What do Australian primary care clinicians need to provide long-acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice.

BACKGROUND: Uptake of long-acting reversible contraception (LARC) is lower in Australia compared with other high-income countries, and access to early medical abortion (EMA) is variable with only 11% of general practitioners (GPs) providing EMA. The AusCAPPS (Australian Contraception and Abortion Primary Care Practitioner Support) Network is a virtual community of practice established to support GPs, nurses and pharmacists to provide LARC and EMA in primary care. Evaluating participant engagement with AusCAPPS presents an opportunity to understand clinician needs in relation to LARC and EMA care. METHODS: Data were collected from July 2021 until July 2023. Numbers of online resource views on AusCAPPS were analysed descriptively and text from participant posts underwent qualitative content analysis. RESULTS: In mid-2023 AusCAPPS had 1911 members: 1133 (59%) GPs, 439 (23%) pharmacists and 272 (14%) nurses. Concise point-of-care documents were the most frequently viewed resource type. Of the 655 posts, most were created by GPs (532, 81.2%), followed by nurses (88, 13.4%) then pharmacists (16, 2.4%). GPs most commonly posted about clinical issues (263, 49% of GP posts). Nurses posted most frequently about service implementation (24, 27% of nurse posts). Pharmacists posted most about health system and regulatory issues (7, 44% of pharmacist posts). CONCLUSIONS: GPs, nurses and pharmacists each have professional needs for peer support and resources to initiate or continue LARC and EMA care, with GPs in particular seeking further clinical education and upskilling. Development of resources, training and implementation support may improve LARC and EMA provision in Australian primary care.

Models of care for intrauterine device provision in Australian general practice.

BACKGROUND AND OBJECTIVES: Intrauterine devices (IUDs) are safe and effective forms of long-acting reversible contraception. However, uptake in Australia is low. Although general practitioners (GPs) manage contraceptive provision, little is known about IUD service delivery. This study aims to describe the models of care (MoC) used in the provision of IUDs by Australian GPs. METHOD: Semistructured telephone interviews were conducted with 20 GP IUD providers nationwide. Data were deidentified, transcribed, thematically analysed and evaluated using The Royal Australian College of General Practitioners' Quality framework for Australian general practice. RESULTS: Three MoC were described: common, streamlined and same-day insertion. The common model involved three to four appointments but was of the lowest quality. The streamlined MoC had a maximum of two appointments. Few GPs delivered same-day insertion. Task-sharing and adaptable MoC were identified. DISCUSSION: The quality of current MoC for IUD provision is non-standardised and largely inadequate. Increased GP awareness about and operation of high-quality MoC will enhance IUD access.

Interconception care in Australian general practice: a qualitative study.

BACKGROUND: GPs provide care for women across the lifespan. This care currently includes preconception and postpartum phases of a woman's life. Interconception care (ICC) addresses women's health issues between pregnancies that then have impact on maternal and infant outcomes, such as lifestyle and biomedical risks, interpregnancy intervals, and contraception provision. However, ICC in general practice is not well established. AIM: To explore GP perspectives about ICC. DESIGN AND SETTING: Qualitative interviews were undertaken with GPs between May and July 2018. METHOD: Eighteen GPs were purposively recruited from South-Eastern Australia. Audiorecorded semi- structured interviews were transcribed verbatim and analysed thematically using the Framework Method. RESULTS: Most participants were unfamiliar with the concept of ICC. Delivery was mainly opportunistic, depending on the woman's presenting need. Rather than a distinct and required intervention, participants conceptualised components of ICC as forming part of routine practice. GPs described many challenges including lack of clarity about recommended ICC content and timing, lack of engagement and perceived value from mothers, and time constraints during consultations. Facilitators included care continuity and the availability of patient education material. CONCLUSION: Findings indicate that ICC is not a familiar concept for GPs, who feel that they have limited capacity to deliver such care. Further research to evaluate patient perspectives and potential models of care is required before ICC improvements can be developed, trialled, and evaluated. These models could include the colocation of multidisciplinary services and services in combination with well-child visits.

Women's needs for lifestyle risk reduction engagement during the interconception period: a scoping review.

