Assessment, incidence and factors associated with urinary incontinence in older Aboriginal Australians.

BACKGROUND: Little is known about urinary incontinence in older Aboriginal Australians. AIM: To describe urinary incontinence assessment, prevalence, incidence and associated conditions in older Aboriginal Australians. METHODS: Wave 1 consisted of 363 Aboriginal participants aged ≥45 years from Western Australia; 289 participants participated in Wave 2, with 184 included at both time points. Urinary incontinence was assessed by self-report, family report and the modified International Consultation on Incontinence Questionnaire (ICIQ). We investigated factors associated with incontinence with binary logistic regression. Sensitivity and specificity analyses of incontinence measures were undertaken using the ICIQ score ≥2 as the reference standard. RESULTS: Participant mean age was 61.2 ± 11.2 years. Prevalence of incontinence at Wave 2 (n = 289) using self-report was 24.6%; using ICIQ ≥2 was 22.5%; and family report 14.2%. Incidence after follow-up of 6.7 years was 33 (23.6%), higher than estimates of 5-20% in other populations. Cross-sectional associations with incontinence include female sex (odds ratio (OR) = 6.82; 95% confidence interval (CI) 2.98-15.57), stroke (OR = 3.55; 95% CI 1.43-8.77), head injury (OR = 3.15; 95% CI 1.54-6.45) and depressive symptoms (OR = 1.07; 95% CI 1.01-1.14). Longitudinal associations were age (OR = 1.05; 95% CI 1.01-1.09) and female sex (OR = 2.37; 95% CI 0.99-5.67). Sensitivity (81.5%) and specificity (93.5%) of self-report were high. CONCLUSION: The prevalence and incidence of urinary incontinence in Aboriginal Australians is high with risk factors of older age and female sex. The modified ICIQ and self-report appear to be appropriate incontinence screens. Further research to understand causes and treatments within this population is urgently required.

"Juggling many balls": Working and studying among first-year nursing students.

AIMS AND OBJECTIVES: To explore the experiences of first-year nursing students, their motivations for working and how they juggled study and other commitments while engaging in paid work. BACKGROUND: There has been a global rise in the number of students balancing full-time study, paid work and other commitments, with the main antecedent financial reasons. DESIGN: Qualitative exploratory study. METHODS: Drawn from a larger Australasian sequential exploratory mixed-method study, this qualitative study was conducted with fifty first-year undergraduate nursing and midwifery students who commenced their nursing studies in 2017. Telephone or face-to-face interviews were conducted with purposively selected students engaged in either nursing or non-nursing fields of work. Interviews were conducted from April-July 2017. Interviews lasted from 15-40 min. Results were thematically analysed. EQUATOR guidelines for qualitative research (COREQ) applied. FINDINGS: Two main themes and accompanying subthemes were identified. The first theme explored students' motivation behind combining work and study and identified the need for financial security and "me time". The second theme "Juggling many balls" provided insights into the benefits students perceived, how they kept the "balls" in the air and at times dropped "balls" while balancing work, study and other commitments. CONCLUSIONS: The motivation behind paid work was mainly financial; however, students also reported work allowed an escape and time for self which had social and health benefits. Working provided a range of positive benefits, including a sense of achievement, improved self-esteem and financial independence. RELEVANCE TO CLINICAL PRACTICE: Being able to juggle and multi-task improved skills such as organisation and the ability to prioritise, all skills that have applicability for the role as registered nurse.

Core components of the rural nurse specialist role in New Zealand.

