Looking Beyond Nursing Education Practice to Include Sustainable Health-Care Systems Processes.

The education of nurses must continuously evolve for the application of best practice to occur. There are times that require a more meaningful pathway of sustainable health-care systems integration. Sustainable health-care systems processes include a series of actions to maintain sustainable health-care outcomes for both humans and the environment. Traditional practice usually conforms to a medicalized approach. However, due to changing global patterns of unsustainability, of which health-care facilities are a part, the community of nurses have been called upon to be leaders in transformation that goes beyond traditional training to encompass innovative holistic systems processes designed to address the welfare of humans, areas of mitigation, and adaptation strategies, along with the 17 United Nations Sustainable Development Goals. This article highlights why challenging and updating nursing education practice is required and provides a possible solution through an innovative program-the NurSus TOOLKIT.

New Insight into the Prevalence and Risk Factors for Three Distinct Hoof Conformation Traits in UK Commercial Sheep Flocks.

Lameness in sheep continues to be a global health, welfare and economic concern. Damaged, misshapen or overgrown feet have the potential to cause lameness either directly, or indirectly. There is a lack of understanding of the predisposing factors for different hoof conformation traits in sheep. Our exploratory study aimed to investigate the prevalence of, and risk factors for, three distinct hoof conformation traits relating to the sole and heel, hoof wall, and hoof wall overgrowth. Feet of 400 ewes from four UK commercial sheep farms were inspected at four time points across 12 months. For each conformation trait, a four-point ordinal system was used to score each individual claw, and foot-level scores were calculated. We present 92.4% of foot-level observations to be affected by ≥1 conformation traits. Whilst hoof conformation traits were correlated to some degree, a unique set of sheep-, foot- and farm-level factors were associated with each distinct conformation trait. We provide, for the first time, key insight into the multifaceted and multifactorial aetiology of hoof conformation in sheep, building upon previous landmark studies. Our results inform hypotheses for future prospective studies investigating the risk factors for adverse hoof conformation in sheep.

Prevalence and Temporal Dynamics of White Line Disease in Sheep: An Exploratory Investigation into Disease Distribution and Associated Risk Factors.

Lameness in sheep is a global health, welfare and economic concern. White line disease (WLD), also known as shelly hoof, is a prevalent, non-infectious cause of lameness, characterised by the breakdown of the white line. Little is known about the predisposing factors, nor the individual disease dynamics over time. Our exploratory study aimed to investigate the prevalence and temporal dynamics of WLD, and the associated risk factors. Feet of 400 ewes from four UK commercial sheep farms were inspected for WLD at four time points across 12 months. The change in WLD state at foot-level (develop or recover) was calculated for three transition periods. We present WLD to be widespread, affecting 46.8% of foot-level and 76.6% of sheep-level observations. States in WLD changed over time, with feet readily developing and recovering from WLD within the study period. The presence of WLD at foot-level, the number of feet affected at sheep-level and dynamics in development and recovery were driven by a variety of foot-, sheep- and farm-level factors. We provide key insight into the multifaceted aetiology of WLD and corroborate previous studies demonstrating its multifactorial nature. Our study highlights an opportunity to reduce WLD prevalence and informs hypotheses for future prospective studies.

Characterisation of Dichelobacter nodosus on Misshapen and Damaged Ovine Feet: A Longitudinal Study of Four UK Sheep Flocks.

Dichelobacter nodosus is the causal agent of ovine footrot, a contagious disease of welfare and economic concern worldwide. Damaged feet may be subclinical carriers of D. nodosus and covertly spread infection. Accordingly, we evaluated the risk of misshapen and damaged feet on D. nodosus presence and load in four commercial UK sheep flocks. Foot-level observations and swabs (n = 972) were collected from ewes (n = 85) over 12 months. On average, ewes were sampled three times. Feet were inspected for disease and scored (good/poor) for three hoof conformation traits (sole and heel, wall, and wall overgrowth). Swabs were analysed for presence and load of D. nodosus, and mixed models were constructed. Poor hoof conformation traits were present in 92.5% of foot-level observations. Feet with poor sole and heel conformation were more likely to have higher D. nodosus loads (ß = 0.19, 95% CI: 0.04-0.35) than those with good conformation. Furthermore, on feet positive for D. nodosus, wall overgrowth was associated with higher D. nodosus loads (ß = 0.27, 95% CI: 0.01-0.52). Feet with aspects of poor conformation covertly harbour D. nodosus and are a source of infection. Flock management should be guided by hoof conformation to reduce disease challenge.

