Lin Zhao

Psychosocial interventions for people with diabetes and co-morbid depression. A systematic review

AIMS AND OBJECTIVESnTo examine the effectiveness of psychosocial interventions on depressive symptoms and glycaemic control of adults with Type 1 or 2 diabetes and co-morbid depression.nnnBACKGROUNDnDiabetes is a chronic disease that affects as many as 382 million people in the world. Diabetes management is a challenging daily task which can be overwhelming and lead to depression. Both diabetes and co-morbid depression have a negative bidirectional influence on each other, which is detrimental for the individuals quality of life. This co-morbidity places a huge burden on the individual, family, health care system, and the economy, with an associated 50-75% increase in health care costs.nnnDESIGNnA systematic review.nnnMETHODSnFour electronic databases were searched including Cochrane Library, CINAHL, MEDLINE, and PsycINFO for articles written in English from the year 1998 to 2013. Data extraction of vital information from included studies was conducted and the effect sizes were calculated for the outcomes.nnnRESULTSnTen interventional primary studies were retrieved from the search; six were randomised studies. Nine out of ten studies reported that psychosocial interventions were effective for depression with effect sizes ranging from small (-0.24) to large (-1.74). No effect was found for the glycaemic control outcome. The interventions came in a myriad of intervention type, delivery method, duration, and intensity, therefore a meta-analysis was not conducted. The review found that nurses were competent in delivering psychosocial interventions for this population. Methodological quality was below average amongst the study with various biases present.nnnCONCLUSIONSnThe results and effect sizes were promising but due to the high number of bias risks, it cannot be determined if psychosocial interventions were found to be effective in people with diabetes and co-morbid depression.nnnRELEVANCE TO CLINICAL PRACTICEnPsychosocial interventions have the potential to make improvements in depression, alleviating the global burden on people with diabetes, keeping in mind the best intervention modality tailoring to the clients needs and preferences. Nurses and other health professionals involved in caring for this group are in a good stead to carry out these interventions.

HIV infection as a predictor of methadone maintenance outcomes in Chinese injection drug users

This papers design is descriptive and correlational based on retrospective self-report survey data collected in Kunming city, China. The study investigated the difference between a group of Chinese HIV positive (N=36) and negative (N=131) opioid dependent adults maintained on methadone treatment. Comparisons were based on their quality of life (QOL), methadone treatment adherence, adverse symptom occurrence related to methadone treatment, and HIV-related behavior changes. No significant differences were found between the two groups in age, methadone maintenance dose, methadone adherence, sex desire, and drug craving level. Participants who were HIV positive reported significantly lower scores on physical health and total health-related qualify of life. They also reported greater engagement in injection related risk behavior before methadone treatment than those who tested HIV negative. For both groups, sexual and injection risk behavior significantly decreased following initiation of methadone treatment. A regression model revealed that those infected with HIV, associated significantly with higher likelihood of reporting constipation and lack of appetite, and higher frequency of reporting abdominal pain and nausea than HIV negative patients. The primary implication of these findings is that HIV positive persons in methadone treatment may require more focused services to meet their special HIV care and substance treatment needs.

Effect of Methadone Dose on Maintenance Treatment and Health Consequences Among Heroin Addicts in South China

A retrospective cross-sectional study was conducted with a convenience sample of 197 adults receiving methadone maintenance treatment in Kunming city, South China, in 2010. The aim of the study was to determine the association of methadone maintenance dose on a variety of treatment outcomes. Treatment modalities, the adverse reactions to methadone treatment, the physical and mental outcomes of the treatment, and risk behavior changes were assessed. Multilevel negative and logistic binomial regression analyses were carried out, which demonstrated that methadone maintenance dose in this sample was not associated with improved treatment adherence or with quality of life. We concluded that dose had a small, if negligible, influence on the changes in adverse effects of methadone. Further research in dose differences between the genders should be conducted.

The interaction of pregnancy, substance use and mental illness on birthing outcomes in Australia

BACKGROUNDnthis study aimed to (1) assess the prevalence, and demographic features of women with a history of mental illness during pregnancy and childbirth, (2) investigate maternal and perinatal outcomes in relation to mental illness and substance use, and (3) determine the effects of maternal characteristics, history of mental illness and substance use on birth outcomes.nnnMETHODSnthe records of 22,193 pregnant women who gave birth at one tertiary level health service comprising three maternity settings in Victoria, Australia from 2009 to 2011 were reviewed.Univariate comparisons for socio-demographic and birthing outcome variables by substance use and mental illness category were performed. A multivariable logistic regression model was developed to examine the effects of maternal characteristics on birth outcomes.nnnRESULTSnmental illness was recorded for 1.08/1,000 delivery hospitalisations.Mothers with a history of mental illness had a significantly higher proportion of babies born with low birth weight (OR = 1.85, 95% CI 1.64 -2.09) and low Apgar 1 scores<7 (OR = 1.47, 95% CI 1.26 - 1.70).Differences in health behaviours were also noted between the two groups.Babies born to women with an illicit and poly substance use history reported an average birth weight at 2,951 (SD 777) grams compared to birth weight of approximately 3,300 g of smoking and alcohol user groups, as well as shorter gestational age and lower birth weight. There was a statistically significant interaction between the effects of mental illness and substance use on birth weight. This interaction effect was not significant for gestational age. Logistic regression showed the strongest predictor of reporting a premature birth and low birth weight was using substances, recording an odds ratio of 1.95 (95% CI 1.50-2.53) and 2.73 (95% CI 2.15-3.47) respectively.nnnCONCLUSIONSnmental health history should be highlighted as being a common morbidity and the increased risk of poorer birth outcomes especially when the women were also using substances, alcohol or tobacco should be acknowledged by the health practitioners.