BACKGROUND: Unhealthy lifestyle is responsible for many chronic conditions, and antenatal engagement with women about lifestyle behaviours can be too late to prevent some adverse pregnancy outcomes and subsequent childhood risks. To reduce the risk of future adverse outcomes, the interconception period is an opportunity to implement positive health changes. The aim of this scoping review was to explore women's needs for lifestyle risk reduction engagement during the interconception period. METHODS: The JBI methodology guided our scoping review. Six databases were searched for peer-reviewed, English-language research papers published between 2010 and 2021 on topics including perceptions, attitudes, lifestyle, postpartum, preconception and interconception. Title-abstract and full text screening was independently undertaken by two authors. Included papers' reference lists were searched to find additional papers. The main concepts were then identified using a descriptive and tabular approach. RESULTS: A total of 1734 papers were screened and 33 met our inclusion criteria. Most included papers (82%, n=27) reported on nutrition and/or physical activity. Papers identified interconception through postpartum and/or preconception. Women's self-management needs for lifestyle risk reduction engagement during interconception included: informational needs, managing competing priorities, physical and mental health, self-perception and motivation, access to services and professional support, and family and peer networks. CONCLUSIONS: There is a range of challenges for women to engage in lifestyle risk reduction during interconception. To enable women's preferences for how lifestyle risk reduction activities can be enacted, issues including childcare, ongoing and tailored health professional support, domestic support, cost and health literacy need to be addressed.

Impacts of the 2019/20 bushfires and COVID-19 pandemic on the physical and mental health of older Australians: a cross-sectional survey.

BACKGROUND: In 2019/20 major bushfires devastated Australia's East Coast. Shortly afterward the COVID-19 pandemic was declared. Older people are disproportionately affected by disasters and are at high risk from respiratory pandemics. However, little is known about how these events impact on older peoples' health and well-being and engagement with services such as primary care. OBJECTIVE: To explore the health impacts of the 2019/20 bushfires and the COVID-19 pandemic on older Australians' health and well-being. METHODS: One hundred and fifty-five people aged over 65 years living in South-eastern New South Wales, Australia participated in an online survey. The survey measured the impacts of the bushfires and COVID-19 on physical and mental health and the capacity of older people to manage these impacts. RESULTS: Most respondents felt that the bushfires caused them to feel anxious/worried (86.2%) and negatively affected their physical (59.9%) and mental (57.2%) health. While many participants had similar feelings about COVID-19, significantly fewer felt these physical and mental health impacts than from the bushfires. A significantly greater perceived level of impact was observed for females and those with health problems. More respondents described negative mental health than physical health effects. Those who felt more impacted by the events had lower levels of resilience, social connection and support, and self-rated health. CONCLUSION: The health impacts identified in this study represent an opportunity for primary care to intervene to both ensure that people with support needs are identified and provided timely support and that older people are prepared for future disasters.

Increasing the availability of long-acting reversible contraception and medical abortion in primary care: the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) cohort study protocol.

INTRODUCTION: Although primary care practitioners are the main providers of long-acting reversible contraception (LARC) and early medical abortion (EMA) in Australia, few provide these services. A professional community of practice (CoP) has the potential to improve LARC and EMA provision through evidence-based guidance, expert support and peer-to-peer engagement.The primary objective is to establish, implement and evaluate an innovative, multidisciplinary online CoP (AusCAPPS Network) to increase LARC and EMA services in Australian primary care. Secondary objectives are to (1) increase the number of general practitioners (GPs) and pharmacists certified to provide or dispense EMA, respectively, (2) increase LARC and EMA prescription rates and, (3) improve primary care practitioners' knowledge, attitudes and provision of LARC and EMA. METHODS AND ANALYSIS: A stakeholder knowledge exchange workshop (KEW) will be conducted to inform the AusCAPPS Network design. Once live, we aim to reach 3000 GPs, practice nurses and community pharmacists members. Changes in the number of GPs and pharmacists certified to provide or dispense EMA, respectively, and changes in the number of LARCs and EMAs prescribed will be gleaned through health service data. Changes in the knowledge attitudes and practices will be gleaned through an online survey with 500 individuals from each professional group at baseline and 12 months after members have joined AusCAPPs; and experiences of the AusCAPPS Network will be evaluated using interviews with the project team plus a convenience sample of 20 intervention participants from each professional group. The project is underpinned by the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, and a realist framework will inform analysis. ETHICS AND DISSEMINATION: Ethical approval was received from the Monash University Human Research Ethics Committee (No. 28002). Dissemination will occur through KEWs, presentations, publications and domestic and international networks. TRIAL REGISTRATION NUMBER: ACTRN12622000655741.

