibility and legitimacy; however, the processes through which these changes occur are unclear. Our aim was to explore a coproduction research team's experiences of their involvement in research about young people with type 1 diabetes mellitus (T1DM). METHODS: Semi-structured interviews conducted with two young people with T1DM, two parents, one diabetes educator, one endocrinologist-scientist and one research-engineer explored experiences of coproduction research and its impact on both the research and the participants. Drawing on grounded theory, we undertook inductive analysis and storyline mapping to develop a theorized framework of mechanisms supporting the process of coproduction in T1DM research with young people. FINDINGS: The framework involving coproduction partners in research about young people with type 1 diabetes centres on the unique expertize that different team members bring to the research and describes conditions that enable expert contributions through the enactment of a variety of expert roles. The framework also describes outcomes-the impact of the expert contributions on both the research and the team members involved. CONCLUSION: The findings of this small exploratory study provide a sound foundation to develop further understanding about structures and processes that are integral for the success of coproduction research teams. The framework may provide a guide for researchers planning to incorporate coproduction, on elements that are important for this model of research to succeed. It may also inform coproduction impact assessment research and be used for hypothesis testing and expansion in future studies.

Intertwined like a double helix: A meta-synthesis of the qualitative literature examining the experiences of living with someone with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a chronic serious condition of uncertain course and outcome. There is relatively little literature on the experiences of people who live with a person with MS. They inhabit a locus of care that spans caring for (a relational act) and caring about (a moral stance, addressing fairness, compassion and justice) the person with MS. METHODS: Using the theoretical lens of personhood, we undertook a scoping review and meta-synthesis of the qualitative literature on the experiences of people who live with a person with MS, focusing on the nature of, and constraints upon, caring. RESULTS: Of 330 articles, 49 were included in the review. We identified five themes. One of these-seeking information and support-reflects the political economy of care. Two are concerned with the moral domain of care: caring as labour and living with uncertainty. The final two themes-changing identities and adapting to life with a person with MS-point to the negotiation and reconstitution of personhood for both the person with MS and the people they live with. CONCLUSION: People with MS are embedded in relational social networks of partners, family and friends, which are fundamental in the support of their personhood; the people who live with them are 'co-constituents of the patient's identity' assisting them to make sense of their world and self in times of disruption due to illness. Support services and health care professionals caring for people with MS are currently very much patient-centred; young people in particular report that their roles are elided in the health system's interaction with a parent with MS. There is a need to look beyond the person with MS and recognize the relational network of people who surround them and broaden their focus to encompass this network. PATIENT AND PUBLIC INVOLVEMENT: Our research team includes four members with MS and two members with lived experience of living or working with people with MS. A third person (not a team member) who lives with a partner with MS provided feedback on the paper.

The role of machine learning in developing non-magnetic resonance imaging based biomarkers for multiple sclerosis: a systematic review.

BACKGROUND: Multiple sclerosis (MS) is a neurological condition whose symptoms, severity, and progression over time vary enormously among individuals. Ideally, each person living with MS should be provided with an accurate prognosis at the time of diagnosis, precision in initial and subsequent treatment decisions, and improved timeliness in detecting the need to reassess treatment regimens. To manage these three components, discovering an accurate, objective measure of overall disease severity is essential. Machine learning (ML) algorithms can contribute to finding such a clinically useful biomarker of MS through their ability to search and analyze datasets about potential biomarkers at scale. Our aim was to conduct a systematic review to determine how, and in what way, ML has been applied to the study of MS biomarkers on data from sources other than magnetic resonance imaging. METHODS: Systematic searches through eight databases were conducted for literature published in 2014-2020 on MS and specified ML algorithms. RESULTS: Of the 1, 052 returned papers, 66 met the inclusion criteria. All included papers addressed developing classifiers for MS identification or measuring its progression, typically, using hold-out evaluation on subsets of fewer than 200 participants with MS. These classifiers focused on biomarkers of MS, ranging from those derived from omics and phenotypical data (34.5% clinical, 33.3% biological, 23.0% physiological, and 9.2% drug response). Algorithmic choices were dependent on both the amount of data available for supervised ML (91.5%; 49.2% classification and 42.3% regression) and the requirement to be able to justify the resulting decision-making principles in healthcare settings. Therefore, algorithms based on decision trees and support vector machines were commonly used, and the maximum average performance of 89.9% AUC was found in random forests comparing with other ML algorithms. CONCLUSIONS: ML is applicable to determining how candidate biomarkers perform in the assessment of disease severity. However, applying ML research to develop decision aids to help clinicians optimize treatment strategies and analyze treatment responses in individual patients calls for creating appropriate data resources and shared experimental protocols. They should target proceeding from segregated classification of signals or natural language to both holistic analyses across data modalities and clinically-meaningful differentiation of disease.

