Putting it into practice: Infection control professionals' perspectives on early career nursing graduates' microbiology and infection control knowledge and practice.

BACKGROUND: The microbiology component of Australian undergraduate nursing programmes varies considerably. Any actual or potential impact of this variation on infection control practice, as a nursing graduate, is relatively unknown. AIMS: The aim of this study was to explore infection control professionals' perceptions of the importance of microbiology and infection control training in undergraduate nursing curricula and the perceived retention of that knowledge and its transferability to practice. METHOD: Semi-structured interviews were conducted with eight infection control professionals from a range of hospital settings in Australia. FINDINGS: Four main themes emerged: Theory versus practice, importance of role modelling, disjunction between university curricula and 'the real world,' and learning in context. CONCLUSION: As the underpinning element of infection control practice, the role of microbiology education and training in nursing education will benefit from review. Further discussions about the nature and timing of theoretical microbiology content and assessment of undergraduate students' microbiology knowledge to ensure retention and appropriate application of that knowledge in practice are urgently needed.

Infection Prevention and Control Among Paramedics: A Scoping Review.

BACKGROUND: Paramedics are exposed to many infectious diseases in their daily professional activities, leading to a high risk of transmitting infectious diseases to patients in out-of-hospital settings, and possibly leading to healthcare associated infections in hospitals and the community. The coronavirus disease 2019 pandemic has highlighted the importance of infection prevention and control in healthcare more broadly and the role of paramedics in infection control is considered even more critical. Despite this, in many countries such as Australia, research into infection prevention and control research has mainly been focused on in-hospital health care professionals with limited out-of-hospital studies. METHODS: This scoping review was conducted based upon Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to evaluate the literature relating to knowledge and awareness of infection prevention and control in paramedics in Australia and other countries. RESULTS/DISCUSSION: Based upon the selection criteria applied, six papers were identified for inclusion in this review. In many studies reviewed, infection prevention and control was identified by paramedics as being important, however compliance with hand hygiene practices was low and most studies highlighting the need for more education and training on infectious disease for paramedics. CONCLUSION: The current evidence suggests that paramedics have poor compliance with recommended IPC practices. The profession needs to improve IPC education, training, and culture.

A Narrative Review of Studies Comparing Efficacy and Safety of Citalopram with Atypical Antipsychotics for Agitation in Behavioral and Psychological Symptoms of Dementia (BPSD).

BACKGROUND: Psychomotor agitation as part of the behavioral and psychological symptoms of dementia (BPSD) is one of the common issues found in aged care facilities. The current inadequate management strategies lead to poor functional and medical outcomes. Psychotropic interventions are the current preferred treatment method, but should these medications be the prescribers' first preference? This review aims to compare pharmacological interventions for psychomotor agitation, judging them according to their effectuality and justifiability profiles. This is to be achieved by retrieving information from Randomized Control Trials (RCTs) and systematic reviews. OBJECTIVES: This review evaluates evidence from RCTs, systematic reviews, and meta-analyses of BPSD patients who have taken agitation treatments. Assessing the efficacy of citalopram, other selective serotonin reuptake inhibitors (SSRIs) and antipsychotic treatments were compared to each other for the purpose of improving agitation outcomes and lowering patient side effects. METHODS: This review includes RCT that compared citalopram with one or more atypical antipsychotics or with a placebo, along with systematic reviews comparing citalopram (SSRI) with antipsychotics such as quetiapine, olanzapine, and risperidone. Studies were extracted by searching and accessing databases, such as PubMed, OVID, and Cochrane with restrictions of date from 2000 to 2021 and published in the English language. CONCLUSION: There are still a limited number of studies including SSRIs for the treatment of agitation in BPSD. SSRIs such as citalopram were associated with a reduction in the symptoms of agitation, and lower risk of adverse effects when compared to antipsychotics. Future studies are required to assess the long-term safety and efficacy of SSRI treatments for agitation in BPSD.

Case Report of an Interprofessional Intervention to Improve Quality of Life for a Fluid-Limited Patient.

This was a case of an 81-year-old female, an amputee, who presented at hospital with a fractured neck of femur after a fall in the nursing home. The patient was being treated for several complex chronic conditions for which 30 regular medicines were prescribed and 100 tablets were being taken per day. The patient was fluid limited to 1500 mL per day but the need to swallow such a high number of tablets meant that there was no fluid allowance available for any other drinks, not even a cup of tea. In the nursing home, the patient had multiple prescribers, not all from the one surgery. The pharmacist conducted a multifaceted review of the patient's medication and lifestyle factors. Working collaboratively with the wider health care team, the intervention was able to reduce the number of medications and improve the patient's quality of life through improving the effectiveness of other lifestyle factors. This case not only showcases pharmacist interventions but also the synergistic benefit of interprofessional working with patients with chronic and complex conditions. This is arguably more critical in rural or remote areas where there is commonly a paucity of most health practitioners, health assistants and technicians.