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.

The impact of COVID-19 on the delivery of care by Australian primary health care nurses.

This qualitative study describes the impact of the first wave of the COVID-19 pandemic on the provision of care by Australian primary health care (PHC) nurses. Participants were purposefully recruited following completion of a national survey about PHC nurses' experiences during the pandemic. Twenty-five semi-structured interviews were conducted by two experienced researchers and professionally transcribed. The mean duration of interviews was 38.5 min. Thematic analysis revealed three themes about the impact of COVID-19 on PHC nurses' provision of care. These were: workplace adjustments, changes in healthcare delivery and concerns about long-term health impacts of COVID-19. The sudden disruption and de-stabilisation of care delivery was reported as significantly impacting on initial service provision, although participants reported adapting quickly and finding new ways to deliver care. The impact of the pandemic on high risk communities and mental health support needs of clients created additional challenges, although some participants reported positive outcomes such as increased confidence of some clients to provide self-care. There were concerns about the potential long-term health impact on communities due to reduced levels of cancer screening, disrupted management of chronic conditions and reduced opportunistic health assessments. Findings from this study demonstrated how PHC nurses played an important role in the continued provision of PHC by adapting quickly to changed circumstances, adjusting and modifying clinical activities, and by monitoring for future potential negative outcomes from the pandemic. These findings are important for the future management of pandemics and inform the long-term planning of PHC services.

The impact of COVID-19 on primary health care delivery in Australia.

AIMS: To validate the 'safe and effective staffing tool' and explore the impact of COVID-19 on the quality of Australian primary health care (PHC). DESIGN: A national survey was conducted from October to December 2020. METHODS: The online survey was distributed via social media and professional organisations to PHC nurses. RESULTS: Three-hundred fifty-nine PHC nurses participated. A two-factor solution was found with factors named; 'Perception of quality of care provided' and 'Personal satisfaction with care delivered'. Cronbach's alpha demonstrated good internal consistency for the total scale (α = .915) and each subscale (α = .879/α = .864). Nearly three-quarters of participants (71.3%) were satisfied with the quality of care they delivered. Participants working in general practice, and those with more nursing experience had significantly higher scores in the factor 'perceptions of quality of care provided' and the total 'quality and satisfaction with care'. A lack of time, inadequate supervision and support, and performing non-nursing duties were reported to be impacting care quality. Most participants (80.5%) reported that COVID-19 had impacted negatively on the detection and management of non-COVID related health conditions. CONCLUSION: The 'safe and effective staffing tool' is a valid and reliable measure of perceived quality of care and satisfaction with care delivered. Many PHC nurses perceive that there has been an overall reduction in the quality of care delivered due to COVID-19 and feel that there is a lack of adequate supervision and workplace support. Given the limited baseline data, further research is required to understand the extent that COVID-19 impacts these findings. However, this study demonstrates that strategies need to be implemented to support PHC nurses to provide high-quality care to optimise health outcomes and maintain nurse satisfaction. IMPACT: This is the first attempt to evaluate care quality in Australian PHC. Policymaking requires this evidence to drive changes to better support PHC nurses.

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.

Primary Health Care Nurses' Perceptions of Risk During COVID-19: A Qualitative Study.

PURPOSE: COVID-19 has presented health care professionals with unprecedented challenges. Significant risks have emerged as nurses have continued to work in delivering frontline health care during the pandemic. Feeling "at risk" has significant deleterious effects on nurses. The study sought to explore the perceptions of risk by Australian primary health care nurses (PHC) during COVID-19. METHODS: Twenty-five Australian PHC nurses were purposively recruited from survey respondents who indicated a willingness to be interviewed. Phone interviews were undertaken between June and August 2020. Audio-recordings were transcribed and analyzed thematically. FINDINGS: Participants shared concerns about risks in the workplace that emerged during COVID-19 and described the strategies used to mitigate these identified risks. Three themes were identified: (a) Professional concerns, (b) Personal/family concerns, and (c) Patient needs. CONCLUSIONS: Understanding PHC nurses' perceptions of risk during COVID-19 provides an important insight into how they can be better supported to manage the risks that they face and feel safer in their workplace. Ensuring that PHC nurses are well-supported is important to optimize job satisfaction, reduce burnout and improve patient care. CLINICAL RELEVANCE: There is a need to ensure that nurses feel safe during crises such as pandemics to protect both individual nurses and the broader workforce. Protecting the health workforce is essential to optimizing service delivery and promoting health outcomes.