Evaluation of the Brief Coping Orientation to Problems Experienced scale and exploration of coping among primary health care nurses during COVID-19.

AIM: This study aimed to explore primary health care nurses' coping strategies and evaluate the psychometric properties of the Brief Coping Orientation to Problems Experienced (COPE) scale. BACKGROUND: Primary health care nurses are experiencing significant COVID-19-related psychological impacts. Beyond understanding the impacts, there is a need to explore coping strategies. METHODS: This online cross-sectional survey was completed by 359 Australian primary health care nurses between October and December 2020. RESULTS: Factor analysis revealed seven factors (support, disengagement and venting, humour, positive reframing, acceptance, substance use and spiritual/religious beliefs) (Cronbach's alpha > .69). There was an association between age, years of nursing and years of primary health care nursing and the factors of 'support', 'disengagement and venting' and 'positive reframing'. Years of experience were also associated with the factor 'humour'. Urban respondents had higher scores for the 'support' factor. CONCLUSIONS: The Brief COPE scale is a valid and reliable tool for assessing primary health care nurses' coping. As demographic characteristics impact the coping strategies that nurses use, supports need to be tailored to optimize their impact. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to consider the workforce demographics when designing and implementing support strategies. The Brief COPE can identify current coping strategies and inform interventions to build coping capacity.

Mental health, safety and support during COVID-19: A cross-sectional study of primary health care nurses.

AIM: The aim of this study is to explore primary health care nurses' mental health, concerns and perceived safety and supports during COVID-19. BACKGROUND: Respiratory pandemics have negative impacts on nurses' wellbeing. While literature is replete with hospital nurses' experiences, there is less exploration of COVID-19 impacts on primary health care nurses. Given the importance of primary health care nurses in the health system, understanding their experiences is vital. METHODS: Three hundred and fifty nine primary health care nurses responded to an online cross-sectional survey. The Depression Anxiety Stress Scales (DASS-21) was used to measure emotional state. Data were analysed using descriptive and inferential statistics. RESULTS: DASS-21 scores indicated that 39.6% of participants were experiencing symptoms of depression, anxiety or stress. Of those, 41.8% were experiencing symptoms on one scale, 26.9% were experiencing symptoms on two scales and 31.2% were experiencing symptoms across all three scales. Most participants identified that their feelings were related to COVID-19. CONCLUSIONS: COVID-19 is having a significant impact on primary health care nurses' mental health. Nurse managers need to develop strategies to effectively address nurses' concerns and effectively support them to sustain the workforce during and after the pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Findings from this study can inform the design of effective nurse support programmes to reduce mental health impacts and promote staff wellbeing during the pandemic.

Social value of maintaining baby-friendly hospital initiative accreditation in Australia: case study.

BACKGROUND: Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These were developed to ensure that maternity services remove barriers for mothers and families to successfully initiate breastfeeding and to continue breastfeeding through referral to community support after hospital discharge. While more than three in four births in Australia take place in public hospitals, in 2020 only 26% of Australian hospitals were BFHI-accredited. So what is the social return to investing in BFHI accreditation in Australia, and does it incentivize BFHI accreditation? This study aimed to examine the social value of maintaining the BFHI accreditation in one public maternity unit in Australia using the Social Return on Investment (SROI) framework. This novel method was developed in 2000 and measures social, environmental and economic outcomes of change using monetary values. METHOD: The study was non-experimental and was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital with around 1000 births annually. This facility provided an opportunity to illustrate costs for maintaining BFHI accreditation in a relatively affluent urban population. Stakeholders considered within scope of the study were the mother-baby dyad and the maternity facility. We interviewed the hospital's Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. Analysis was informed by the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. This information was supplemented with micro costing studies from the literature that measure the benefits of the BFHI. RESULTS: The social return from the BFHI in this facility was calculated to be AU$ 1,375,050. The total investment required was AU$ 24,433 per year. Therefore, the SROI ratio was approximately AU$ 55:1 (sensitivity analysis: AU$ 16-112), which meant that every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit. CONCLUSIONS: Scaled up nationally, the BFHI could provide important benefits to the Australian health system and national economy. In this public hospital, the BFHI produced social value greater than the cost of investment, providing new evidence of its effectiveness and economic gains as a public health intervention. Our findings using a novel tool to calculate the social rate of return, indicate that the BHFI accreditation is an investment in the health and wellbeing of families, communities and the Australian economy, as well as in health equity.

