An ordinary life: People with dementia living in a residential setting.

The aim of this research was to explore the experiences of care support workers and family members of the impact of a new care approach in a specialised unit as it shifted from a clinical to an inclusive model, focused on creating an ordinary life for people with dementia and their families. The research was a partnership between the unit staff and university researchers. Using a qualitative approach, data were collected in focus groups with 11 family members and nine staff members. Thematic analysis identified the themes personalised care for people with dementia, family involvement - continuing to care, and staff competence and confidence to care. A personalised approach to supporting people with dementia was considered paramount, communicative family-staff relationships enhanced the social environment, and competence enhanced confidence and quality care. Participants identified positive ways of working that benefited staff and families and they reported increased well-being for the people with dementia on the unit. Developing well-articulated and systematically implemented local models of care provides opportunities for family and staff creativity and engagement, enhancing care for people with dementia. Strong and effective leadership is required to enable these approaches to become a reality.

Readiness and recovery: Transferring between methadone and buprenorphine/naloxone for the treatment of opioid use disorder.

Long-acting opioids are prescribed as part of treatment for opioid use disorders; methadone and buprenorphine are well researched and commonly prescribed for the treatment of opioid use disorder. Meta-analysis suggests that buprenorphine has a slightly poorer retention rate in treatment as compared to methadone. Benefits of buprenorphine/naloxone include greater ease in ceasing treatment and less use of illicit opioids while in treatment as compared to methadone. There are a number of qualitative and mixed-method studies that ask patients about their experiences of methadone maintenance and buprenorphine maintenance treatment. This research aimed to understand perspectives of receiving buprenorphine/naloxone for the treatment of opioid use disorder. A qualitative descriptive approach was used. Seven participants with a current diagnosis of opioid use disorder treated with buprenorphine/naloxone were interviewed. Thematic analysis extracted four themes: drivers for opioid substitution treatment change; readiness for buprenorphine/naloxone substitution treatment; absence of effect from buprenorphine/naloxone; and an increased sense of citizenship on buprenorphine/naloxone. This study identified a number of factors influencing participants' decision-making in transferring between methadone and buprenorphine/naloxone for the treatment of their opioid use disorder. Methadone was preferred by those seeking sedation and wishing to continue using other opioids, and buprenorphine/naloxone was most effective for participants no longer wishing to experience sedation and seeing opioid abstinence as an end point in their recovery. Changing treatment expectations are important to consider when determining medication selection and highlight the importance of quality information when determining the most suitable medication for the treatment of opioid use disorder.

Primary health-care nurses and Internet health information-seeking: Access, barriers and quality checks.

Online information is a critical resource for evidence-based practice and patient education. This study aimed to establish New Zealand nurses' access and evaluation of online health information in the primary care context using a postal questionnaire survey; there were 630 respondents from a random sample of 931 nurses. The majority of respondents were satisfied with work access to online information (84.5%, n = 501) and searched for online information at least several times a week (57.5%, n = 343). The major barrier to online information seeking was insufficient time, but 68 respondents had no work online information access. The level of nursing qualification was significantly correlated with computer confidence and information quality checking. A range of information evaluation approaches was used. Most nurses in study accessed and evaluated Internet information in contrast to the findings of earlier studies, but there were barriers preventing universal integration into practice.

From 'pleasure to chemistry': the experience of carbohydrate counting with and without carbohydrate restriction for people with Type 1 diabetes.

INTRODUCTION: Matching carbohydrate intake with insulin dosage is recommended management for people with Type 1 diabetes. However, international interest in restricted carbohydrate diets is growing. General practitioners and practice nurses need to know how to advise people with Type 1 diabetes regarding low-carbohydrate diets. This study aimed to explore the carbohydrate counting experiences of people with Type 1 diabetes in a trial with and without a diet restricted to 75 g of carbohydrate per day. METHODS: Eight participants were interviewed by focus group or interview 12 weeks after a carbohydrate counting course with individual dietary choice or the same course with information on restricted carbohydrate eating and a daily maximum intake of 75 g of carbohydrate. Data were analysed using a qualitative thematic analysis approach. FINDINGS: Themes included the need for insulin management skills, impact of the dietary experience, and need for dietary knowledge. The restricted-carbohydrate group encountered mealtime insulin resistance and difficulty managing insulin dosages when transitioning on and off the low-carbohydrate diet. The diet impacted on mood, feelings of satiety and it was reported that food changed from being 'a pleasure to chemistry'. Both groups described feeling empowered to manage their diabetes as a result of the carbohydrate counting course. CONCLUSION: Participants reported increased knowledge and challenging insulin management. The restricted-carbohydrate group reported mealtime insulin resistance and a strong dietary impact. Extra health professional support may be required, especially at dietary transition periods. More research is warranted into the reported mealtime insulin resistance.

