Joining forces to understand what matters most: qualitative insights into the patient experience of outpatient rheumatology care.

Objective: People with rheumatic diseases are frequent, long-term attenders of health-care services. Their care experiences are central to improving services. The aim of this study was to explore real-world experiences and priorities of people attending outpatient rheumatology care and those of health-care professionals (HCPs) providing care. Methods: This qualitative study consisted of five semi-structured focus groups. Participants included rheumatology outpatients (n = 16) of two tertiary teaching hospitals and HCPs (n = 14; rheumatologists, rheumatology trainees, physiotherapists, a specialty nurse and a pharmacist). Participants explored priorities when attending outpatient services, real experiences and aspirations for improving future care. Transcripts were coded using inductive and deductive thematic analysis. Results: Seven key themes were identified: smooth flow of technical processes, care coordination, individualized care, information sharing, clinical excellence, patient empowerment and comprehensive care. The findings were aligned conceptually with quality standards in Australia and worldwide. Different sub-themes and prioritization of concerns emerged from patient and HCP subgroups. Highly prioritized themes for patients pertained to processes and technical aspects of care. HCPs focused on themes relating to non-technical aspects of service provision: information sharing, individualization of care, patient advocacy and empowerment. Conclusion: This study captured valuable insights into the current experience of outpatient rheumatology care from the perspective of patients and HCPs. It informs a collective understanding of differing and shared priorities, positives of current care and areas requiring change. Themes derived from the study data can be conceptualized in terms of the process, content and impact of care. Such domains can be measured longitudinally by routine implementation of validated patient-reported experience measures in rheumatology.

An Example of Inquiry-Based Learning in a Transition to Nursing Practice Curriculum.

BACKGROUND: Graduate nurses are known to experience transition shock when they enter the workforce. Graduate nurse programs are designed to alleviate aspects of transition shock. METHOD: Best practice in development and delivery of transition programs is currently limited in the literature, and there are few examples focusing on curriculum design that can be adapted by health services to develop and support new nurses. RESULTS: An inquiry-based learning approach was used as the underlying andragogy to frame a contemporary transition curriculum to support graduate nurses. CONCLUSION: Inquiry-based learning can be used to support graduate nurses to improve critical thinking, confidence, and job satisfaction during the most challenging years of their professional lives. [J Contin Educ Nurs. 2023;54(6):268-274.].

Comparison of experiences of nursing staff and patients before and after move to 100% single-bed room hospital in Australia: mixed methods.

BACKGROUND: There is sufficient and consistent international evidence of issues reported by nurses working in single-bed room environments, requiring a design that is not only comfortable for patients but meets nurses working needs. This paper presents a comparison of nursing staff and patients experience prior to a move to 100% single-bed room hospital in 2016 (Stage 1) and actual experiences after the move in 2021 (Stage 2) in South Australia. METHOD: Mixed method case study design. Survey sample of forty-two nursing staff; twelve patient interviews of their experiences of current environment and; thirteen nursing staff interviews of their experiences delivering nursing care in 100% single bed-room environment. RESULTS: Nurses and patients highlighted single-bed rooms contributed to patients' privacy, confidentiality, dignity and comfort. As anticipated in Stage 1, nurses in Stage 2 reported lack of patient and staff visibility. This impacted workload, workflow and concern for patient safety. CONCLUSION: Patient and nursing staff experiences are interdependent, and implications of single-bed room accommodation are complicated. Future impacts on the health system will continue to affect hospital design, which must consider nurses working needs and patient safety and comfort.

Impact of Dual Intensive Care Unit and Rapid Response Team Nursing Roles on Service Delivery in the Intensive Care Unit.

BACKGROUND: Rapid response teams generally consist of multidisciplinary specialist staff members with advanced knowledge and skills to manage deteriorating patients outside of the intensive care unit. These teams consist predominantly of intensive care unit nurses, who often undertake intensive care unit and rapid response team duties concurrently. Little has been published on the impact of these nurses' absence while attending a rapid response call on the nursing workforce, patient care, and resource allocation in the intensive care unit. OBJECTIVE: To explore the impact of nurses' absence due to attending rapid response calls in other areas of the hospital on service delivery and resource allocation in the intensive care unit. METHODS: A comprehensive search of 3 databases was performed to identify studies on relationships among the rapid response team, the intensive care unit, and nursing staff. RESULTS: The search yielded 6 quantitative studies, 2 qualitative studies, and a mixed-methods study that were included for analysis. Four key themes were identified: (1) workforce, staffing processes, and resource allocation; (2) alterations to workload and resource allocation; (3) adverse events or incidents; and (4) funding variability of rapid response team models. Review of the studies indicated that dual intensive care unit and rapid response team nursing roles have negative effects on nurses' workload, increase the risk of adverse events, and may compromise patient safety. CONCLUSION: The staffing of both the intensive care unit and the rapid response team should be examined carefully with an eye toward sustainability, cost-effectiveness, and clear outcome measures.