Lessons for the global primary care response to COVID-19: a rapid review of evidence from past epidemics.

BACKGROUND: COVID-19 is the fifth and most significant infectious disease epidemic this century. Primary health care providers, which include those working in primary care and public health roles, have critical responsibilities in the management of health emergencies. OBJECTIVE: To synthesize accounts of primary care lessons learnt from past epidemics and their relevance to COVID-19. METHODS: We conducted a review of lessons learnt from previous infectious disease epidemics for primary care, and their relevance to COVID-19. We searched PubMed/MEDLINE, PROQUEST and Google Scholar, hand-searched reference lists of included studies, and included research identified through professional contacts. RESULTS: Of 173 publications identified, 31 publications describing experiences of four epidemics in 11 countries were included. Synthesis of findings identified six key lessons: (i) improve collaboration, communication and integration between public health and primary care; (ii) strengthen the primary health care system; (iii) provide consistent, coordinated and reliable information emanating from a trusted source; (iv) define the role of primary care during pandemics; (v) protect the primary care workforce and the community and (vi) evaluate the effectiveness of interventions. CONCLUSIONS: Evidence highlights distinct challenges to integrating and supporting primary care in response to infectious disease epidemics that have persisted over time, emerging again during COVID-19. These insights provide an opportunity for strengthening, and improved preparedness, that cannot be ignored in a world where the frequency, virility and global reach of infectious disease outbreaks are increasing. It is not too soon to plan for the next pandemic, which may already be on the horizon.

Infectious disease epidemics are increasing in frequency and spread. Primary health care providers are at the forefront of community health care, and have an important role in managing health emergencies such as infectious disease epidemics. It is important to use lessons learnt from past epidemics to inform current health system responses. We examined evidence from past epidemics and identified six key lessons that have emerged in 11 countries during four previous epidemics and again during the COVID-19 pandemic. These lessons highlight the importance of integrating pandemic responses across health care disciplines, strengthening the primary health care system, defining the role of primary care during epidemics, protecting the health care workforce and the community, providing clear and consistent information and evaluating the effectiveness of health care responses. Health system weaknesses are exposed to health emergencies. Identification of these recurring lessons for primary health care provides an opportunity to definitively prepare for future infectious disease epidemics.

'They're getting a taste of our world': A qualitative study of people with multiple sclerosis' experiences of accessing health care during the COVID-19 pandemic in the Australian Capital Territory.

BACKGROUND: People with multiple sclerosis (MS), who are often immunocompromised, require complex care and engage with a variety of health-care providers to manage their health. OBJECTIVE: To elucidate people with MS' experiences of accessing health care during the COVID-19 pandemic in Australia. DESIGN: A qualitative study involving semi-structured interviews and thematic analysis. SETTINGS AND PARTICIPANTS: Eight adults with a clinical diagnosis of MS participated in telephone or video call interviews between June and July 2020. RESULTS: Participants were aware that having MS made them more vulnerable to contracting COVID-19. In some cases, usual care was postponed or not sought. Some circumstances warranted the risk of a face-to-face consultation. Benefits of telehealth consultations included improved access, convenience and being contact-free. In comparison with video consultations, those via telephone were considered less personal and limited capacity to read body language, and for physical examination. Most participants hoped to incorporate telehealth into their future health-care routines. DISCUSSION AND CONCLUSION: Personal risk assessment and trust in health-care professionals are determinants of the mode through which people with MS accessed health care during the COVID-19 pandemic. Telehealth has been a valuable tool to mitigate COVID-19 transmission through enabling contact-free consultations. People with MS may find specific value in video consultations, which enable visualization of physical function. There is a need for training and support for all clinicians to conduct remote consultations. PATIENT OR PUBLIC CONTRIBUTION: This study was conducted by a team comprised of four people with MS, a neurologist and four health services researchers.