Medical education and informal teaching by nurses and midwives.

OBJECTIVE: The aim of this study was to examine the contribution of nurses and midwives to the education of medical colleagues in the clinical context. METHODS: The research design was a cross-sectional survey using an online questionnaire. A subsample of 2906 respondents, from a total of 4763 nurses and midwives participating in a web-based study, had taught doctors in the 12 months prior to the survey. The questionnaire generated mainly categorical data analysed with descriptive statistics. RESULTS: In the group of respondents who taught doctors (n =2906), most provided informal teaching (92.9%, n=2677). Nearly a quarter (23.9%, n=695) self-rated the amount of time spent teaching as at least moderate in duration. The most common named teaching topics were documentation (74.8%, n=2005) and implementing unit procedures (74.3, n=1987), followed by medication charting (61.9%, n=1657) and choosing correct medications (55.8%, n=1493). Respondents felt their contributions were unrecognised by the doctors and students they taught (43.9%, n=1256). CONCLUSIONS: Educational contributions while unrecognised could be considered positively by the respondents. However, discussion of teaching responsibilities is necessary to support the development of teaching protocols and supervision responsibilities as respondents reported teaching clinical medical tasks related to medications, consent and other skills within the medical domain. Study limitations include the nature of self-reported responses which cannot be validated and data drawn from a survey concluded in 2009.

Primary health care nurses and heart failure education: a survey.

INTRODUCTION: Heart failure education contributes to effective self-management. New Zealand primary health care nurses' contributions to heart failure educational activities have not been researched. AIM: To identify primary health care nurses' heart failure educational activities in terms of duration and frequency, topics covered, resources used and strategies for Maori and other ethnic groups. METHODS: A cross-sectional survey of a random sample of 961 primary health care nurses using a postal questionnaire. RESULTS: Of 630 respondents (65.5%), 369 worked with patients with heart failure and 339 provided heart failure education. One-third of respondents providing education (33.3%; n=113) delivered sessions from 16 to 60 minutes. The main educational topics covered were on the physical aspects of heart failure; prognosis, spiritual/existential and psychosocial topics were least often addressed. One-quarter of the group providing education did not use educational resources (n=86). The majority of respondents reported they would find more education about heart failure useful or very useful (80.2%; n=292), along with nurse practitioner support (64.7%; n=229). Maori-centred services and resources and involving whanau/family in education were the most frequently mentioned Maori-specific education strategies. DISCUSSION: A consistent approach to heart failure education is important to address knowledge gaps in a timely manner. This study affirms the contribution made by primary health care nurses in chronic illness education and highlights the need for further development and investment in ongoing heart failure nursing education and specialist nursing support.

The informed consent process in randomised controlled trials: a nurse-led process.

Clinical trials are carried out with human participants to answer questions about the best way to diagnose, treat and prevent illness. Participants must give informed consent to take part in clinical trials that requires understanding of how clinical trials work and their purpose. Randomised controlled trials provide strong evidence but their complex design is difficult for both clinicians and participants to understand. Increasingly, ensuring informed consent in randomised controlled trials has become part of the clinical research nurse role. The aim of this study was to explore in depth the clinical research nurse role in the informed consent process using a qualitative descriptive approach. Three clinical research nurses were interviewed and data analysed using a thematic analysis approach. Three themes were identified to describe the process of ensuring informed consent. The first theme, Preparatory partnerships, canvassed the relationships required prior to initiation of the informed consent process. The second theme, Partnering the participant, emphasises the need for ensuring voluntariness and understanding, along with patient advocacy. The third theme, Partnership with the project, highlights the clinical research nurse contribution to the capacity of the trial to answer the research question through appropriate recruiting and follow up of participants. Gaining informed consent in randomised controlled trials was complex and required multiple partnerships. A wide variety of skills was used to protect the safety of trial participants and promote quality research. The information from this study contributes to a greater understanding of the clinical research nurse role, and suggests the informed consent process in trials can be a nurse-led one. In order to gain collegial, employer and industry recognition it is important this aspect of the nursing role is acknowledged.

Nurses and heart failure education in medical wards.

