An integrative review of missed nursing care and the general practice nurse.

BACKGROUND: The phenomenon of missed care has received increasing interest over the past decade. Previous studies have used a missed care framework to identify missed nursing tasks, although these have primarily been within the acute care environment. The aim of this research was to identify missed care specific to the role of the general practice nurse. METHODS: An integrative review method was adopted, using The Mixed Methods Appraisal Tool to assist in a methodological appraisal of both experimental, theoretical, and qualitative studies. Thematic analysis was then used to analyse and present a narrative synthesis of the data. DATA SOURCES: CINAHL, SCOPUS, Web of Science and Google Scholar databases were searched between 2011 and 2022 for empirical research that reported missed care and the general practice nurse. RESULTS: Of the 787 papers identified, 10 papers met the inclusion criteria. Three themes identified missed care in relation to primary healthcare nurses: under-staffing and resourcing, communication difficulties, and role confusion. CONCLUSION: Isolating missed care by general practice nurses was challenging because much of the research failed to separate out general practice nurses from community and primary health care nurses. This challenge was exacerbated by disparity in the way that a general practice nurse is defined and presented in the various databases. While some themes such as those related to communication and understaffing and resourcing demonstrate some parallels with the acute sector, more research is required to identify missed care specific to the general practice nurse.

"I was just a shell": Mental health concerns for women in perimenopause and menopause.

Early detection of deteriorating mental health for women who are experiencing symptoms associated with perimenopause and menopause is critical to ensure the well-being of women. Unfortunately, many women during this phase of their lives find it difficult to access relevant and timely treatment. This concurrent mixed methods study using an online survey and qualitative interviews explored Australian women's knowledge and experiences of perimenopause and menopause and specifically reports on findings associated with women's mental health. Four hundred and eleven women completed the online survey in its entirety and 25 women participated in semi-structured interviews between April and July 2022. Survey data were analysed using SPSS and, in this article, data are presented as descriptive statistics. Qualitative interviews were analysed using thematic analysis guided by Braun and Clarke (2013; 2019). Quantitative and qualitative data specific to women's mental health were integrated into three themes: (1) increased anxiety and depression, (2) a negative impact on emotions and (3) a negative impact on self-worth. Findings from this study will help to inform clinical services for women as it highlights the need to improve education about perimenopause and menopause for healthcare providers and women.

Impact of a general practice nurse intervention to improve blood pressure control: The ImPress study.

BACKGROUND AND OBJECTIVES: Hypertension is a highly prevalent but often poorly controlled risk factor for cardiovascular disease (CVD). This study examined the effectiveness of a general practice nurse (GPN) intervention to reduce blood pressure in adults with hypertension who are at high risk of CVD. METHOD: A cluster randomised control trial was performed across 10 general practices. Systolic (SBP) and diastolic (DBP) blood pressure were evaluated at six and 12 months. RESULTS: The adjusted mean difference between intervention and control groups at six months was 8.1 mmHg (95% confidence interval [CI]: -2.92, 18.94 mmHg; P=0.146) for SBP and 0.18 mmHg (95% CI: -6.54, 4.91 mmHg; P=0.775) for DBP. The adjusted mean difference between groups at 12 months was 11.3 mmHg (95% CI: 1.18, 21.42 mmHg; P=0.030) for SBP and 7.1 mmHg (95% CI: -8.62, 22.90 mmHg; P=0.362) for DBP. DISCUSSION: Clinically significant between-group differences in mean SBP at six and 12 months provide evidence for GPNs to play a greater role in managing hypertension.