The Social Value of Implementing the Ten Steps to Successful Breastfeeding in an Indonesian Hospital: A Case Study.

Background: Despite the known importance of breastfeeding for women's and children's health, global exclusive prevalence among infants under 6 months old is estimated at only 41%. In 2018, Indonesia had a lower exclusive breastfeeding rate of 37% at 6 months postpartum; ranging from 20% to 56%, showing unequal breastfeeding support throughout the country. The World Health Organization (WHO) launched the Ten Steps to Successful Breastfeeding (Ten Steps) in 1989, later embedded in UNICEF's Baby-Friendly Hospital Initiative (BFHI) program in 1991. The BFHI aims to encourage maternity facilities worldwide to ensure adequate education and support for breastfeeding mothers by adhering to the Ten Steps and complying with the International Code of Marketing of Breastmilk Substitutes. An Indonesian survey in 2011 found that less than one in 10 government hospitals implemented the Ten Steps. It has been common for Indonesian health services to collaborate with infant formula companies. While no Indonesian hospitals are currently BFHI-accredited, the WHO/UNICEF Ten Steps (updated in 2018) have been adopted in Indonesia's national regulation of maternity facilities since 2012. Internationally, implementation of the Ten Steps individually and as a package has been associated with benefits to breastfeeding rates and maternal and infant health. However, to date, few studies have examined the impact of implementing the Ten Steps in economic terms. This study aims to measure the economic benefit of Ten Steps implementation in an Indonesian hospital. Methods: The study was conducted in January 2020 in Airlangga University Hospital, Surabaya, Indonesia, which has implemented the Ten Steps since it was established in 2012. To understand and generate evidence on the social value of the Ten Steps, we conducted a "Social Return on Investment (SROI)" study of implementing the Ten Steps in this maternity facility. To estimate the costs relating to the Ten Steps we interviewed the financial and nursing managers, a senior pediatrician, and senior midwife due to their detailed understanding of the implementation of the Ten Steps in the hospital. The interview was guided by a questionnaire which we developed based on the 2018 WHO/UNICEF Ten Steps to Successful Breastfeeding. The analysis was supported with peer-reviewed literature on the benefits of Ten Steps breastfeeding outcomes. Results: The total per annum value of investment (cost) required to implement Ten Steps in Airlangga University Hospital was US$ 972,303. The estimate yearly benefit was US$ 22,642,661. The social return on the investment in implementing Ten Steps in this facility was calculated to be US$ 49 (sensitivity analysis: US$ 18-65). Thus, for every US$ 1 invested in Ten Steps implementation by Airlangga Hospital could be expected to generate approximately US$ 49 of benefit. Conclusions: Investment in the Ten Steps implementation in this Surabaya maternity facility produced a social value 49 times greater than the cost of investment. This provides novel evidence of breastfeeding as a public health tool, demonstrating the value of the investment, in terms of social impact for mothers, babies, families, communities, and countries. Breastfeeding has the potential to help address inequity throughout the lifetime by providing the equal best start to all infants regardless of their background. Indonesia's initial moves towards implementing the WHO/UNICEF Ten Steps can be strengthened by integrating all elements into the national regulation and health care system.

'It struck at the heart of who I thought I was': A meta-synthesis of the qualitative literature examining the experiences of people with multiple sclerosis.

BACKGROUND: People with multiple sclerosis (MS) have varied experiences and approaches to self-management. This review aimed to explore the experiences of people with MS, and consider the implications of these experiences for clinical practice and research. METHODS: A meta-synthesis of the qualitative literature examining experiences of people with MS was conducted using systematic searches of ProQuest, PubMed, CINAHL and PsycINFO. We incorporated feedback from team members with MS as expert patient knowledge-users to capture the complex subjectivities of persons with lived experience responding to research on lived experience of the same disease. RESULTS: Of 1680 unique articles, 77 met the inclusion criteria. We identified five experiential themes: (a) the quest for knowledge, expertise and understanding, (b) uncertain trajectories (c) loss of valued roles and activities, and the threat of a changing identity, (d) managing fatigue and its impacts on life and relationships, and (f) adapting to life with MS. These themes were distributed across three domains related to disease (symptoms; diagnosis; progression and relapse) and two contexts (the health-care sector; and work, social and family life). CONCLUSION: The majority of people in the studies included in this review expressed a determination to adapt to MS, indicating a strong motivation for people with MS and clinicians to collaborate in the quest for knowledge. Clinicians caring for people with MS need to consider the experiential and social outcomes of this disease such as fatigue and the preservation of valued social roles, and incorporate this into case management and clinical planning.