Experiences of Australian primary healthcare nurses in using telehealth during COVID-19: a qualitative study.

OBJECTIVE: This study sought to explore the experiences of Australian primary healthcare (PHC) nurses in the use of telehealth during COVID-19. Telehealth was defined as the use of any telecommunications mode (eg, telephone and videoconferencing) to deliver healthcare. DESIGN AND SETTING: Thematic analysis of qualitative interviews undertaken in Australian PHC. PARTICIPANTS: Twenty-five PHC nurses who had participated in a national survey about their experiences during COVID-19 were recruited using purposive sampling. METHODS: Semistructured telephone interviews were conducted from June to August 2020. Interviews lasted a mean of 38.5 min. They were audio-recorded and transcribed before thematic analysis was undertaken. The consolidated criteria for reporting qualitative research were followed. RESULTS: Four overarching themes were identified: preparedness, accessibility of telehealth, care experience and impacts on the PHC nurses' role. Some nurses were experienced in the use of telehealth, while others indicated a lack of preparation and limited appropriate technology to support its use. Telehealth enabled patients to access care but did not support complex clinical assessment. Participants indicated that patient engagement in telehealth was dependent on access and confidence using technology, perceived safety when physically attending the practice and the value they placed on care via telehealth. Many participants expressed frustration about telehealth funding and its impact on facilitating nurses to practise to their full scope. CONCLUSION: Telehealth has provided a means to continue PHC service delivery during COVID-19. While there are advantages to adopting this technology, considerations of the challenges and lessons from this experience are important to inform the future implementation of telehealth initiatives.

The psychological well-being of primary healthcare nurses during COVID-19: A qualitative study.

AIM: To explore primary healthcare nurses' psychological well-being related to the COVID-19 pandemic. DESIGN: Qualitative descriptive study. METHODS: Semi-structured interviews were conducted with 25 participants between June and August 2020 who indicated their willingness to participate in an interview following a national survey. Interviews were audio-recorded and transcribed verbatim by professional transcribers. Data were analysed using thematic analysis. RESULTS: The importance of professional and public support and acknowledgement of the nurses' role during the pandemic positively influenced feelings of being valued. The psychological impact of negative experiences increased anxiety and stress levels. Participants reported a range of self-care strategies, including increased vigilance with infection control at home and work and attention to physical exercise and diet. Most participants remained positive about their roles and career decisions, although some indicated that the negative psychological impacts prompted re-evaluation of their career. CONCLUSIONS: Primary healthcare nurses have been exposed to a range of personal and professional stressors during the pandemic that have impacted their psychological well-being. Awareness of stressors and an understanding of what has helped and what has impacted well-being are important in guiding future workplace support systems. Further work to explore the long-term impact of these stressors and the effectiveness of coping strategies employed by primary healthcare nurses is warranted. IMPACT: Managers and professional organisations need to consider the personal and professional stressors that have impacted on primary healthcare nurses' psychological well-being to promote health and well-being among nurses following COVID-19.

Barriers and facilitators to lifestyle risk communication by Australian general practice nurses.

Lifestyle risk factors are antecedents to many chronic conditions and are largely modifiable. Health professional support is often sought to reduce lifestyle risk. The ongoing relationship general practice nurses typically have with patients situates them ideally to provide this support. This paper explores the barriers and facilitators to lifestyle risk communication by registered nurses (RNs) in Australian general practice. Fifteen general practice RNs from south-eastern Australia participated in semistructured interviews. Verbatim transcriptions of the audio-recorded interviews were analysed using thematic analysis. Six themes emerged in terms of perceived barriers and facilitators: educational preparation and confidence; organisational and funding arrangements; lifestyle risk prioritisation; organisational support; autonomous roles; and supporting patients' needs. Although communication about lifestyle risk factors is within the general practice nurses' scope of practice, concerted efforts fostering interdisciplinary collaboration, the prioritisation of time, funding and educational opportunities would better support this role, at the same time optimising chronic disease management and patient outcomes.