Heart failure is a chronic debilitating disease with significant hospitalisation rates. Information and education are foundational elements in making the lifestyle changes required for effective self-management of the symptoms of heart failure. This paper reports a study of medical nurses' education activities with heart failure patients in terms of the topics they addressed and the educational resources they found most useful. A random sample of 540 medical ward nurses were surveyed in 2009 using a postal questionnaire. The response rate was 47% (234 medical ward nurses who cared for patients with heart failure). Quantitative data were analysed using descriptive statistics, qualitative data through a content analysis approach. The majority of respondents (66.7%) cared for patients with heart failure several times each week. The total time spent on educational activities by most respondents (70.6%) was estimated as 20 minutes or less over the hospitalisation. Printed material was the most commonly used education resource although 35 respondents also referred to online information and 84 nurses did not use educational material at all. The most frequent education topics discussed were medication, signs and symptoms and general information about heart failure. Psychological factors and prognosis information were the topics least discussed with patients. Respondent suggestions to improve patient access to heart failure information included more printed information in wards such as pamphlets in various languages, information about useful websites and having key resources available in te reo Maori. The heart failure educator was identified as an important resource for both nurses and patients. The study highlighted the limited time many respondents spent on educational activities and the need for readily available educational resources to optimise patient heart failure education opportunities.

Nurses' use of online health information in medical wards.

AIM: This paper is a report of a study of nurses' access, use and evaluation of online health information in medical wards. BACKGROUND: Online health information is commonly used by patients with chronic illness to support their education needs. Nurses have a critical role in assisting patients to access and use this information. METHOD: This descriptive cross-sectional survey of a random sample of 540 nurses employed in medical wards was carried out in 2009. The response rate was 58·7% (293). The analytical approach included descriptive statistics and non-parametric tests of correlation and differences between groups. A content analysis was performed on the qualitative data. RESULTS: Most respondents (78·6%) were satisfied with work Internet access and 58·2% believed that the use of online information improved care delivery. Nearly half the group was aware of patient misconceptions about their illness due to incorrect interpretations of online information, but only 24·4% checked if patients used online information. There was a significant association between assessing patients use and awareness of patient misconceptions. CONCLUSION: The findings of this study highlight that while online resources add to education opportunities, the ongoing nursing assessment required to determine online information needs is not always incorporated into nursing practice. Patient misunderstandings of online material were also identified; developing patient competency in evaluating open access health information should now be recognized as an integral aspect of illness management education.

Is anybody listening? A qualitative study of nurses' reflections on practice.

AIM AND OBJECTIVES: To explore nurses' perceptions of the reality of practice based on data from the Nurses and Midwives e-cohort Study which examined the workforce characteristics, work-life balance and health of nurses. BACKGROUND: Recruitment and retention of the nursing workforce is of international concern as demands increase due to demographic changes, political pressure and community expectations, in a climate of economic constraint. DESIGN: Qualitative analysis of data from a cohort of Australian, New Zealand and UK nurses. METHOD: Of the 7604 participants in the electronic cohort, 1909 provided qualitative comments of which 162 related to nursing practice; thematic analysis resulted in four high order themes. The analytical discussion is structured around 'care' as the organising construct. RESULTS: Four themes emerged: 'embodied care' which discusses the impact of work on the nurse's physical and emotional health; 'quantity/quality care' which addresses increasing pressures of work and ability to provide quality care; 'organisational (non)care' raising the seeming lack of support from management; and '(un)collegial/self care' where bullying and professional relationships were raised. CONCLUSIONS: Issues raised by participants have been discussed in the nursing literature for several years yet nurses still experience these negative aspects of nursing. It appears there is a significant gap between what is known about the practice environment, recommendations for change and change occurring: the management equivalent of the theory-practice gap, resulting in nurses intending to leave the profession. RELEVANCE TO CLINICAL PRACTICE: Research demonstrates that a well-qualified, stable nursing workforce improves quality of health care and health outcomes. Changing the work environment and fostering a positive workplace culture seems fundamental to supporting the retention of nurses, that this is not occurring in some areas in the current climate is a concern for the profession and those responsible for the provision of care.

Shaping student nurses' attitudes towards older people through learning and experience.

This paper reports an exploratory New Zealand study comparing student nurses' attitudes towards older people before and after an introductory nursing paper that included gerontology theory and clinical practice in an aged care setting. Health professionals are exposed to ageist attitudes that permeate Western societies. Theoretical content and clinical experiences in nursing programmes should lead to attitudes that inform the practice of competent and caring practitioners. The Kogan Attitudes Towards Old People Scale (1961) was administered to 56 student nurses at the beginning and end of the first semester of study in a Bachelor of Nursing programme. The results showed a statistically significant positive shift in students' self reported attitudes towards older people following the integrated theoretical and clinical paper. The findings contribute to the international evidence supporting the view that education about ageing shapes attitudes when integrated with positive clinical placement opportunities.