INTRODUCTION: New Zealand has a rural population with unique healthcare needs. Traditionally, rural health care has been provided by medical general practitioners (GPs); however, as the number of GPs declines, the rural nurse specialist (RNS) role has emerged. The RNS is a registered nurse with advanced nursing skills that enable independent, autonomous practice within rural areas. The health needs of each rural community are specific to that area and the RNS role has been developed according to local healthcare needs. The purpose of this research was to provide a description of the RNS role in New Zealand. METHODS: A descriptive exploratory approach was used in this qualitative study. The study was conducted in two parts. Phase 1 consisted of document content analysis of RNS position descriptions and phase 2 comprised four semi-structured interviews with RNSs. Data were analysed using thematic analysis. The Modified Strong Model of Advanced Practice was utilised as a framework for thematic analysis during both phases. RESULTS: Rural nurse specialists demonstrated a wide variance in the understanding of the term 'RNS'. The RNS role was found to include provision of care across a wide range of settings according to local needs. Advanced assessment skills were expected by employers and considered a major component of the role by RNSs. Advanced assessments skills were utilised to enhance communication and thus increase collaboration with other health professionals. The ability to effectively communicate and collaborate with other health professionals was found to be a high priority. However, RNSs perceived that collaboration and thus patient care was affected by a lack of role clarity. The nurse practitioner (NP) role in New Zealand was considered more effective, with greater role recognition for the NP. Education was considered essential to maintain advanced assessment skills. RNSs identified providing education in the form of health promotion relevant to local needs as important. There was a lack of information regarding publication and professional leadership, highlighting this as an area for development. Another issue was the importance of stress management in an isolated area. CONCLUSION: The RNS role requires advanced knowledge to provide independent patient care. Advanced skills utilised include assessment, diagnosis and treatment of patients. RNSs must have postgraduate education to develop the advanced skills required in this role. RNSs perceive the NP role as having better role clarity; therefore, all participants were considering becoming an NP. There are barriers to becoming an NP, thus an expansion of the current RNS role is recommended. Further recommendations from this study include increased professional leadership to improve RNS visibility and further continued interprofessional education to enhance collaboration.

The negative impact of smartphone usage on nursing students: An integrative literature review.

BACKGROUND: Smartphones are ubiquitous, and for some, an indispensable companion. In nursing education curricula and clinical healthcare settings, smartphones have the potential to augment student learning. Nursing students report significant benefits to smartphone use, which extend beyond learning, to include enhanced communication, clinical decision making and evidence-based practice. Despite these benefits, little is known about the negative impact of smartphones on student learning. OBJECTIVES: This integrative review aimed to synthesise findings from published research that referred to the detrimental direct or indirect effect of smartphone usage on nursing students. DESIGN: The integrative review was guided by the five-stage approach as conceptualised by Whittemore and Knafl (2005). METHODS: Seven electronic databases were systematically searched in consultation with a university librarian (CINAHL Plus, Ovid Medline ALL, Nursing and Allied Health Database, PsycINFO, PubMed, Scopus and ERIC) using a combination of key search terms and medical subject headings. A total of 646 articles were retrieved, and following removal of duplicates, screening of titles and abstracts, a final 27 articles met the inclusion criteria for this review. RESULTS: Studies in the review originated from Korea (n = 7), Turkey (n = 6), India (n = 4), Spain (n = 3), USA (n = 2), Spain/Portugal (n = 1), Iran (n = 1), France (n = 1), Canada (n = 1) and Egypt (n = 1). Personal smartphone use was reported to be a distraction within clinical and classroom learning, and considered as uncivil, and compromised professionalism. Frequently, smartphones were used for entertainment (e.g. social networking) rather than professional purposes. The studies identified a concerning level of nomophobia and smartphone addiction among nursing students that caused stress and anxiety, and adversely affected sleep, learning and academic performance. Recommendations were proposed for smartphone policies. CONCLUSIONS: Excessive smartphones use among nursing students may adversely affect physical and mental health and potentially impact on student learning within the classroom and clinical environment. Educators should consider the implementation of policies or guidance for the responsible use of smartphones by nursing students whilst in the classroom setting and during clinical placement, to mitigate the potential negative impact on health and academic performance.

Nurse practitioner access to radiology and laboratory services.