Sheep farmers' attitudes towards lameness control: Qualitative exploration of factors affecting adoption of the lameness Five-Point Plan.

In 2014, best-practice recommendations to treat and control lameness in sheep in the UK were consolidated into a national program, the Five-Point Plan (5PP). As recent evidence suggests that only the minority of sheep farmers are implementing all management practices listed in the 5PP, qualitative investigation is vital to ensure future promotion is aligned with psychological and contextual factors affecting farmers' decision-making. This qualitative study sought to explore farmers' attitudes and the factors affecting uptake of best-practice measures listed in the 5PP. Semi-structured interviews were conducted in 2019 with 12 sheep farmers from England and Wales. In accordance with Thematic Analysis and the principles of Grounded Theory, data collection and analysis were performed iteratively. Two overarching themes, delineated by subthemes, emerged during analysis; (1) Barriers to adoption of 5PP measures and (2) Motivation to adopt 5PP measures. Various farmer-centric factors and physical resources were identified as key barriers or obstacles that limited farmers' ability to implement 5PP measures outright, or restricted their ability to make changes to facilitate future adoption. Conversely, internal and external influences were identified to increase farmers' willingness and motivation to implement practices listed on the 5PP. Heterogeneity in farmer perceptions, attitudes, experiences and circumstances identified in this study highlights the difficulty in promoting a one-size-fits-all lameness control plan, where a unique combination of intrinsic factors, social influences, and physical restrictions affect implementation. Future initiatives should focus on removing barriers by changing farmers' perceptions and mindset towards lameness control, and building farmers' confidence in their ability to implement practices. Furthermore, farmers' social licence to farm and their desire to improve their reputation within society, presents an important opportunity to further engage farmers in implementing control practices. Increasing peer-to-peer knowledge transfer opportunities and effective farmer-veterinarian communication and rapport could help establish 5PP measures as normative behaviours.

Uptake of the lameness Five-Point Plan and its association with farmer-reported lameness prevalence: A cross-sectional study of 532 UK sheep farmers.

The aims of this research were to determine the uptake of a national strategy to reduce lameness in the UK flock, known as the Five-Point Plan (5 P P); explore the association between footrot vaccination (Footvax®) use and 5 P P adoption; investigate the management practices associated with farmer-reported percentage lameness through risk factor analysis; and identify the population attributable fractions of these management practices. In 2014, the 5 P P was launched to provide a practical, farm-level framework to help farmers reduce lameness to reach Farm Animal Welfare Committee (FAWC) targets. No published studies have explicitly explored its uptake in UK flocks nor its association with lameness prevalence. Understanding what parts of the 5 P P farmers adopt and which elements contribute towards the greatest reduction in lameness are integral in informing future strategies. Between November 2018 and February 2019, 532 UK sheep farmers completed a cross-sectional online and paper-based survey. The geometric mean of farmer-reported percentage lameness in ewes was 3.2 % (95 % CI: 2.8-3.6). Farmers adopted a median of 3 points of the plan, but was only fully-adopted by 5.8 % of farmers. The number of points adopted increased with flock size, with larger commercial flocks more likely to cull and vaccinate against footrot, but smaller, pedigree flocks were more likely to treat individual lame sheep. Vaccination was poorly associated with the uptake of other points of the 5 P P. Eight flock management factors were associated with significantly higher percentage lameness in ewes; not carrying out measures to avoid lameness transmission, not quarantining bought in stock, not treating individual lame sheep within three days, maintaining an open flock and foot trimming were all associated with a higher risk of lameness in flocks studied. In addition, using Footvax® for ≤5 years was associated with a higher risk of lameness, although vaccination could be a consequence of high flock lameness or these farmers were not implementing other effective managements, such as treating promptly. The highest PAFs were calculated for trimming lame sheep (16.9 %), maintaining an open flock (13.5 %) and not carrying out measures to avoid lameness transmission (11.8 %). We provide new evidence documenting the benefits of adopting parts of the 5 P P on reducing lameness prevalence in UK flocks, although uptake of these measures could be improved in flocks. Encouraging uptake of these measures could make an important contribution towards reducing the prevalence of lameness and reaching 2021 FAWC ≤ 2% lameness prevalence targets.