Living with food allergy: What this means for children.

Health-related knowledge, skills and attitudes that translate to behaviours are important foundations for healthy living. However, deficiencies in any one of these factors have the potential to impact quality of life. This study investigates how Australian children perceive and manage their food allergy as they transition through childhood onto adolescence. To measure this, children aged 12 years and under completed an online survey [under 8 years and 8-12 years] on knowledge, skills and attitudes. Although recruitment involved advertisements to over 700 Australian pre-schools, 44 allergy specialists and multiple representations to the patient support group, Allergy & Anaphylaxis Australia, completion relied on parental notification and/or guidance. Of the 139 participants recruited, 114 commenced the survey with 65 participants under 8 years (58%) and 49 between 8 and 12 years. Results showed participants recognised different ways to keep safe with children under 8 years (N = 65) 100% cognisant of the need to check with 'Mum/Dad' or teachers if they could safely eat food as well as the importance of not swapping lunches, while there was a slight change in compliance for those aged 8-12 years as three (6.1%, n = 3/49) children did not see the necessity of asking an adult/teacher if a food item was safe to eat. Older children were also less likely to tell friends about their food allergy even if they thought they were having an allergic reaction, despite children under 8 years more likely to feel different to friends (38%, n = 24/64) compared to those aged 8-12 years (31%, n = 14/45). Although both groups disliked parents' fussing, for children under 8 years, there was a strong association between this and 'feeling different to friends'. Results from this study highlight the importance of normalising food allergy at home and in the community, so children are confident in telling others about their food allergy.

Cultural Humility: A Proposed Model for a Continuing Professional Development Program.

Continuing professional development (CPD) is an essential component of professional practice for registered health practitioners to maintain and enhance knowledge, skills and abilities. There are many topics that practitioners may pursue relevant to their practice environment, and, in recent years, providing culturally safe and respectful practice is an emerging area of need. Unfortunately, many health professionals, whilst willing to offer cultural safe healthcare, may be uncertain of how to enact that practice. The World Health Organisation recognises attainment of the highest possible standard of health as a basic human right, and cultural safety is increasingly becoming an expectation of health professionals. To address this need and the insufficiency of support in the literature, the authors have presented a discussion paper on various aspects of cultural safety and the underlying constructs, such as cultures, that support it. The discussion takes into account core constructs that signpost the path to cultural safety and recognises the role and accountability of all levels of the healthcare system, not merely the practitioner. Finally, we propose a model program for a cultural humility CPD activity incorporating pre-work, online modules, interactive workshop, reflection on professional practice and a post-workshop evaluation.

Parent perceptions in managing children with food allergy: An Australian perspective.

INTRODUCTION: Food allergy affects up to 10% of Australian children, and living with food allergic children can be challenging for parents. This study explored parental perceptions and knowledge as they navigate a new reality of keeping their child safe. METHODS: Parents of children with food allergies completed an online food allergy survey in 2015. Questions explored health knowledge, skills, and attitudes (KSAs) as well as quality of life (QoL) through the inclusion of the Food Allergy Quality of Life - Parental Burden instrument (FAQL-PB). Notification of the survey included advertisements to more than 700 randomly selected Australia-wide preschools, 44 allergy specialists, and Allergy & Anaphylaxis Australia. Responses were tabulated and analysed. RESULTS: Of the 400 participants who logged on, 357 commenced the survey and 318 finished. Questionnaire analysis showed that 44.1% of parents (n = 135) hesitated to use an adrenaline auto-injector and may be influenced by a classification system where symptom severity is not universally understood. While 79% would sign up to a national Anaphylaxis Registry, intention to participate in clinical trials using vaccines was disclosed by only 56%. Allergen labelling and community acceptance continue to be the most challenging aspects of managing a food allergy, and 50% of parents reported that food allergy played a role in choosing a preschool or primary school. Overall, quality of life for participants was influenced more by gender (male) and age of the child than where they lived - capital city or regional location; however, regional participants were more frustrated over lack of appreciation relating to the seriousness of food allergy (p = 0.010). CONCLUSION: Results highlight the need for educational strategies for both the food allergy community and public, particularly in regional areas, since there is a perceived lack of appreciation as to the seriousness of food allergy. Educational resources and relevant networks are required to support parents and caregivers in the management of children with food allergy.

A Comprehensive Evaluation of Studies on the Adverse Effects of Medications in Australian Aged care Facilities: A Scoping Review.