With the advent of the New Zealand nurse practitioner (NP) role in 2001, ordering, conducting and interpreting diagnostic and laboratory tests became part of the NP scope of practice. However, anecdotal literature suggests there are national inconsistencies, barriers and limitations for some nurse practitioners in accessing diagnostic services. This paper is a report on a quantitative descriptive survey completed in 2008 exploring NP access to radiology and laboratory services. A purposive sample of all New Zealand registered NPs (as at 1 July 2008) were invited to participate (n = 47). The response rate was 79% (n = 37). The findings demonstrated some positive trends particularly in accessing laboratory tests, but generally there are barriers, inconsistencies and limitations for NPs when ordering tests. The majority of respondents directly order laboratory tests (75%, n = 27) that are processed under their own name. Access to radiology services is variable. Only 44% (n = 15) of respondents order plain x-rays/ultrasounds and 9% (n = 3) order advanced radiology tests that are processed under their own name. The research highlighted the need for national consistency and improved NP access to radiology and laboratory services.

The type and amount of paid work while studying influence academic performance of first year nursing students: An inception cohort study.

BACKGROUND: Working while engaging in tertiary studies can have potential benefits for students in developing their repertoire of employability skills, including teamwork, time management, customer service and interpersonal communication. Not unexpectedly engaging in excessive hours of work can have a detrimental effect on students' grades. Yet little is known about the impact of engaging in different types of paid work (nursing or non-nursing), and the amounts, on first year nursing students' academic performance across different nursing programs. OBJECTIVES: The aim of this study was to examine the association between: a) amount; and b) type of term-time weekly paid work, particularly its effect on academic performance, among commencing undergraduate students in the first semester of nursing studies across different nursing programs. DESIGN: Inception cohort study. SETTINGS: Four tertiary institutes across Australia and New Zealand. PARTICIPANTS: All commencing Bachelor of Nursing students attending Orientation sessions at their respective institutes were invited to participate in the study. The median age of participants was 23 years, the majority (87.5%) were female and nearly two-thirds were non-school leavers. Among those in paid work, the median hours worked was 20 h. METHODS: A baseline survey, completed by consenting students at the start of their Orientation session included items related to respondents' demographic data, self-reported paid work engagement (type and hours); we also requested their permission to link grade point average (academic performance data) at the end of first semester. Data were analysed using SPSS Version 25. RESULTS: A total of 1314 students completed the survey and 89% of survey respondents agreed for their survey to be linked to academic grades at the end of the semester. There was an inverse relationship between time spent in weekly paid work and academic performance. Additionally, three predictors emerged as statistically significant for high grade point average: (i) engaging in non-nursing related work (AOR: 1.64, 95% CI: 1.19-2.26); (ii) not being first in family to attend university (AOR: 1.57, 95% CI: 1.20-2.07) and; (iii) being a school-leaver (AOR: 1.49, 95% CI: 1.12-1.98). CONCLUSIONS: Despite the diversity among undergraduate nursing students studying across Australasia, it is evident that the amount and type of paid work engagement can impact on students' academic performance while studying. This underscores the importance for tertiary institutes to not only support students in their learning but also understand the need to achieve the right balance, in working while studying, to support students' academic success.

First year nursing students' perceptions of learning interpersonal communication skills in their paid work: A multi-site Australasian study.

Nursing students are increasingly undertaking paid work while studying and most choose paid work in health care or hospitality. This paper is drawn from a larger sequential exploratory mixed-method study which examined the relationship between students working while studying nursing and the impact on academic performance. In this paper, we explored first year nursing students' perceptions of communication skills gained through paid work. Using a qualitative exploratory design, 50 first year commencing nursing students from four nursing schools (3 Australia; 1 New Zealand) were interviewed. Inductive thematic analysis was used which identified two themes: (i) recognising the value of learning interpersonal communication skills and; (ii)opportunities to develop effective interpersonal communication skills. Paid work provides interpersonal communication skills; active listening, being present and interacting while multi-tasking and emotion management. Undergraduate education providers need to recognise the benefits of paid work for students, including enhancing interpersonal skills.

Influences on Indigenous and Pacific students' health career choices: a longitudinal cohort study.