General practice nurses' communication strategies for lifestyle risk reduction: A content analysis.

AIMS: To explore how general practice nurses (GPNs) communicate lifestyle risk reduction with patients presenting for chronic disease consultations. DESIGN: Qualitative content analysis of video observations. METHODS: The audio of 14 video-recorded GPN chronic disease management (CDM) consultations were transcribed verbatim. Deductive content analysis was undertaken using the exploring, guiding, and choosing model, an adaptation of steps used in motivational interviewing (MI). Data collection occurred between August 2017 - March 2018. RESULTS: General practice nurses demonstrated relational skills including the use of open-ended questions, content reflections, and affirmations. However, greater use of collaborative agenda setting, double-sided reflections, summarizing patient priorities, and 'importance and confidence scales' could enhance discussions about lifestyle risk reduction. CONCLUSION: Although GPNs were using some MI techniques, there was room for skill development. Enhancing GPNs' MI skills has the potential to optimize their effectiveness in communicating about lifestyle risk reduction and the reduction of chronic disease. Ongoing professional development in MI skills and lifestyle risk communication needs to be supported by nurses, workplaces, and educational providers. IMPACT: This study has identified GPNs' strengths and challenges in relation to lifestyle risk communication. Fostering these skills has the potential to reduce risk of lifestyle attributable chronic disease.

Lifestyle risk factor communication by nurses in general practice: Understanding the interactional elements.

AIM: This paper seeks to explore general practice nurses' perceptions of interactional factors supporting communication with patients about lifestyle risk. DESIGN: Qualitative descriptive study embedded in a concurrent mixed methods design. METHODS: Fifteen Australian general practice nurses were interviewed following video-recorded chronic disease management consultations between August 2017 - March 2018. RESULTS: The theme of 'Interactional Factors' comprised of the subthemes 'Relational factors' and 'Patient factors'. Relational factors referred to communication techniques and methods supporting temporal continuity with patients about lifestyle risk. Patient factors included consumers' motivation, willingness, and readiness to prioritize lifestyle changes. Lack of awareness of the nurses' role was perceived to have an impact on initiation of lifestyle risk conversations. CONCLUSION: Strategies optimizing continuity of nursing care enhance the capacity for lifestyle risk reduction conversations with patients. Ongoing training in patient-centred communication and increasing patients' awareness of general practice nurses' roles would also better support these discussions. IMPACT: This research identifies ways the general practice nurses' role in supporting lifestyle risk reduction can be improved. Optimizing the general practice nurses' role in lifestyle risk communication can enhance the behaviour change and chronic disease management.

Nonverbal communication between registered nurses and patients during chronic disease management consultations: Observations from general practice.

AIMS AND OBJECTIVES: This study explores nonverbal communication behaviours between general practice nurses and patients during chronic disease consultations. BACKGROUND: Nonverbal communication is an important aspect of nurse-patient lifestyle risk reduction conversations. Despite the growing role of general practice nurses in lifestyle risk modification when managing chronic disease, few studies have investigated how this communication occurs. DESIGN: Observational study within a concurrent mixed methods project. METHODS: Thirty-six consultations by 14 general practice nurses were video-recorded between August 2017 and March 2018. Video analysis used the Nonverbal Accommodation Analysis System. The STROBE checklist was used to guide this paper. RESULTS: Joint convergence of nurse-patient behaviours such as laughing, smiling and eye contact was most common (44%; n = 157). Patient-nurse eye contact time decreased significantly across the consultation, while nurse gesturing increased significantly. No significant relationship between consultation length and convergent to divergent behaviour categorisation or nurse-computer use across the consultation was found. CONCLUSIONS: The high levels of convergent behaviours are promising for person-centred care. However, scope exists to enhance nonverbal interactions around lifestyle risk reduction. Supporting nurses with skills and improved environments for lifestyle risk communication has potential to improve therapeutic relationships and patient outcomes. RELEVANCE TO CLINICAL PRACTICE: These results indicate that nurses support patients through nonverbal interactions during conversations of lifestyle risk reduction. However, there are opportunities to improve this practice for future interventions.