The impact of the COVID-19 pandemic on Australian hospital-based nursing and midwifery educators.

Background: The COVID-19 pandemic significantly disrupted health services and their staff, including nursing and midwifery educators. Nursing and midwifery educators were tasked with meeting nurses' and midwives' rapidly-changing educational requirements, and supporting the nursing and midwifery workforce through the pandemic. Thus, nursing and midwifery educators were pivotal to the pandemic response. Aim: To assess the impact of the COVID-19 pandemic on nursing and midwifery educators across four large, multisite Australian health services. Methods: Qualitative descriptive study. All nursing and midwifery educators from public health services in Melbourne, Victoria (n = 3) and Adelaide, South Australia (n=1) were invited to participate in a semistructured interview (July - November 2020). Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically. Findings: Forty-six nursing and midwifery educators participated in interviews. Across the health services, two similar themes and six sub-themes were identified. In the first theme, "Occupational impacts of COVID-19," participants described adjusting to providing education during the pandemic, managing increased workloads, concerns about not being able to carry out their usual education activities and the importance of support at work. The second theme, "Psychological impacts of COVID-19," included two sub-themes: the negative impact on participants' own mental health and difficulties supporting the mental health of other staff members. Participants from all health services identified unexpected positive impacts; online education, virtual meetings and working at home were perceived as practices to be continued postpandemic. Conclusions: Hospital-based nursing and midwifery educators demonstrated agility in adjusting to the fast-changing requirements of providing education during the pandemic. Educators would benefit from continued occupational and psychosocial support during the COVID-19 pandemic, and inclusion in discussions to inform hospitals' preparedness for managing the education of nurses and midwives during future pandemics.

Social barriers to Type 2 diabetes self-management: the role of capital.

Approaches to self-management traditionally focus upon individual capacity to make behavioural change. In this paper, we use Bourdieu's concepts of habitus and capital to demonstrate the impact of structural inequalities upon chronic illness self-management through exploring findings from 28 semi-structured interviews conducted with people from a lower socioeconomic region of Adelaide, South Australia who have type 2 diabetes. The data suggests that access to capital is a significant barrier to type 2 diabetes self-management. While many participants described having sufficient cultural capital to access and assess health information, they often lacked economic capital and social capital in the form of support networks who promote health. Participants were often involved in social networks in which activities which are contrary to self-management have symbolic value. As a consequence, they entered relationships with health professionals at a disadvantage. We conclude that structural barriers to self-management arising from habitus resulting in the performance of health behaviours rooted in cultural and class background and limited access to capital in the form of economic resources, social networks, health knowledge and prestige may have a negative impact on capacity for type 2 diabetes self-management.

Issues that impact on Aboriginal health workers' and registered nurses' provision of diabetes health care in rural and remote health settings.

UNLABELLED: Type 2 diabetes mellitus is an established health problem for Indigenous Australians. One strategy to address this issue is to educate health professionals in diabetes management and education. OBJECTIVE: The objective of this paper is to identify important issues that compromise the clinical practice of rural and remote Aboriginal health workers (AHWs) and registered nurses (RNs) who undertook an accredited Australian Diabetes Educators Association diabetes course and to suggest strategies to improve practice. DESIGN: The design used a qualitative approach and discussion schedule to elicit responses. SETTING: The setting involved two Aboriginal community controlled and seven mainstream health services in the Far Western region of New South Wales. PARTICIPANTS: The participants were experienced diabetes educators (RNs and AHWs), managers and students currently enrolled in the course (n = 17). RESULTS: The results indicated issues that compromise diabetes practice and identified strategies to improve practice. Issues were: the confusing funding practices by health providers, the duplication of health services, the lack of recognition of diabetes qualifications and the transient nature of Indigenous people. Strategies included the need for: continuous dedicated diabetes health funding, a role clarification for diabetes educators, strategic diabetes planning and the importance of diabetes educators working in partnership. CONCLUSION: The conclusion from this study indicates that if the delivery of diabetes health services to Indigenous Australians is to improve it is necessary to address these identified issues.

Living and learning in a rural environment: a nursing student perspective.

This study investigates the influences on nursing student learning who live and learn in the same rural environment. BACKGROUND: A declining health workforce has been identified both globally and in Australia, the effects of which have become significantly apparent in the rural nursing sector. In support of rural educational programs the literature portrays rural clinical practice experiences as significant to student learning. However, there is little available research on what influences learning for the nursing student who studies in their own rural community. RESEARCH AIMS AND DESIGN: The aim of this study was to understand what influences student learning in the rural clinical environment. Through a multiple case study design five nursing students and two clinical preceptors from a rural clinical venue were interviewed. The interviews were transcribed and thematically analysed to identify factors that influenced student learning outcomes. RESEARCH FINDINGS: The most significant influence on nursing student learning in the rural clinical environment was found to include the environment itself, the complex relationships unique to living and studying in a rural community along with the capacity to link theory to practice. The rural environment influences those in it, the demands placed on them, the relationships they form, the ability to promote learning and the time to teach and learn.