Background: It is not understood how Maori and Pacific students in New Zealand choose nursing as a health career. Findings regarding influences arose from a study focusing on an incubator programme in New Zealand. Objectives: The aim of this study was to investigate whether secondary school students' participation in an Incubator Programme at secondary school influences students' choice of tertiary education. One of the aims of Programme Incubator (PI) is to encourage Indigenous (Maori) and Pacific students to consider a career in health. Methods: This longitudinal cohort study followed two cohorts of secondary school students from five schools. Participants completed a survey before and after participating in PI. Results: Of possible career options, nursing was the most common. Influences on career choices were personal experience, exposure to the media, careers advisors and teachers. Conclusions: PI is more attractive to Maori and Pacific people, than other populations. PI has been found to broaden and confirm available career options for some students. Nursing is a popular career choice for secondary students.

"Feeling part of a team" a mixed method evaluation of a dedicated education unit pilot programme.

The clinical learning environment is integral to the sustainability of the nursing workforce. Traditionally undergraduate nursing students were preceptored one-to-one with a registered nurse. With an increasingly complex clinical environment and more RNs working part-time, that model has become problematic. The Dedicated Education Unit (DEU) is a model of student learning whereby students are nurtured by all staff in a clinical area, clinical and academic staff collectively support the student and student learning is a collaborative process. In this study, a pilot DEU model in three clinical areas of one District Health Board in New Zealand was evaluated. These DEU are different from others reported in the literature as three unique nursing programmes from two Tertiary education providers (TEPs) in an urban area in New Zealand were involved in the pilot. The approach in this study was a mixed method descriptive evaluation design, undertaken in two phases: phase one was an online anonymous survey completed by 42 nurses and nurse managers employed in three DEUs and 24 undergraduate third year nursing students who were completing their final nine week pre-graduate placement. Phase two was six separate focus groups with registered nurses and undergraduate nursing students. Students (91%) and staff (85%) were satisfied with their participation in the DEU. Students described feeling part of the health care team and staff reported enjoying working with students from different programmes, also noting the supportive DEU structure gave them more opportunity to engage with student learning. Role clarification was an issue which needs to be resolved. Staff from three units at a District Health Board and three unique nursing programmes were able to develop learning partnerships, collaborating together to provide a positive, nurturing learning environment for nursing students and a clinical setting where nurses enjoyed their teaching/coaching roles.

Dietetics students' construction of competence through assessment and placement experiences.

AIM: Competency standards are widely adopted as a framework to describe standards of performance required in the workplace. Little is known, however, about how students construct competence. This qualitative study aimed to explore how dietetics students ready to graduate construct the concept of competence and the role of assessment in developing professional competence. METHODS: A qualitative description was used to gather data from a convenience sample of students ready to graduate from universities with accredited dietetics programs across Australia (10 out of 15 at the time of the study). A total of 11 focus groups were conducted to explore perspectives of competence and experiences of 'competency-based' assessment. Data were audio-recorded, transcribed and analysed using a thematic analysis approach. RESULTS: A total of 81 (n = 81) participants across 10 universities representing 22% of total students participated in the focus groups. Themes revealed that: (i) there is no shared understanding of competence; (ii) current work placement experiences may not reflect current standards or workforce needs; (iii) assessment approaches may not fully support the development of competence; and (iv) the competent performance of supervising dietitians/clinical educators in the workplace influences the construction of competence. CONCLUSIONS: There is a need to work towards a shared understanding of dietetic entry-level competence in the profession. 'Work-based' learning experiences may need to be modified to ensure students meet current competency standards. Practitioners involved in student supervision need to acknowledge the influential role they have in the development of the future workforce.

Culture shapes nursing practice: Findings from a New Zealand study.