Telehealth's future in Australian primary health care: a qualitative study exploring lessons learnt from the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, telehealth emerged as a means of safely providing primary healthcare (PHC) consultations. In Australia, changes to telehealth funding led to the reconsideration of the role of telehealth in the ongoing provision of PHC services. AIM: To investigate GPs', registered nurses' (RNs), nurse practitioners' (NPs), and allied health (AH) clinicians perceptions of the sustainability of telehealth in PHC post-pandemic. DESIGN & SETTING: Semi-structured interviews were undertaken with 33 purposively selected clinicians, including GPs (n = 13), RNs (n = 5), NPs (n = 9), and AH clinicians (n = 6) working in PHC settings across Australia. Participants were drawn from responders to a national survey of PHC providers (n = 217). METHOD: The thematic analysis approach reported by Braun and Clarke was used to analyse the interview data. RESULTS: Data analysis revealed that the perception of providers was represented by the following two themes: lessons learnt; and the sustainability of telehealth. Lessons learnt included the need for rapid adaptation to telehealth, use of technology, and the pandemic being a catalyst for long-term change. The sustainability of telehealth in PHC comprised four subthemes around challenges: the funding model, maintaining patient and provider safety, hybrid service models, and access to support. CONCLUSION: Providers required resilience and flexibility to adapt to telehealth. Funding models must reward providers from an outcome focus, rather than placing limits on telehealth's use. Hybrid approaches to service delivery will best meet the needs of the community but must be accompanied by support and education for PHC professionals.

Telehealth use in Australian primary healthcare during COVID-19: a cross-sectional descriptive survey.

OBJECTIVE: This study aimed to investigate Australian primary healthcare professionals' experiences of the rapid upscaling of telehealth during COVID-19. DESIGN: A cross-sectional survey. PARTICIPANTS AND SETTING: Two hundred and seventeen general practitioners, nurses and allied health professionals employed in primary healthcare settings across Australia were recruited via social media and professional organisations. METHODS: An online survey was disseminated between December 2020 and March 2021. The survey comprised items about individual demographics, experiences of delivering telehealth consultations, perceived quality of telehealth consultations and future perceptions of telehealth. RESULTS: Telephone was the most widely used method of providing telehealth, with less than 50% of participants using a combination of telephone and video. Key barriers to telehealth use related to the inability to undertake physical examination or physical intervention. Telehealth was perceived to improve access to healthcare for some vulnerable groups and those living in rural settings, but reduced access for people from non-English-speaking backgrounds. Quality of telehealth care was considered mostly or somewhat the same as care provided face-to-face, with actual or perceived negative outcomes related to missed or delayed diagnosis. Overwhelmingly, participants wanted telehealth to continue with guaranteed ongoing funding. Some 43.7% of participants identified the need to further improve telehealth models of care. CONCLUSION: The rapid shift to telehealth has facilitated ongoing care during the COVID-19 pandemic. However, further work is required to better understand how telehealth can be best harnessed to add value to service delivery in usual care.

Response Rates to Methylnaltrexone in Hospitalized Cancer Patients.

Context: Methylnaltrexone is a peripherally-acting mu-opioid receptor antagonist studied in both cancer and non-cancer patients with opioid-induced constipation (OIC), but mostly in the outpatient setting. For adult hospitalized cancer patients with OIC, its effectiveness is unknown. Objectives: Describe the efficacy of methylnaltrexone for OIC in the inpatient setting, defined as bowel movement (BM) within 24 hours of methylnaltrexone administration. Methods: We performed a single-center, retrospective chart review of all hospitalized, adult patients with a cancer diagnosis who received methylnaltrexone from the palliative care team between January 1st, 2012 and July 1st, 2019. Results: We identified 194 patients. The mean age was 59, 50.5% were male and 88% were white. 192 patients (98%) received the 8 mg dose subcutaneously. The median oral morphine equivalent (OME) was 135 mg (IQR 70-354 mg). 45% (95% confidence interval, 38-53%) had a BM within 24 hours. Higher OME was correlated with successful BM, with a response in 93% (86/92) of patients receiving ≥150 OME and 2% (2/102) of patients receiving <150 OME (P < .0001). Prior laxative use did not predict response at 24 hours whether these were osmotic laxatives (40.7% vs 47.1%, P = .52), stimulant laxatives (45.7% vs 45.2%, P > .99), or stool softeners (44.7% vs 46.1%, P = .89). Conclusion: Methylnaltrexone has a high response rate when used as treatment for OIC in hospitalized adult cancer patients, especially for patients taking ≥150 OME.

An exploration of women's knowledge and experience of perimenopause and menopause: An integrative literature review.