The experiences of remote and rural Aboriginal Health Workers and registered nurses who undertook a postgraduate diabetes course to improve the health of Indigenous Australians.

This paper reports on an evaluation of an educational initiative that seeks to improve the diabetes health outcomes of a vulnerable group, Indigenous Australians residing in remote and rural New South Wales. In this context seven Aboriginal Health Workers (AHWs) and ten registered nurses (RNs) undertook an accredited Australian Diabetes Educators Association (ADEA) course. The aims of this study were to identify the beliefs, attitudes and experiences of this group concerning specialist diabetes training, strategies already used by managers and those that could be used to help consolidate the diabetes expertise of AHWs and RNs. The findings indicate specialist diabetes training and constructive support is required if AHWs and RNs are to develop from a novice to an expert. We concluded that the ADEA diabetes course is highly relevant to the needs of Indigenous Australians and that constructive support from managers and the university is most important in the development of diabetes expertise.

Celebrating the end of school life: a pilot study.

INTRODUCTION: Celebrating the end of secondary schooling ("Schoolies Festival") is an established part of the school culture in Australia, with thousands of young students converging at beachside locations to celebrate this rite of passage. The aim of this study was to identify what young people believe is important to remain safe and healthy at this mass-gathering event. METHODS: This study was conducted using postcard surveys requesting demographic data and responses to the questions: (1) What do you think is important to stay safe and healthy at this event?; (2) What do you think is risky attending this event?; (3) Which of these is most likely to affect you at this event?; and (4) Where would you seek medical support? The surveys were distributed to attendees of a "Schoolies Festival" in Adelaide, Australia in 2008. RESULTS: One hundred sixty-five of the 300 postcards were returned completed. The average age of the respondents was 17.7 years. "Not using drugs" was considered important to staying safe and healthy by 120 (73%) of respondents; "drinking alcohol responsibly" was considered important by 89 (54%); and "violent behavior" and "exposure to illicit drugs" were identified as important risks by 135 (82%) and 98 (59%) of participants, respectively. Only 35 (21%) of respondents indicated that they would seek on-site health care if needed. CONCLUSION: Young people attending mass-gathering celebrations have valid concerns about drinking responsibly, exposure to illicit drugs, and sexual harassment. Health messages or health promotion strategies aimed at their specific concerns would be helpful in the mitigation of illness or injury at such events.

Type 1 diabetes mellitus (T1DM) self management in hospital; is it possible? A literature review.

AIM: To review research evidence on the adults with type 1 diabetes mellitus (T1DM)'s ability to continue self management in the hospital setting. BACKGROUND: A person with T1DM requires a daily management routine to control glycaemia levels known as self management. On admission to hospital anecdotal evidence suggests people with T1DM are managed by health professionals and self management is difficult. A review of the literature is required to explore the anecdotal evidence. DESIGN: A literature review of available primary peer-reviewed research on self management of T1DM in hospital. METHOD: A systematic search of the literature published between 1998 and 2008 was undertaken to identify research available on self management of T1DM in hospital. The mixed methods review was conducted using critique tools for randomised control trials, qualitative and quantitative studies. Four main themes were identified; Glycaemic control, development of self management, the expert patient and T1DM management in hospital. RESULTS: Sixteen related publications were identified. In the context of their daily life adults with T1DM perceive their ability to self manage as important and view themselves as 'experts' in their self management. However, there is a recognised conflict about T1DM management between the 'expert' and health professional. Furthermore, management of T1DM by health professionals in the hospital setting has been identified as having a biomedical focus and being poorly managed. CONCLUSION: People with T1DM have knowledge and skills to self manage. Whilst there is support for adults to actively self manage their illness to maintain glycaemic control, there is no support in the literature regarding a continuation of self management in the hospital setting.

Lessons learned at World Youth Day: collecting data and using postcards at mass gatherings.

INTRODUCTION: World Youth Day (WYD) and its associated activities were held in Sydney, Australia from 15-20 July 2008. The aims of this research were to pilot the use of postcards at mass gatherings and to collect baseline data of how young people (age 16-25 years) identify factors that may affect their health and safety when attending mass gatherings. HYPOTHESIS: The concerns of young people in relation to their health and safety at mass gatherings are poorly understood. It was decided that postcards would be an effective method of data collection in the mobile mass gathering environment. METHODS: The research setting was the Pilgrim Walk at WYD. Participants on this walk were young people. To measure their health and safety concerns, a postcard was developed using a Likert scale to rank their attitudes on a continuum. RESULTS: Young people stated that staying hydrated, having enough to eat, and being safe in a crowd were important to them. They also indicated that they perceived, overcrowding, getting to and from an event, and violent behavior as the greatest risks to their health and safety at a mass gathering. CONCLUSIONS: The problems with postcard distribution at a "mobile" mass gathering have been identified. Even so, results gathered showed that young people were focused on "in the moment" aspects of their health; such as access to food and water. They also had concerns for their safety due to potential overcrowding and/or violent behavior.