Sustainable lamb production: Evaluation of factors affecting lamb growth using hierarchical, cross classified and multiple memberships models.

In light of current concerns about the sustainability of red meat production in a world with increasing global demand for food from animal origin there is a need for a better understanding of factors that influence the growth rate and feed conversion efficiency of animals on commercial farms. The primary objective of this observational study was to use longitudinal data to quantify the simultaneous effects of multiple ewe and lamb factors on lamb growth rate. A secondary aim was to evaluate model structures that specifically account for lamb grouping effects during the growth period and compare these to classical hierarchical growth rate models. A total of 4172 weight recordings from 805 lambs and data on disease events were collected over a 6-month period from a commercial pedigree sheep flock. Three mixed model structures were compared, hierarchical, cross classified and multiple membership, and final estimates determined within a Bayesian framework. The multiple membership structure provided the best model fit and was used for final inference; taking account of the effect of lamb grouping over time provided the best estimates of lamb growth rate. Ewe lameness and mastitis cases had a deleterious impact on lamb growth. Lambs from ewes identified with mastitis during lactation were on average 3.0 (standard error (SE) 1.6) kg lighter during the four month growth period than lambs from unaffected ewes. Lambs from ewes that were not lame during pregnancy were 3.0 (SE 1.2) kg heavier at eight weeks of age than lambs from ewes with a least one lameness case during the same period. Lambs from ewes lame either during the first 4 weeks or between 4-8 weeks of a lamb's life (but not lame during pregnancy) were also significantly heavier at 56 days of age, than lambs reared by ewes that were lame during pregnancy (2.8 (SE 1.2) and 3.4 (SE 1.2) kg respectively). Cases of pneumonia and bacterial arthritis in lambs had a significant negative impact on lamb growth with affected lambs being on average 5.5 (SE 1.1) kg and 2.2 (SE 1.2) kg less than non-affected lambs respectively after the disease event. Prior to a case of lameness or pneumonia, lambs were significantly heavier than unaffected lambs suggesting a possible trade-off between growth and immune function. Overall, the study provides evidence that that a combination of ewe and lamb characteristics and disease events play an important role in determining lamb growth rate and that heavier lambs may be more susceptible to disease.

Primary health care decision making in pre-dialysis chronic kidney disease.

OBJECTIVES: This qualitative descriptive study explored the primary health care decisions of a group of 12 Australians in Stages 3B to 5 with chronic kidney disease in the preservation of kidney health. METHODS: Questioning within the qualitative interviews focused on gaining an understanding of the participants' perceptions of their kidney health and the decisions made as a consequence of their interaction within the Australian primary health care system. RESULTS: Participants were dependent on their General Practitioner to recognise their symptoms, make the correct diagnosis and authorise the correct referral for specialist nephrology care. Three pathways in this process were identified: 'easy'; 'difficult' and 'protracted'. Clinician failure to correctly attribute symptoms to chronic kidney disease influenced the 'difficult' pathway, while failure to adequately communicate kidney health status influenced the 'protracted' pathway. Use of the language of 'recovery', 'stability' and 'protection' held meaning to the participants in gaining an understanding of their kidney health. DISCUSSION: Identifying pathways to diagnosis and referral can raise awareness of the challenges kidney health consumers face in their participation within the primary health care arena. Using consumer meaningful language improves the capacity of these consumers to engage in their own primary health care agenda.

Australian rural, remote and urban community nurses' health promotion role and function.