AIM: To explore the international literature related to women's knowledge and experience of perimenopause and menopause and to inform future directions for research and individualised healthcare delivery. BACKGROUND: Menopause is a normal physiological process experienced by most women. Despite this, care and support is fragmented and the implication on women's long-term health is not sufficiently understood. DESIGN: An integrative review of primary research on women's knowledge and experience of perimenopause and menopause. METHOD: CINAHL, Medline, Wiley Online Library, SCOPUS, PubMed and Google Scholar were searched from 2011 to 2021.Quantitative and qualitative studies written in English exploring women's knowledge and experience of menopause were included. The search strategy for the review complied with PRISMA guidelines. The mixed methods appraisal tool was used to assess quality. Thematic analysis was employed to present a narrative synthesis of the data. RESULTS: A total of 17 studies, comprising 10 quantitative, and seven qualitative studies met the inclusion criteria. The four themes regarding women's knowledge and experience of perimenopause and menopause identified in the literature were as follows: (1) Symptoms associated with perimenopause and menopause; (2) Strategies to manage symptoms; (3) Support and information (4) Attitudes, education and health literacy. CONCLUSION: This integrative review of the international literature highlights that women's knowledge of perimenopause and menopause varies significantly globally and within countries. The experience of perimenopause and menopause for women is heterogenous and influenced by deeply embedded sociocultural patterns. RELEVANCE FOR CLINICAL PRACTICE: This integrative review has shown that individualised support for women during perimenopause and menopause is critical to ensure the diverse needs of women are suitably addressed. NO PATIENT OR PUBLIC CONTRIBUTION: As this was a review of the literature, no patients, service users, caregivers or members of the public were involved in this review.

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.

Understanding nursing students' perceptions of the general practice environment and their priorities for employment settings.

AIM: To explore final year nursing students' perceptions of the general practice environment and their priorities when choosing a workplace. DESIGN: Online survey, reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. METHODS: The validated Profession Scale from the Scale on Community Care Perceptions (SCOPE) tool was used to identify characteristics within the general practice environment and the importance of these in choosing a workplace. To explore the factor structure, exploratory factor analysis was undertaken which was used to revise the survey language and flow before widespread dissemination. RESULTS: Three hundred and fifty-five responses were received. Factor analysis revealed three factors: Provision of care, Employment conditions and Nature of work. Respondents exposed to general practice in the Bachelor of Nursing program or who had a general practice clinical placement had significantly different perceptions across all factors. Although wages, advancement opportunities, work pressures and the physical nature of work were perceived as important in choosing a workplace, they were seen as only moderately present in general practice.

Nurse-led interventions to manage hypertension in general practice: A systematic review and meta-analysis.

To evaluate the impact of general practice nurse-led interventions for blood pressure control and cardiovascular disease risk factor reduction in patients with hypertension. Systematic review and meta-analysis of randomized control trials. CINAHL, Medline and Scopus databases were searched to identify peer-reviewed studies published between 2000 and 2021. A systematic review of randomized control trials was conducted using a structured search strategy. The Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to appraise study quality. Meta-analysis and narrative synthesis were performed to determine the effectiveness of the included interventions. Eleven trials comprising of 4454 participants were included in the review. Meta-analysis showed significant reductions in both systolic and diastolic blood pressure in trials with 6 months or less follow-up. Improvements were also demonstrated in reducing blood lipids, physical activity, general lifestyle measures and medication adherence. Evidence for dietary improvements and reduction in alcohol and smoking rates was inconclusive. Nurse-led interventions for patients with hypertension are heterogeneous in terms of the nature of the intervention and outcomes measured. However, nurse-led interventions in general practice demonstrate significant potential to improve blood pressure and support cardiovascular disease risk factor reduction. Future research should be directed towards elucidating the successful elements of these interventions, evaluating cost-effectiveness and exploring translation into usual care. This review provides evidence that nurses in general practice could enhance current hypertension management through nurse-led interventions.

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.

An integrative review of primary health care nurses' mental health knowledge gaps and learning needs.