OBJECTIVES: This paper reports research undertaken to investigate nurses' and parents' experiences of communication about parental emotions in a hospital setting, with a focus on the environmental and cultural context within which the communication occurs. METHODS: A focused ethnography was employed as the aims were to understand the context within which nurse-parent interaction takes place, by exploring cultural factors, such as ways of living affecting nursing communication. Data collection occurred in a children's unit of a New Zealand hospital, involving 260h of participant observation field work, informal interviews with parents and nurses, followed by 20 formal interviews with nurses and parents. RESULTS: Nurses are cultural brokers, with the potential to be a link between the insider culture, the hospital and the outside, the parents. Parents look to nurses for cultural brokerage, to help them cross the strong cultural boundaries present in a hospital unit. CONCLUSION: The context and culture of a hospital unit influences nurse-parent communication. There is a disconnection between parents' emotional needs in hospital and nurses' ability to meet those needs. PRACTICE IMPLICATIONS: Nurses must be supported to provide effective cultural brokerage for parents. Unit managers need to acknowledge that meeting parents' diverse needs is vital.

'By the way .how's your sex life?' - A descriptive study reporting primary health care registered nurses engagement with youth about sexual health.

INTRODUCTION Youth rates of sexually transmitted infections in New Zealand are among the highest in the Organisation for Economic Cooperation and Development. Registered nurses employed in primary healthcare settings (PHC RNs) may lack confidence engaging with youth about their sexual health. AIM To identify what facilitates PHC RNs to discuss sexual health with youth. METHODS This descriptive study was undertaken in two phases. In phase one, 23 PHC RNs completed an online survey. Phase two followed up the survey with semi-structured interviews with seven PHC RNs. RESULTS Most PHC RNs are female, aged between 40 and 60 years old and identify with New Zealand or other European ethnicity. Participants identified specific educational needs relating to youth sexual health that are not being met: legal and ethical issues (65%); cultural issues (65%); youth sexual (44%) and psychological (52%) development; and working with gay, lesbian, bisexual or transsexual youth (48%). Lack of time was cited as a barrier to engaging with youth about sexual health by 30% of the participants. Ongoing support practices such as regular debriefing, reflections of practice and case reviews with colleagues (74%); support from other sexual health providers (87%); and access to educational materials about youth sexual health aimed at health professionals (100%) were perceived to be useful to increase confidence in discussing sexual health with youth. DISCUSSION The PHC RNs lacked knowledge and confidence engaging with youth about sexual health. PHC RNs need resourcing to provide culturally safe, effective sexual health care to youth.

Interprofessional undergraduate students talk about nurses and nursing: A qualitative study.

OBJECTIVES: To understand the discourse amongst a range of health professional students, including nursing, talking about nurses and nursing. DESIGN: A qualitative descriptive study which employed the use of focus groups. SETTINGS: A rural and residential interprofessional immersion programme in a rural location in New Zealand. The participants were final year undergraduates drawn from seven different degrees (dentistry, dietetics, medicine, nursing, occupational therapy, pharmacy and physiotherapy). METHODS: Data were collected from separate and sequential group interviews; each of which comprised a different mix of students and always included nursing students. Each student participated once. Data were analysed by comparing datum with datum until recurrent themes emerged. RESULTS: The discourse in relation to nurses and nursing identified two overarching themes 'constrained conversations' and 'the benefit of IPE: what nursing might become'. Within those themes there were four contributing sub themes; 'nursing as doing', 'limiting our vocabulary', 'becoming part of the conversation 'and 'moving from the present to the future what nursing might become'. CONCLUSIONS: The interprofessional experience for student nurses not only enabled them to learn about other professions but was a forum in which they were able to articulate the role of the nurse. This was an unintended and positive by-product of the IPE programme.

Synthesis and anti-HIV activity of 4'-azido- and 4'-methoxynucleosides.