Community nurses have often been 'touted' as potential major contributors to health promotion. Critical literature, however, often states that this has not been the case. Furthermore, most studies examining nurses' role and function have occurred mainly in hospital settings. This is a sequential mixed-methods study of two groups of community nurses from a Sydney urban area (n = 100) and from rural and remote areas (n = 49) within New South Wales, Australia. A piloted questionnaire survey was developed based on the five action areas of the Ottawa Charter for Health Promotion. Following this, 10 qualitative interviews were conducted for both groups, plus a focus group to support or refute survey results. Findings showed that rural and remote nurses had more positive attitudes towards health promotion and its clinical implementation. Survey and interview data confirmed that urban community nurses had a narrower focus on caring for individuals rather than groups, agreeing that time constraints impacted on their limited health promotion role. There was agreement about lack of resources (material and people) to update health promotion knowledge and skills. Rural and remote nurses were more likely to have limited educational opportunities. All nurses undertook more development of personal skills (DPS, health education) than any other action area. The findings highlight the need for more education and resources for community nurses to assist their understanding of health promotion concepts. It is hoped that community nurse leaders will collectively become more effective health promoters and contribute to healthy reform in primary health care sectors.

Evaluation of the health promotion activities of paediatric nurses: is the Ottawa Charter for Health Promotion a useful framework?

Researchers were involved in an evaluative approach to examine the health promotion activities of paediatric nurses from a paediatric tertiary hospital centre (N = 83) and five paediatric non-tertiary hospital centres (N = 48) from Sydney, Australia. The aims of this study were to understand the nature of heath promotion in paediatric nursing practice by examining nurses' attitudes, investigating paediatric nurses' involvement in the five action area of the Ottawa Charter, and identifying barriers to the implementation of health promotion in practice. The researchers developed a health promotion survey based around the Ottawa Charter for Health Promotion (World Health Organisation, 1986a), and a literature review of nurses' involvement in health promotion. Results showed that tertiary paediatric nurses undertook more varied health promotion activities such as creating supportive environments (CSE), reorienting health services (RHS) and building healthy public policy (BHPP) than did non-tertiary paediatric nurses who were involved in only one action area of the Charter, that of developing personal skills (DPS). This research revealed that within paediatric nursing practice the action areas of the Ottawa Charter of BHPP and CSE were important; and that there is support for the advocacy role of paediatric nurses. There is also evidence that paediatric nurses may have health promotion knowledge deficits associated with the Ottawa Charter, and that the environment of multidisciplinary allied health professionals in a tertiary paediatric centre may positively influence senior paediatric nurses and their capacity to be involved in varied health promotion activities associated with the Ottawa Charter.

Reframing the Australian nurse teacher competencies: do they reflect the 'REAL' world of nurse teacher practice?

The Australian nurse teacher competencies were introduced in 1996; however, the researchers perceived that changes to the health care system and a nursing workforce shortage may have affected nurse teacher roles over the past decade. This study aimed to explore perceptions of nurse teachers on the applicability of the current Australian nurse teacher competencies to practice, and modify the nurse teacher competencies to better reflect current practice. Methodology utilized mixed methods, and data collection was via focus groups, telephone interviews, and survey data. Results revealed that participants were mostly positive about the original competency statements, although there were some variations between items. Themes that emerged from the qualitative data were: changing trends in health care; preparation for teaching; understanding of the competencies, contextual influences on education role; nurse teachers as change agents, and resource management. Conclusions were that the Australian nurse teacher competencies (1996) were reflective of the current generic roles of nurse teachers however some of the competencies needed reframing to meet the current needs of nurse teachers. However, changes needed to be made in areas such as reducing complex language, inclusion of technology, and cultural competencies. Nurse teachers were supportive of the research because they valued the teacher competencies for reflection on their practice and the development of portfolios, job descriptions and performance appraisals.

Using patterns of knowing in nursing as a possible framework for nursing care of homeless families with children.

In developed countries such as Australia, the United Kingdom and the United States of America, homeless families are amongst the fastest growing subpopulations of the homeless. This paper seeks to explore the major issues involved in the health and nursing care of such families, and proposes that the patterns of knowing in nursing offer a pertinent, guiding framework for nurses to understand the phenomenon and to optimize holistic nursing care for homeless families with children.

The involvement of parents and nurses in the care of acutely-ill children in a non-specialist paediatric setting.