Piloting a mass gathering conceptual framework at an Adelaide schoolies festival.

UNLABELLED: During the summer months in Australia, school leavers celebrate their end of school life at schoolies festivals around the nation. These events are typically described as a mass gathering as they are an organised event taking place within a defined space, attended by a large number of people. A project was undertaken to analyse the usefulness of Arbon's (2004) conceptual model of mass gatherings in order to develop a process to better understand the Adelaide Schoolies Festival. METHOD: Arbon's conceptual framework describes the inter-relationship between the psychosocial, environmental and bio-medical domains of a mass gathering. Each domain has set characteristics which help to understand the impact on the mass gathering event. The characteristics within three domains were collected using field work and bio-medical data to examine the relationship between injury and illness rates. RESULTS: Using the conceptual framework to evaluate this schoolies event helped create an understanding of the physiology, environment and behaviour contributing to patient presentations. Results showed that the schoolies crowd was active and energetic, and the main crowd behaviour observed was dancing and socialising with friends. The environmental domain was characterised by a grassy outdoor venue that was bounded and dry. Due to the overall health of the crowd, activities undertaken and the supportive environment, the majority of injuries to schoolies were minor (68%). However, twenty-four percent of schoolies who presented with alcohol related illness were found to have consumed alcohol at risky levels; half of this cohort was transported to hospital. CONCLUSION: The conceptual framework successfully guided a higher level of examination of the mass gathering event. In particular, the framework facilitated a greater understanding of the inter-relationships of the various characteristics of a mass gathering event, in this case the Adelaide Schoolies Festival.

Prevalence, risk factors and strategies to prevent dehydration in older adults.

The treatment of dehydration in older adults admitted from residential care to an acute hospital setting may lead to haemodynamic stability. There is however an increased risk for short or long term alterations in physiological, cognitive and psychological status and ultimately, decreased quality of life. Such acute care admissions could be decreased where preventative strategies tailored to address individual risk factors are combined with more frequent assessment of the degree of hydration. The questionable reliability of assessment criteria in older adults increases the need to use multiple signs and symptoms in the identification and differentiation of early and late stages of dehydration. This article reviews various risk factors, explores the reliability of clinical signs and symptoms and reinforces the need to use multiple patient assessment cues if nurses are to differentiate between, and accurately respond to, the various causes of dehydration. Specific strategies to maintain hydration in older adults are also identified.

The impact of a postgraduate diabetes course on the perceptions Aboriginal health workers and supervisors in South Australia.

Contemporary diabetes management is a specialised area of health care and qualified health professionals in this country seeking employment as diabetes educators are first advised to undertake a postgraduate accredited Australian Diabetes Educators Association (ADEA) course. In 1998, aware that type 2 diabetes was a major health problem in the Aboriginal population, Flinders University opened its ADEA accredited course to Aboriginal health workers. This initiative was supported by the South Australian Aboriginal Health Partnership, and the Aboriginal Health Council of South Australia and, as a result, three cohorts of Aboriginal health workers (n=31) were funded to undertake the diabetes course between 1998 and 2001. This was the first time in Australia that health workers in large numbers had undertaken an accredited ADEA course that had been developed for registered nurses and allied health professionals. In view of the different educational background of the two groups, it was thought that the course may not meet the learning needs of Aboriginal health workers. Thus, a qualitative study using critical ethnography was undertaken in fourteen sites in South Australia. The aim was to identify the perceptions of the course held by the health workers who had undertaken the course and the supervisors whose responsibility it was to oversee their clinical activities. It also included establishing whether the course was relevant to the health care needs of Aboriginal people with diabetes in South Australia. The participant group was comprised from the health workers (n=18) who had undertaken the diabetes course and their supervisors (n=21). Data collection and analysis took place between 2001 and 2002. The instrument used was a semi-structured questionnaire. The methods included interviewing and tape recording, observation and fieldwork. The transcripts were thematically analysed and managed by using NVivo software. Three main themes emerged: the positive and negative perceptions of the course held by the participants, the development of the health workers as health professionals and the relevance of the course to the health care needs of Aboriginal people with diabetes. We concluded that other Schools of Nursing & Midwifery in Australia who offer ADEA courses might also enable Aboriginal health workers to access their courses. This contribution would greatly help improve the diabetes health status of Aboriginal people.