Exploring nurse practitioner practice in Australian rural primary health care settings: A scoping review.

INTRODUCTION: Australians in rural areas experience limited access to services and poorer health outcomes than residents of metropolitan areas. Nurse practitioners (NPs) were introduced in 2000 to reduce pressure on the health system, address workforce shortages and improve rural populations' access to health care services. OBJECTIVE: This scoping review sought to identify, examine and synthesise research evidence of NP practice in Australian rural primary health care services to better understand how NPs are addressing service gaps in rural areas and to identify existing gaps in our knowledge. DESIGN: Peer-reviewed and grey literature from July 2012 to June 2022 was accessed from seven electronic databases, grey literature and hand searching of reference lists and citations. FINDINGS: From 154 articles, 19 articles of relevance were identified. Several projects describe the processes required for success, whilst others reported the challenges and barriers encountered. Limited research evidence of rural NP practice exists with a significant gap about how roles operate and their value in primary health care. DISCUSSION: Uptake and envisaged benefits of rural primary health care NP roles have yet to be realised, with barriers to implementing and sustaining NP roles persisting. Low-level awareness with ambiguity at health service and community level adversely impact on systematic implementation of NP roles. CONCLUSIONS: Robust evaluations demonstrating the value of NP skills and practice are needed in combination with bipartisan support from all levels of health care and government providing adequate funding to enable effective implementation of NP roles in poorly resourced rural areas.

Re-orientating health and nursing care: a qualitative study on indigenous conceptualisations of wellbeing.

BACKGROUND: Health systems often fail to address the wellbeing needs of older Indigenous populations; this is attributed to a lack of knowledge of Indigenous health systems arising from a privileging of dominant western biomedical epistemologies. In Aotearoa/New Zealand, there is a dearth of nursing knowledge relating to Maori, which negatively impacts on the provision of holistic nursing care. This research explores insights and perspectives of older Maori adult's (pakeke) perceptions of wellbeing so nurses can provide culturally responsive care and support the wellbeing of Indigenous New Zealanders. METHODS: An Indigenous kaupapa Maori methodology underpinned and directed this research project. Audio-recorded interviews were conducted face to face in participants' homes, marae (meeting house) and workplaces. Pakeke over the age of 55 participated in in-depth interviews. A total of 10 pakeke were interviewed and narratives were thematically analysed in accordance with meanings derived from Maori worldviews. RESULTS: Wellbeing was attributed to the holistic interconnection and balancing of whanau (wider family), whanaungatanga (social connectedness), hinengaro (mental and emotional wellbeing), taha tinana (physical wellbeing) and wairua (spirituality). CONCLUSION: The findings offer unique insights into how wellbeing is constructed for pakeke; the results are unique but consistent with international accounts of older Indigenous peoples. Pakeke wellbeing can be supported by acknowledging existing cultural and spiritual beliefs and peer-support initiatives. Nursing models of care should prioritise Indigenous ways of knowing; this research offers nursing-focused recommendations to improve care.

Social connectedness and self-perceived health of older adults in New Zealand.

The objective of this research was to explore social connectedness and associations with self-perceived health amongst older adults in New Zealand at a population level. The data for this analysis were derived from the 2016 Health and Lifestyle Survey, a nationally representative survey administered via face-to-face interviews. The findings from this analysis of 1,374 respondents, all of whom were over the age of 55 years, highlight that being female, belonging to older age groups (above 70 years), being employed full-time or part-time, connecting online with known people, considering cultural connections to be important and not feeling isolated from others are significantly and positively associated with positive self-perceived health. The findings underscore the resilience potential of older adults and importance of social connectedness for positive health and well-being. In addition, the findings reveal target areas that would benefit by intervention and support by health professionals and policy makers.

The 'work' of self-care for people with cardiovascular disease and prediabetes: An interpretive description.

BACKGROUND: Cardiovascular disease and sustained high blood glucose (prediabetes) are established concurrent diagnoses. People with these concomitant conditions carry out self-care which is overt (e.g., daily weighing or taking a specific diet), plus there are also concealed facets of self-care (e.g., accessing information about diet or medications). Also of note is the need to 'work' to achieve a self-determined level of self-care. The 'work' put into self-care is currently under-reported when people discuss their progress with health professionals. OBJECTIVE: Our research aimed to demonstrate that aspects of self-care are typically concealed. A further objective was to reveal the extent of 'work' dedicated to self-care. DESIGN: Interviews were conducted with 23 participants to reveal their experiences of long-term conditions, cardiovascular disease and prediabetes. Interpretive description underpinned the development of a thematic representation of the data. SETTING AND PARTICIPANTS: Recruitment was from a tertiary hospital coronary care unit in New Zealand. Included participants were those with an acute coronary event, also found to have a high blood glucose. Those people known to have diabetes prior to admission were not included. METHOD: Participants were interviewed once, for approximately 60 min, nine months after discharge home. The data is analysed using thematic analysis, organising an interpretation into themes. RESULTS: Self-care requires 'work', the work itself was frequently understated by participants, they trivialised their important role in their self-care. Participants often required prompting to discuss the responsibilities, choices and behaviours they participated in to support self-care to improve their health and well-being. Participant data showed how the 'work' of self-care aligned to three work themes: solo self-care, teamwork, and constant companion self-care. CONCLUSION: Nurses can improve the outcomes for people with long-term conditions by acknowledging and incorporating the often concealed 'work' of self-care when assessing, planning and implementing health care in any clinical setting. A important recommendation for nurses is to support people-as-patients, by encouraging self-determination and working with the preferences patients have for self-care, in order to enhance their quality of life while living with ill-health.