The examination of both parents' and nurses' expectations and attitudes towards parental participation in the care of ill children in a community hospital, non-specialty setting was undertaken in this exploratory, qualitative research study within Australia. First, in this triangulated research study, 14 in-depth interviews with parents were carried out about their participation in the care of their ill children. Content analysis revealed that the four main themes were to do with parental factors including control, expectations, support and emotion; communication; the importance of being with your child; and the fact that mothers do the mothering and nurses do the nursing. Two focus group sessions were held with paediatric nursing staff. Content analysis confirmed real communication problems between nurses and parents. Implications that arose for nursing practice were for in-service workshops to improve communication between nurses and families as well as workshops to prepare students of university nursing programmes offering paediatric electives.

Validating the revised Health Belief Model for young families: implications for nurses' health promotion practice.

By modifying the Health Belief Model (HBM) nurses can provide health promotion guidance for families through the revised HBM for young families. The constructs 'perceived behavioral control' and 'behavioral intention' from Ajzen's Theory of Planned Behavior were added to the HBM to provide a health orientation. An initial qualitative study informed the second quantitative study through thematic data obtained by interviewing parents about family health. The second comparative study of low and high socioeconomic status families of preschool-aged children living in western Sydney, Australia, measured family health through the Parental Health Behavior Questionnaire (PHBQ). After a small pilot study, the researcher distributed 150 questionnaires to center directors from preschools, kindergartens and long day care, who then handed out questionnaires to interested parents. Data collection occurred in 1998 with consenting parents returning the questionnaires for collection by the researchers. A convenience sample of 103 was obtained with a 69% return rate. Analysis was undertaken through MANCOVA. Justification for validity occurred through logical analysis and hypothesis testing, based on the literature, while reliability was acknowledged by undertaking Cronbach coefficient alphas on small variable clusters. Results support the constructs 'perceived behavioral control' and 'behavioral intention' in the revised model, suggesting that for families of different socioeconomic background, differences emerge in terms of their perceived control over their child's health and the initiation of health behaviors for their child. Recommendations for further research are for refinement of the PHBQ, new research with different families, and further testing of all the model constructs.

Revisiting the Health Belief Model: nurses applying it to young families and their health promotion needs.

The Health Belief Model (HBM) was reviewed with the aim of modifying it so that it reflected a health promotion stance for young families. Since this model's inception, health professionals like nurses have been involved in using the HBM to guide their practice. It is argued that to assist families, nurses now need a model that is focused on "health." In support of this approach, reorienting the HBM and basing it on "positive" health definitions associated with health promotion, by modifying it through adding the constructs "perceived behavioral control" (representing health locus of control) and "behavioral intention" from Ajzen will provide nurses with a more appropriate and useful model for interacting with families and their preschool children. A summary of positive and negative aspects of the modification of the HBM is presented, followed by a strategy for the process of validating the revised HBM for young families.

Capturing parents' understanding about the health behaviors they practice with their preschool-aged children.

This qualitative, descriptive study first explored parents' concept of health and then examined the health practices they undertook for their preschool-aged children. The purposive sample of 11 parent couples and 3 single parents (14 parent sets in total) with preschool-aged children attending long daycare and preschool/kindergarten centers was equally distributed between parents from two different socioeconomic groups in two suburbs of western Sydney, Australia. Consenting parents were interviewed and transcripts were analyzed concurrently in accordance with a grounded theory approach (Glaser Strauss, 1967). Results revealed the presence of three themes, and practice implications for community nurses stem from them. These themes were Educating About Family Health, The Dynamic, Multidimensional Nature of Teaching Child Health Behavior, and The Intergenerational Theme. There was only minimal support for health-related socioeconomic differences. The study also found that most families with preschool-aged children were engaged in illness prevention rather than health promotion. Unlike those families focused on illness prevention, families focused on a health promotion mode were more sophisticated in their educational strategies and used more educational strategies associated with developing their child's health behaviors. This research validated the importance of the intergenerational transmission of values, particularly by mothers. The health behaviors that mothers considered important, and that they reinforced with their children, were transmitted equally to their daughters and sons.