Representations of people with dementia - subaltern, person, citizen.

This study traces shifts in health professional representations of people with dementia. The concepts of subaltern, personhood and citizenship are used to draw attention to issues around visibility, voice and inclusion. Professional discourses and practices draw upon, and are shaped by historical and contemporary representations. Until recently, people with dementia were subaltern in nursing and medical discourses; marginalised and silenced. The incorporation of contemporary representations foregrounding personhood and citizenship into health professional accounts provide space for transformative styles of care. Privileging personhood centralises the person with dementia in social networks, focusing on their experiences and relationships. Respecting citizenship involves challenging discrimination and stigma: nursing from a rights-based approach necessitates listening and being responsive to the needs of the person with dementia. Incorporating contemporary representations in health professional practice requires the discarding of the historically dominant elite and authoritarian accounts of dementia still apparent in some nursing texts along with, perhaps, the historically burdened term of dementia itself.

The experiences of people with an intersex condition: a journey from silence to voice.

AIM AND OBJECTIVES: The aim of this research was to explore the experiences of people with intersex conditions. The main objective was to contribute to knowledge of the condition by giving voice to a group of people who are invisible in society. BACKGROUND: Medical management of intersex conditions has historically focused on erasing visual bodily difference through gender assignation and medical/surgical intervention to ensure congruent body appearance. People with intersex conditions require support to live free from shame in a normalising society and need particularly sensitive care when engaged with the health system. DESIGN: A small-scale qualitative study was undertaken. Recruitment of participants was difficult because of barriers created by invisibility and marginalisation. After extensive and careful negotiation with one contact, three people in New Zealand agreed to participate in the research. METHODS: In-depth interviews were undertaken and thematic analysis used to develop themes that were common across participants' experiences. RESULTS: Three themes emerged from the data: managing silence, coping with difference and development of acceptance. These themes highlight: the negative impact of societal ignorance, lack of acceptance of body difference and the journey from silence to disclosure and acceptance of individuality and choice in gender identification. CONCLUSION: These findings highlight the need for nurses to be knowledgeable and skilled communicators to ensure age-appropriate information and support is provided to enable individual choice in gender identification and normalisation for people with intersex conditions. RELEVANCE TO CLINICAL PRACTICE: Many nurses will be unaware of the condition of being intersex and have little knowledge of the challenges faced by this group yet are likely to be involved in their care. People with intersex conditions require particularly sensitive care and nurses can provide appropriate, supportive and 'safe' care if they are aware of the condition and its challenges.

Caring in residential aged-care. Qualitative findings from an e-cohort sub-study.

AIM: The aim of this e-cohort sub-study was to explore and describe nurses' understandings of 'caring' in residential aged-care. BACKGROUND: The quality of the work environment is an important issue for recruitment, retention and workforce planning. Knowledge about the people in and the place that is the residential aged-care facility may assist with the problems surrounding the recruitment and retention of nurses in the workforce. DESIGN: Qualitative electronic cohort sub-study. METHODS: This paper presents the qualitative research findings from an electronic cohort sub-study of 58 registered and enrolled nurses working in the residential aged-care sector in 2007. Data were collected through an open ended question and a qualitative content analysis was used to generate the core categories. RESULTS: The concept of caring was grounded in and constrained by, the everyday reality of the nurses in the study. Organisational imperatives for the completion of documentation necessary for accreditation and funding combined with under-staffing restricted the time available for caring practices. Some nurses represented residential care faculties as devoid of care, others as a place where the resident was central to their work and care. The staff perceived of themselves as an ageing workforce in need of rejuvenation and resourcing. CONCLUSION: The concept of caring is manifest in nurses' language as they describe their workplace, the residents, themselves and the structures that impact on what they do. Good caring manifests itself when the residents are central to the business of the aged care facility. However, nurses in this study describe a range of restrictive factors impeding caring practices and diminishing workforce morale and motivation to create environments that can truly be called a 'home-away-from-home' and one that all people would find acceptable. RELEVANCE TO CLINICAL PRACTICE: These findings have implications for aged-care sector recruitment, retention and workforce planning within residential aged-care facilities.

The Internet as a research site: establishment of a web-based longitudinal study of the nursing and midwifery workforce in three countries.