Home-based chemically induced whitening (bleaching) of teeth in adults: A summary of a systematic review.

The demand for whiter teeth has been increasing, and home-based remedies are a popular way of whitening the teeth. These products may be prescribed by the dentist or purchased over the counter and comprise different modes to whiten the teeth and are administered in a range of ways by the person. This review found that the evidence was insufficient to draw reliable conclusions about the intervention, i.e., the use of these whitening products. The results indicated that people may experience side effects that irritate the mouth and gums. Therefore, nurses should direct people who are interested in teeth whitening to their dental professional for a discussion.

Circuit class therapy for improving mobility after stroke: A Cochrane review summary.

After a stroke, people characteristically experience a loss of function. Reviewers (English et al., 2017) provide evidence-based insights into the value of instigating CCT into post-stroke rehabilitation. The review examines the effectiveness of CCT for people who have experienced stroke. The meta-analysis includes seventeen trials comprising 1297 participants. Results demonstrate that CCT is a worthwhile intervention to establish and support mobility post-stroke. The primary effect of CCT was to improve walking capacity, measured by a walk test. CCT improves gaining independence in activities of daily living.

Home to die from the intensive care unit: A qualitative descriptive study of the family's experience.

BACKGROUND: Many people would choose to die at home, and this can be an option for intensive care patients. However, there is limited exploration of the impact on the family. AIM: To gain insight into family members' experiences when an adult intensive care unit patient is taken home to die. METHODS: Methodology is qualitative description, utilising purposeful sampling, unstructured interviews and thematic analysis. Four participants, from two different families were interviewed. The setting was a tertiary level Intensive Care Unit in New Zealand. FINDINGS: The experience was described as a kaleidoscope of events with two main themes: 'value' family member's found in the patient going home, and their experience of the 'process'. 'Value' subthemes: going home being the patient's own decision, home as an end-of-life environment, and the patient's positive response to being at home. 'Process' subthemes: care and support received, stress of a family member being in intensive care, feeling that everything happened quickly, and concerns and uncertainties. CONCLUSION: Going home to die from the intensive care unit can be a positive but challenging experience for the family. Full collaboration between the patient, family and staff is essential, to ensure the family are appropriately supported.

Cardiovascular disease and prediabetes as complex illness: People's perspectives.

Cardiovascular disease (CVD) and sustained high blood glucose as prediabetes are an established comorbidity. People's experience in reconciling these long-term conditions requires deeper appreciation if nurses are to more effectively support person-centred care for people who have them. Our analysis explores the initial experience of people admitted to hospital with CVD who then find they also have sustained high blood glucose. Our methodology is informed by the philosophy of Gadamer and applies interpretive description to develop an interpretation of participant experiences. The major theme emerging from participant interviews was the 'invisible disequilibrium' characterised by three subthemes: 'losing equilibrium', 'becoming embattled' and 'evolving illness'. This study examines CVD and prediabetes in conjunction with the Gadamerian notion of the 'whole', as being in a social and emotional world in which illness is also a component part. We explore how participants lived within an 'invisible disequilibrium', with prediabetes frequently remaining unnoticed, while CVD was manifest. To identify multiple conditions and support effective intervention to manage them as part of person-centric care, nursing practice should explore the 'whole' of the person's experience, value people's knowledge as potential indicators of complex illness, thereby reducing the risk of accelerating complex illness.

Building confidence: an exploration of nurses undertaking a postgraduate biological science course.

UNLABELLED: This study aimed to explore the impact of studying biological science at a postgraduate level and how this impacted on nursing practice. The term biological sciences in this research encompasses elements of physiology, genetics, biochemistry and pathophysiology. METHOD: A qualitative research study was designed, that involved the dissemination of a pre- and post-course semi-structured questionnaire for a biological science course, as part of a Master of Nursing programme at a New Zealand University, thus exploring the impact of undertaking a postgraduate biological sciences course. The responses were analysed into themes, based on interpretive concepts. RESULTS: The primary themes revealed improvement in confidence as: confidence in communication, confidence in linking nursing theoretical knowledge to practice and confidence in clinical nursing knowledge. CONCLUSION: This study highlights the need to privilege clinically-derived nursing knowledge, and that confidence in this nursing knowledge and clinical practice can be instilled through employing the model of theory-guided practice.

Parenting a child with medically diagnosed severe food allergies in New Zealand: the experience of being unsupported in keeping their children healthy and safe.

AIMS: To explore parental experiences of caring for a child with medically diagnosed severe food allergies (MDSFA) in New Zealand. METHOD: This study employed a qualitative methodology, interpretive descriptive analysis, and involved interviews with four parents of children with MDSFA from two different regions in New Zealand. RESULTS: The analysis of the interviews revealed that the experience of parenting a child with MDSFA is an experience of feeling unsupported in the effort to keep the child healthy and safe. Three major themes emerge from this study: the experience of isolation, the burden of accessing resources, and the cost of living with MDSFA. CONCLUSION: The general lack of support experienced by these families from health care professionals is a significant concern both for primary and tertiary health care providers. Multi-disciplinary support is required for these families, and currently there is a lack of health care professionals with the knowledge to support these families. This research highlights that there is a significant need for both workforce development and further research in the area of MDSFA in New Zealand.

Perioperative influences on fluid distribution.

Surgery triggers neuroendocrine, metabolic, and immunologic responses, with considerable effects on normal fluid distribution. Of clinical significance to the nurse is the distribution of fluids from the vascular space during the immediate postoperative period, and their return to the circulation approximately 48 to 72 hours later. Understanding the physiological and clinical significance of fluid shifts during the perioperative period allows the nurse to provide effective patient care.