Developing a positive patient experience with nurses in general practice: An integrated model of patient satisfaction and enablement.

AIM: To develop a conceptual model that provides a comprehensive understanding of the structures and processes underpinning patient enablement and satisfaction in general practice nurse consultations. BACKGROUND: Current evidence regarding patient satisfaction and enablement arising from general practice nursing care is either quantitative or qualitative. To date, no studies have integrated the results of mixed methods research to provide a deeper understanding of processes that facilitate their achievement. DESIGN: A concurrent mixed methods study. METHODS: Our 2013-2014 concurrent mixed methods study comprised a quantitative study that analysed variables identified in interviews with general practice nurses, patients and practice managers with data from a cross-sectional survey of 678 patients receiving nursing care in 21 general practices; and a qualitative study that used a grounded theory approach to in-depth interviews with nurses and patients from these same practices. Using joint displays, we compared and integrated the results of the multilevel analyses and the grounded theory model derived from these studies. FINDINGS: We conceptualized a model-'developing a positive patient experience with nurses in general practice'-in which time, continuity of care, nursing scope of practice and autonomy, and patients' health conditions provide platforms for the processes of triggering healthcare partnerships and tailoring care in nurse consultations. CONCLUSION: This model builds on previous evidence describing processes and characteristics that optimize the quality of care in general practice nurse consultations. It provides a practical tool to inform education and training for general practice nurses and other clinicians.

The process of patient enablement in general practice nurse consultations: a grounded theory study.

AIM: The aim of this study was to gain insight into the process of patient enablement in general practice nursing consultations. BACKGROUND: Enhanced roles for general practice nurses may benefit patients through a range of mechanisms, one of which may be increasing patient enablement. In studies with general practitioners enhanced patient enablement has been associated with increases in self-efficacy and skill development. DESIGN: This study used a constructivist grounded theory design. METHODS: In-depth interviews were conducted with 16 general practice nurses and 23 patients from 21 general practices between September 2013 - March 2014. Data generation and analysis were conducted concurrently using constant comparative analysis and theoretical sampling focussing on the process and outcomes of patient enablement. Use of the storyline technique supported theoretical coding and integration of the data into a theoretical model. FINDINGS: A clearly defined social process that fostered and optimised patient enablement was constructed. The theory of 'developing enabling healthcare partnerships between nurses and patients in general practice' incorporates three stages: triggering enabling healthcare partnerships, tailoring care and the manifestation of patient enablement. Patient enablement was evidenced through: 1. Patients' understanding of their unique healthcare requirements informing their health seeking behaviours and choices; 2. Patients taking an increased lead in their partnership with a nurse and seeking choices in their care and 3. Patients getting health care that reflected their needs, preferences and goals. CONCLUSIONS: This theoretical model is in line with a patient-centred model of health care and is particularly suited to patients with chronic disease.

Usability of patient experience surveys in Australian primary health care: a scoping review.

Monitoring patient experience is essential for stimulating innovation in health care and improving quality and accountability. Internationally, standardised approaches are used to collect patient experience information, but in Australian primary health care (PHC), little is known about which patient experience surveys are used and which aspects of experience they measure. This prevents routine inclusion of patient experience data in quality improvement or system performance measurement. A scoping review was undertaken to identify relevant surveys. Data on survey availability, psychometric properties, target population, method and frequency of administration were extracted. Survey items were mapped against six dimensions of patient experience described internationally. Ninety-five surveys were identified; 34 were developed for use in Australia. Surveys vary in content, size, aspects of experience measured and methods of administration. The quality of data collected and the extent to which it is used in quality improvement is unclear. Collection of patient experience data in Australian PHC is not well developed or standardised and there are few publicly available instruments. There is a need to clearly identify the purposes for which data are to be used and to develop an integrated approach that articulates these collections with other quality and performance data. Some options are discussed.