Aim: this scoping review was designed to identify studies that assess adverse drug reactions (ADRs) for older people in Australian aged care facilities. This review critically evaluates each published study to identify the risk of, or actual, adverse drug events in older people. Inclusion criteria: this review considered any clinical studies that examined the adverse effects of medications in older people who were living in aged care facilities. This review considered qualitative studies, analytical studies, randomized controlled trials (RCTs), descriptive cross-sectional studies, and analytic observational studies that explored the use of medications and their adverse effects on older people in clinical settings (including aged care facilities). Methods: an initial search of the PubMed (United State National Library of Medicine), OvidSP, EBSCOHost, ScienceDirect, Wiley Online, SAGE, and SCOPUS databases, with full text was performed, followed by an analysis of the article's title and abstract. Additionally, MeSH (Medical Subject Headings) was used to describe the article. The initial round of the database search was based on inclusion criteria from studies that assessed tools or protocols aiming to identify the adverse effects of medications on the elderly population suffering chronic conditions or multiple co-morbidities. Two reviewers screened the retrieved papers for inclusion. The data presented in this review are in tabular forms and accompanied by a narrative summary which aligns with the review's objectives. Results: seven studies were identified, and the extracted data from these studies were grouped according their characteristics and the auditing results of each study. Conclusion: it would be beneficial to design a comprehensive or broadly adverse drug reaction assessment tool derived from Australian data that has been used on the elderly in an Australian healthcare setting.

Complementary and alternative medicine and the search for knowledge by conventional health care practitioners.

The use of complementary and alternative medicines (CAM) is growing rapidly within the western world and the nexus with conventional health care services is expanding. Many nurses and other conventional health care providers are not only using CAM themselves but see many of their clients using these medicines and therapies. The attitudes to CAM can influence client satisfaction and client use of different therapies and many practitioners of conventional health care are seeking education and information to enhance their knowledge and use of CAM. This paper reflects on the attitudes to CAM and the education needs and services in the field of CAM as identified by western health care providers, in particular nurses.

Exploring the Health Care Challenges and Health Care Needs of Arabic-Speaking Immigrants with Cardiovascular Disease in Australia.

The Arabic-speaking immigrant group, which makes up the fourth largest language group in Australia, has a high prevalence of cardiovascular disease. The objective of this study was to explore the health care challenges and needs of Arabic-speaking immigrants with cardiovascular disease (CVD), using a comparative approach with English-speaking patients with CVD as the comparable group. Methods: Participants were recruited from community settings in Melbourne, Australia. Face-to-face semi-structured individual interviews were conducted at the recruitment sites. All interviews were audio-taped, transcribed, and coded thematically. Results: 29 participants with CVD were recruited; 15 Arabic-speaking and 14 English-speaking. Arabic-speaking immigrants, and to a lesser extent English-speaking patients with CVD may have specific health care challenges and needs. Arabic-speaking immigrants' health care needs include: effective health care provider (HCP)-patient communication, accessible care, participation in decision-making, and empowerment. English-speaking participants viewed these needs as important for CVD management. However, only a few English-speaking participants cited these needs as unmet health care needs. Conclusion: This study suggests that Arabic-speaking immigrants with CVD may have unique needs including the need for privacy, effective HCP-patient communication that takes into account patients' limited English proficiency, and pharmacist-physician collaboration. Therefore, there may be a need to identify a health care model that can address these patients' health care challenges and needs. This, in turn, may improve their disease management and health outcomes.

Microbiology Education and Infection Control Competency: Offering a New Perspective.

Healthcare-associated infections (HAIs) have become a significant and costly problem for healthcare institutions worldwide. Despite the crucial role of infection prevention and control (IC) procedures, there is a substantial body of evidence to indicate that IC knowledge and practices of health professional graduates is, however, sub-optimal. This paper presents a discussion of the critical role microbiology plays in infection control education and practice, arguing that without an ability to apply microbiology knowledge to IC decision-making, there is an inherent risk of incorrect application of IC practices and thus a risk to patient (and nurse) safety. The authors propose a re-conceptualization of infection control competency, using nursing as an exemplar profession, to reflect practice that is not based on simple memorization of protocols but rather on a sound understanding of microbiology and informed decision-making. The proposal for re-conceptualizing the definition and assessment of IC competence, if adopted, would potentially enhance students' understanding and synthesis of microbiology knowledge and help build students' capacity to apply that knowledge to practice.

Patient medication knowledge and adherence to asthma pharmacotherapy: a pilot study in rural Australia.