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.

The Experiences of Primary Healthcare Nurses During the COVID-19 Pandemic in Australia.

PURPOSE: The COVID-19 pandemic has presented an international health crisis of a scope not seen in our lifetime. While much attention has been paid to health workers in critical care and acute areas, nurses working outside of hospitals are also significantly affected. This study sought to investigate the experience of nurses working in Australian primary healthcare during the COVID-19 pandemic. In particular, it sought to understand the implications on their employment status, role, and access to personal protective equipment. DESIGN AND METHODS: Nurses employed in primary healthcare across Australia were invited to participate in a cross-sectional online survey through social media and professional organizations. The survey tool was composed of demographics, and of questions about the nurses' employment, work role, and access to personal protective equipment. FINDINGS: Of the 637 responses received, nearly half (43.7%) reported a decrease in hours and threatened or actual loss of employment. While most respondents felt that they had sufficient knowledge about COVID-19, they expressed concern about work-related risks to themselves and their family. Most respondents described never or only sometimes having sufficient personal protective equipment in their workplace. Just over half of respondents (54.8%) felt well supported by their employer. A third of respondents (34%) perceived that care provided in their workplace was significantly or slightly worse than before the pandemic. CONCLUSIONS: This is the first study of primary healthcare nurses' experiences during the COVID-19 pandemic. The study findings highlighted a concerning level of insecurity around primary healthcare nursing employment, as well as issues with the availability of personal protective equipment for these nurses. The perception that the pandemic has resulted in reduced quality of care needs further exploration to ensure that those with chronic conditions are supported to maintain and promote health. CLINICAL RELEVANCE: Understanding the implications of COVID-19 on the primary healthcare nursing workforce is vital to ensure staff retention and care quality. Ensuring that the community remains healthy and supported at home is vital to both reduce the burden on the health system and reduce secondary mortality.

The support needs of Australian primary health care nurses during the COVID-19 pandemic.

AIM: To identify Australian primary health care nurses' immediate support needs during the COVID-19 pandemic. BACKGROUND: COVID-19 has had widespread implications for primary health care nurses. Supporting these nurses' capacity to deliver quality care ensures that ongoing health needs can be met. METHODS: Primary health care nurses were recruited to an online survey via social media and professional organisations in April 2020. RESULTS: Six-hundred and thirty-seven responses were included in the analysis. Participants provided 1,213 statements about perceived supports required to provide quality clinical care. From these, seven key categories emerged, namely personal protective equipment, communication, funding, industrial issues, self-care, workplace factors and valuing nurses. CONCLUSION: A number of key issues relating to personal health and safety, care quality and job security need to be addressed to support primary health care nurses during the COVID-19 pandemic. Addressing these support issues can assist in retaining nurses and optimizing the role of primary health care nurses during a pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Responding to the needs of primary health care nurses has the potential to facilitate their role in providing community-based health care. This knowledge can guide the provision of support for primary health care nurses during the current pandemic, as well as informing planning for future health crises across the health service.

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.

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.

Strategies for using non-participatory video research methods in general practice.

BACKGROUND: Non-participatory video research is useful for observing and analysing interactions between clinicians, patients and technology. However, few clinical nursing studies have used non-participatory video observation and there is limited literature describing the approach. AIM: To describe a study that used non-participatory video observation in general practice. DISCUSSION: The authors' experience of non-participatory video research methods indicates that the acceptability of the technique, workplace organisation and consultation space have implications for preparation and data collection. Strategies for success include engaging stakeholders early on, obtaining contextual knowledge and piloting the approach. CONCLUSION: Non-participatory video observation is valuable in understanding interactions between nurses and patients in a naturalistic setting. Careful planning is essential to ensure alignment between research aims, context and technology. The methods for analysing data must be chosen carefully to ensure the research question is answered. IMPLICATIONS FOR PRACTICE: Video observation provides rich data. Careful planning and engagement of participants is required for successful conduct of studies that use the technique.