Background: The global COVID-19 pandemic has escalated the prevalence of mental illness in the community. While specialist mental health nurses have advanced training and skills in mental health care, supporting mental health is a key role for all nurses. As front-line health care professionals, primary health care (PHC) nurses need to be prepared and confident in managing mental health issues. Aim: To critically analyse and synthesise international literature about the knowledge gaps and learning needs of PHC nurses in providing mental health care. Design and methods: An integrative review. The quality of papers was assessed using the Mixed Methods Appraisal Tool. Data were extracted into a summary table and analysed using narrative analysis. Data sources: CINAHL, Ovid MEDLINE, Web of Science and EBSCO electronic databases were searched between 1999 and 2019. Papers were included if they reported original research which explored mental health education/training of nurses working in PHC. Findings: Of the 652 papers identified, 13 met the inclusion criteria. Four themes were identified: preparedness; addressing knowledge gaps, education programs, and facilitators and barriers. Discussion: Despite increasing integration of physical and mental health management in PHC, there is limited evidence relating to knowledge gaps and skills development of PHC nurses or their preparedness to provide mental health care. Conclusion: Findings from this review, together with the global increase in mental illness in communities arising from COVID-19, highlight the need for PHC nurses to identify their mental health learning needs and engage in education to prepare them to meet rising service demands.

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.

New graduate employment in general practice: Perceptions of final-year nursing students.

AIM/OBJECTIVE: This paper sought to investigate the perceptions of final-year nursing students regarding general practice nursing as a new graduate career path. BACKGROUND: General practice nurses have become increasingly important in providing community-based care, in response to the growing burden of chronic conditions and the ageing population. To sustain this workforce, there is a need to optimise strategies to promote a consistent supply of new graduate nurses. DESIGN: This qualitative descriptive study was undertaken within a sequential explanatory mixed methods project. METHODS: Data were collected through semi-structured telephone interviews with sixteen final-year nursing students from five Australian universities. Interviews were analysed using thematic analysis. RESULTS: Four main themes were identified, namely; a) general practice is not a priority career path, b) opportunities for skills development and consolidation, c) perceptions of employment conditions, and d) transition support is limited. CONCLUSION: To meet current workforce needs in areas with increasing demand, nurse educators need to support undergraduate nursing students to explore a wide range of career pathways following graduation. Informed career choices and well-structured educational preparation during undergraduate education may be an effective strategy in building a sustainable future workforce in settings such as general practice.

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.

Understanding perceptions of health, lifestyle risks and chronic disease in middle age.

AIM: The aim of this paper is to explore the perceptions, attitudes and beliefs of middle-aged Australians around their health, lifestyle risks and chronic disease. BACKGROUND: Health promotion and risk reduction are important to stem the rising prevalence of chronic disease. While there has been much emphasis on supporting these strategies in older Australians, there has been less attention on those in middle age. However, as this group age, their health will inevitably be impacted by lifestyle risk. DESIGN: A qualitative descriptive study using semi-structured interviews. Reporting was guided by the COREQ checklist. METHODS: Thirty-four participants aged 40-65 years were recruited across South Eastern New South Wales, Australia, using convenience sampling. Semi-structured interviews were conducted by four registered nurses with qualitative research experience. Verbatim transcripts were analysed using thematic analysis. RESULTS: Sixteen women and 18 men participated in the interviews. Four themes emerged, namely: adopting healthy lifestyles; denial; an impetus for change; and sustaining change. Perceptions about what constituted good health varied, with male participants being more ambivalent about their health. Impetus for change was mostly influenced by family history, awareness of health risks and identification of risks by health professionals. Participants found sustaining change challenging, particularly with regard to smoking cessation and dietary modifications. CONCLUSIONS: Understanding the perceptions of health of middle-aged people is important and enables health professionals to engage in early behavioural change conversations that consider perceived barriers to lifestyle modification. Findings from this study emphasise the importance of discussions about lifestyle risk to reduce the future burden of chronic disease. RELEVANCE TO CLINICAL PRACTICE: These findings illustrate the importance of understanding perceptions of health to guide primary health care nurses to develop person-centred health promotion and chronic disease prevention strategies in this age group.