AIM: The aim of this paper is to describe the development of a web-based longitudinal research project, The Nurses and Midwives e-cohort Study. BACKGROUND: The Internet has only recently been used for health research. However, web-based methodologies are increasingly discussed as significant and inevitable developments in research as Internet access and use rapidly increases worldwide. METHOD: In 2006, a longitudinal web-based study of nurses and midwives workforce participation patterns, health and wellbeing, and lifestyle choices was established. Participating countries are Australia, New Zealand and the United Kingdom. Data collection is handled through a dedicated website using a range of standardized tools combined into one comprehensive questionnaire. Internet-specific data collection and a range of recruitment and retention strategies have been developed for this study. DISCUSSION: Internet-based technology can support the maintenance of cohorts across multiple countries and jurisdictions to explore factors influencing workforce participation. However, barriers to widespread adoption of web-based approaches include website development costs, the need for fast broadband connection for large data collection instruments, and varying degrees of Internet and computer literacy in the nursing and midwifery workforce. CONCLUSION: Many of the issues reported in this paper are transitional in nature at a time of rapid technological development. The development of on-line methods and tools is a major and exciting development in the world of research. Research via the world-wide web can support international collaborations across borders and cultures.

Representations of heart failure in Internet patient information.

AIM: This paper is a report of a study which examined representations of heart failure in Internet patient information. BACKGROUND: The Internet is a popular tool for sourcing health information and has been shown to benefit people with chronic conditions. Nurses as users and producers of Internet health information need to be critical of the information they provide and how this information is portrayed, to support patient knowledge development and decision-making. METHOD: A critical discourse analysis approach was used to examine representations of heart failure in a range of Internet texts. Data were collected from eight websites over 5 days in July 2006. FINDINGS: The two major discursive representations evident in the heart failure texts were labelled 'living with heart failure' and 'biomedical' discourses. While both discourses were evident in all of the Internet sites, most sites privileged the biomedical discourse. Absences from the Internet information included the visibility and role of nurses along with emotional and spiritual dimensions of heart failure. CONCLUSION: Nurses should take individual needs into consideration and be able to critique websites before suggesting appropriate sites to patients. Nurses and consumers can enhance the quality of websites by becoming involved in their development to ensure that all factors that affect health are included, such as the emotional and spiritual aspects of living with heart failure and not just topics that are important within a biomedical view of health.

Nursing students and Internet health information.

This study investigates use of the internet by nursing students to access health information and their evaluation practices in relation to this information. The research method was a retrospective descriptive postal survey. A questionnaire was sent to all undergraduate students enrolled in a Bachelor of Nursing programme at a New Zealand university in 2005. The response rate was 50% or 174 responses. Findings from the study included marked variations in respondents ability to successfully search for and evaluate relevant internet health and nursing information. Few respondents assessed patients use of the internet to gather health information or assisted patients with evaluation. As searching, evaluating and sharing online information is a core element of nursing practice, formal education to develop competency in the ability of all nursing students to retrieve and assess internet health information is essential. The integration of these skills into nursing practice is a vital step in developing new approaches to working with knowledgeable consumers of internet health information.

The impact of endometriosis on work and social participation.

Endometriosis is a debilitating chronic disease that can affect many aspects of everyday life owing to symptoms such as pain and fatigue. This paper reports the findings of a study exploring the impact of symptomatic endometriosis on women's social and working life. The study used a feminist approach. Eighteen women were interviewed and a thematic approach used to analyse the data. The analysis is structured around three themes focusing on issues around disclosure of symptoms in the work place; the impact of symptoms on work, education and social participation; and the strategies used by women in the study to manage endometriosis. A range of health and employment implications are discussed in this paper. In particular, nurses can provide useful support to women by careful assessment and prompt referral for diagnostic procedures and by providing timely and comprehensive information, including information about the lifestyle and nutritional factors recommended by women with endometriosis.

Nurses and Internet health information: a questionnaire survey.

AIM: This paper is a report of a study to identify the extent of postgraduate nursing students' information literacy skills in relation to electronic media and health information and barriers to accessing this information. BACKGROUND: The Internet is a key source of information for a significant group of patients. However, there is evidence of quality issues with some Internet health information sites. Nurses need to be aware of the range and quality of online health information so as to assist patients and families to locate and evaluate relevant and current information. METHOD: A questionnaire designed to collect quantitative and qualitative data was posted to a convenience sample of all students enrolled in a postgraduate nursing programme in December 2005. The response rate was 55.1% or 123 responses. RESULTS: Most respondents had Internet access at home and work and believed that access to online health information resources had improved their practice. However, some had difficulties in accessing computers at work and insufficient time to search for online health information. Concern was expressed about the quality of online information, but the majority of respondents did not assess patient use. Frequent users of online resources were more likely to assess patient use. CONCLUSION: The development of nursing competencies in accessing and using online resources is a key precursor to supporting patients and families' use of the medium. Access to Internet resources at work, along with training and time for searching, is necessary for the development of skills enabling effective use of information technology.