A series of nucleosides were synthesized in which the 4'-hydrogen was substituted with either an azido or a methoxy group. The key steps in the syntheses of the 4'-azido analogues were the stereo- and regioselective addition of iodine azide to a 4'-unsaturated nucleoside precursor followed by an oxidatively assisted displacement of the 5'-iodo group. The 4'-methoxynucleosides were made via epoxidation of 4'-unsaturated nucleosides with in suit epoxide opening by methanol. Reaction-mechanism considerations, empirical conformation rules, NMR-based conformational calculations, and NOE experiments suggest that the 4'-azidonucleosides prefer a 3'-endo (N-type) conformation of the furanose moiety. When evaluated for their inhibitory effect on HIV in A3.01 cell culture, all the 4'-azido-2'-deoxy-beta-D-nucleosides exhibited potent activity. IC50's ranged from 0.80 microM for 4'-azido-2'-deoxyuridine (6c) to 0.003 microM for 4'-azido-2'-deoxyguanosine (6e). Cytotoxicity was detected at 50-1500 times the IC50's in this series. The 4'-methoxy-2'-deoxy-beta-D-nucleosides were 2-3 orders of magnitude less active and less toxic than their azido counterparts. Modifications at the 2'- or 3'-position of the 4'-substituted-2'-deoxynucleosides tended to diminish activity. Further evaluation of 4'-azidothymidine (6a) in H9, PBL, and MT-2 cells infected with HIV demonstrated a similar inhibitory profile to that of AZT. However, 4'-azidothymidine (6a) retained its activity against HIV mutants which were resistant to AZT.

Reducing health disparities for low decile children and families: a nurse-led response.

BACKGROUND AND CONTEXT: Reducing health disparities for children living in deprived areas has been difficult to achieve. This paper describes the implementation of a nurse-led, child-specific clinic within a general practice setting to improve health outcomes for high needs Maori/Pacific Island and NZDep96 quintile groups 4 and 5 children and their whanau/families. ASSESSMENT OF PROBLEM: The medical centre that implemented the clinic had a high number of enrolled children with chronic and recurrent morbidities. Children frequently did not attend clinic appointments, and there was high use of after-hours services. RESULTS: An outcome audit after 18 months demonstrated a significant (>30%) reduction in eczema severity, daily irritability, and daily occurrence of pain. Post-intervention fewer children were hospitalised and there was a 50% reduction in antibiotic use. STRATEGIES FOR IMPROVEMENT: The aim of the nurse-led clinic was to improve health gains, facilitate morbidity control of chronic conditions, and to offer prevention strategies to promote wellness for the target population. The reduction of morbidity severity by 10% was measured with specific morbidity scoring systems for eczema, constipation and nocturnal enuresis. Other outcome indicators measured vomiting/reflux, wheezing/coughing, constipation/soiling, irritability, sleep disturbances, hospital admissions, and antibiotic use. LESSONS: Nurse-led clinics facilitated by nurses with advanced skills can reduce health disparities for the target population. The amount of time the nurse is able to spend with the child and whanau/family, and the provision of opportunistic assessments as required, has effected positive change in those children most in need.

Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review.

PURPOSE: Magnetic resonance imaging (MRI) is of great aid in the diagnosis of knee lesions. Most diagnostic studies comparing MRI and arthroscopy have shown good diagnostic performance in detecting lesions of the menisci and cruciate ligaments. Nevertheless, arthroscopy has remained the reference standard for the diagnosis of internal derangements of the knee, against which alternative diagnostic modalities should be compared. METHODS: We took arthroscopy to be the 'gold standard', and we undertook a systematic review of MRI and arthroscopy in the diagnosis of internal derangements of the knee. We used Coleman scoring methodology to identify scientifically sound articles in a reproducible format. RESULTS: MRI is highly accurate in diagnosing meniscal and anterior cruciate ligament (ACL) tears. It is the most appropriate screening tool before therapeutic arthroscopy. It is preferable to diagnostic arthroscopy in most patients because it avoids the surgical risks of arthroscopy. The results of MRI differ for medial and lateral meniscus and ACL, with only 85% accuracy. CONCLUSIONS: Study design characteristics should also be taken into account whenever a study on MRI assessing its diagnostic performance is designed or reviewed.

Taking aim at infusion confusion.

A comprehensive multidisciplinary approach was used to improve drug infusion safety in an acute care hospital in Melbourne, Australia. This project aimed to reduce the potential for drug infusion-related error, improve drug infusion safety for patients, and encourage incident reporting to inform and guide continuous quality improvement projects. The project applied a systems approach to medication safety, using redesign strategies such as continuous quality improvement (plan, do, study, and act) and re-engineering. Key safety design concepts such as standardization, simplification, and forcing functions were also used.