Asthma is a chronic disease with both inflammatory and bronchoconstrictive elements and often requires multiple medications. Most asthma regimens include medications with different therapeutic modes of action and a number of different medication delivery devices. To effectively participate in their asthma management, patients need to recognize each of their medication types, understand their purpose, adhere to their treatment regimen, and be proficient in using the required delivery devices. This study evaluated patient knowledge of asthma pharmacotherapy and adherence. An interview study was undertaken in two rural locations, in Australia, to elicit participants' knowledge, use, and inhalation device technique. Of participants, 75.9% used preventer medication and the remaining 24.1% used reliever medication only. Of those using preventer medication, 82.5% could distinguish their preventer from a range of asthma medicines. Metered dose inhalers (MDIs) were used by 80% of participants; 23% used a Turbuhaler(R); 24% used an Accuhaler(R); and 5% used an MDI with a spacer device. The study established poor medication knowledge, suboptimal device technique, and disturbing levels of adherence with management recommendations. Asthma education strategies need to be modified to engage patients with low asthma knowledge to achieve improved patient outcomes. Further, strategies need to motivate patients to use preventer medication during times when they feel well.

Attitudes of Australian pharmacists toward complementary and alternative medicines.

BACKGROUND: The increase in the use of complementary and alternative medicine (CAM) by the general public has led to increasing interest in how health professionals view these therapies. OBJECTIVE: To determine the knowledge and attitudes of pharmacists toward CAM. METHODS: An anonymous, self-administered questionnaire was designed and mailed to 1500 randomly selected pharmacists in New South Wales, Australia. RESULTS: Four hundred eighty-four responses were received, with 77% of respondents indicating that they had personally used CAM and 60% correctly identifying that CAM was comprised of more than just botanicals and nutritional agents. The most commonly used CAMs were herbal and vitamin supplements (74%), which was significantly above use of the next most frequent CAM, massage therapy (6%). Most pharmacists (71%) reported offering CAM products for sale; however, 27% of these practices did not have access to CAM information for pharmacy staff or patients. Pharmacists generally viewed CAM positively and believed that they enhanced the customers' image of pharmacy (57%), increased customer numbers (87%), and could increase annual sales (72%). Ninety-one percent of respondents believed that it is necessary for pharmacists to have knowledge of both CAM and conventional medicine to be able to inform patients about their treatment options. Books and journal articles were their primary information sources, with the main reasons for recommending CAM evidence of efficacy and to maintain general health. CONCLUSIONS: CAM use is prevalent among Australian pharmacists. While pharmacists are aware of their role as educators about both CAM and conventional medicines, there is a need for greater access to CAM resources and education on these therapies.

Australian national strategy for pharmacy preceptor education and support.

OBJECTIVES: (i) To develop a national strategy for pharmacy preceptor education and support, with special consideration for rural and remote practitioners. (ii) To deliver an innovative national core pharmacist preceptor education and support model that could be customised for specific undergraduate programs. DESIGN: A steering committee, with representatives from four Pharmacy Schools in three Australian states, was established to develop an educational curriculum and implementation strategy. SETTING: The project was designed to provide an online educational program for preceptors of Australian pharmacy students, particularly those in rural areas. SUBJECTS: The recipients of this program will primarily be rural pharmacy preceptors but could also be urban practitioners. INTERVENTIONS: After consultation with an advisory group, the steering committee considered the educational content, delivery strategy and adaptability of the package to maintain its currency and links to universities, pharmacy boards and professional organisations: an extensive literature search was conducted; writers and an educational designer were employed. The steering committee reviewed and modified the content before transfer of the program to the worldwide web. MAIN OUTCOME MEASURE: The development of a Pharmacy Preceptor Education Program suitable for national application and able to fulfil the needs of rural preceptors. RESULTS: A Preceptor Education Program has been developed suitable for use in all Australian states and capable of meeting the needs of rural pharmacy preceptors. CONCLUSIONS: Collaboration between four schools of pharmacy and pharmacy professional bodies has resulted in development of a flexible program for preceptors of undergraduate pharmacy students. This program can be developed for use by preceptors of pharmacy graduates, and in other disciplines.

Respiratory function testing: the impact of respiratory scientists on the training and support of primary health care providers.

OBJECTIVE: In rural Australia access to doctors is limited, access to respiratory physicians even more so and these are the traditional sources of lung function testing. The aim of this study was to assess the feasibility of training and supporting existing rural primary healthcare providers in lung function testing as a screening and monitoring mechanism due to the shortage of healthcare professionals capable of providing such a service. METHODOLOGY: As pharmacists are readily accessible healthcare professionals, they were trained in spirometry measurement and supported with ongoing quality assurance by respiratory scientists. Spirometers were provided to the pharmacists. People purchasing respiratory medications or responding to advertising about the service were tested after giving informed consent. Spirometic assessments were assessed for accuracy and reproducibility. Participants' spirometry results were reviewed and those with abnormal test results were referred to their doctor. RESULTS: Pharmacists were able to competently develop the skills necessary for providing spirometry measurement as a screening and monitoring technique. The level of competence exceeded that reported in previously published studies. Pharmacists were able to successfully identify spirometry results within the normal range. CONCLUSIONS: Training and supporting accessible healthcare professionals to provide lung function testing increases access in areas of need and has implications for respiratory morbidity and mortality in such settings.