Nurses' competence in genetics: An integrative review

The aim of this integrative review was to update a mixed method systematic review by Skirton, OConnor, and Humphreys (2012) that reported on nurses levels of competence in using genetics in clinical practice. Three electronic databases were searched using selected key words. Research studies published in English between January 2011 and September 2017 reporting levels of nurse competence in genetics or genomics were eligible for inclusion. The selected studies were subjected to thematic analysis. Three main themes were identified: (i) genomic knowledge and utilization, (ii) perceived relevance to practice, and (iii) genomic education. While the reviewed papers produced varied findings, many nurses were shown to have poor genomic knowledge and/or competency, and yet there was a consensus that most nurses believe genomics is important to their practice. The present review indicated that in the past 5u2009years nurses have made minimal progress toward achieving the core genomic competencies appropriate for clinical practice.

Exploring the paradox: A cross-sectional study of academic dishonesty among Australian nursing students

BACKGROUNDnUniversities responsibility to ensure academic integrity is frustrated by software and communication tools that facilitate content reuse coupled with a growing international essay writing economy. A wide range of behaviours constitute academic dishonesty and while a complex phenomenon to examine, existing evidence suggests that there is sufficient proliferation (both in volume and variety) of these behaviours among Australian university students to warrant concern. This proliferation presents faculty and staff with new challenges in ensuring academic integrity.nnnOBJECTIVESnThis paper reports findings of a nationwide cross-sectional survey of 361 students enrolled in an Australian nursing degree program and describes the extent of academic dishonesty among those surveyed.nnnDESIGNnAn online survey adapted from previous work was used to collect data on academic dishonesty, professional dishonesty and social desirability bias. Analysis of this data enabled identification of the prevalence of dishonesty, relationships between individual characteristics and dishonest behaviours, associations between academic and professional dishonesty, and the impact of deterrents to such behaviour.nnnRESULTSnPlagiarism was the most frequently reported form of academic misconduct. Most participants indicated that threat of severe punishment and signing of verification statements would deter undesirable academic behaviour. Despite this, a relatively high proportion of students reported engaging in at least one form of academic misconduct, the likelihood of which was higher among younger age groups. Of concern was that a correlation was found between academic and professional misconduct, the most common being the recording of inaccurate or fabricated vital signs and breaching client privacy.nnnCONCLUSIONnIn health professional education, there is a tendency to assume that the nobility of these disciplines would result in a lower incidence of cheating behaviours. The findings of this study support existing literature that refutes this assumption. This study found troubling rates of academic and professional misconduct among the surveyed population.

Genomic Literacy of Registered Nurses and Midwives in Australia: A Cross-Sectional Survey

PURPOSEnRegistered nurses and midwives require a degree of genomic literacy if they are to adequately communicate with other healthcare professionals and provide optimal care to patients, their families, and the community. Several studies have been conducted internationally to assess the genomic literacy of nurses; however, the genomic literacy of Australian registered nurses and midwives has not been investigated. The aim of this study was to measure the genomic literacy of Australian registered nurses and midwives through assessing participants understandings of genomic concepts most critical to nursing and midwifery practice, as well as their perceived knowledge and attitude towards genomics in nursing and midwifery practice.nnnDESIGNnCross-sectional survey of Australian registered nurses and midwives using the Genomic Nursing Concept Inventory (GNCI© ), a 31 multiple-choice question survey instrument. Participants were recruited via two key Australian nursing and midwifery organizations over an 8-month period in 2016.nnnMETHODSnDescriptive and inferential statistical techniques were used to calculate the total GNCI© score and scores on individual subcategories, as well as relationships between demographic variables and GNCI© scores.nnnFINDINGSnMost respondents worked as clinicians (71.4%) in a hospital or hospital-based setting (61.8%). Most registered nurses (80.5%) and midwives (97.2%) reported that genetics was relevant to clinical practice; however, over 80% of registered nurses and midwives believed their knowledge of genetics was poor or average. Genomic knowledge was assessed using the GNCI© . Scores ranged from 3 to 29 (out of a possible 31), with a mean score of 13.3 (SD 4.559) based on 253 (N = 253) respondents, indicating that genomic literacy is low. There was a significant difference between genomic knowledge scores and education and training level (p = .036).nnnCONCLUSIONSnThe genomic literacy of registered nurses and midwives in Australia is low. More must be done to ensure Australian registered nurses and midwives have an adequate level of genomic literacy to provide optimal care to patients, their families, and the community.nnnCLINICAL RELEVANCEnModern medicine requires a healthcare workforce that is literate in genomics. Findings from this study may serve as the catalyst to improve the genomic literacy of the Australian nursing and midwifery workforce, allowing for improved health outcomes for individuals and the wider Australian public.

Australian nursing students’ knowledge and attitudes towards pressure injury prevention: a cross-sectional study

AIMnThe aim of this study was to assess student nurses knowledge of and attitudes towards pressure injury prevention evidence-based guidelines.nnnBACKGROUNDnPressure injuries are a substantial problem in many healthcare settings causing major harm to patients, and generating major economic costs for health service providers. Nurses have a crucial role in the prevention of pressure injuries across all health care settings.nnnDESIGNnA multi-centered, cross-sectional study was conducted using a paper-based questionnaire with undergraduate nursing students enrolled in seven universities with campuses across five Australian states (Queensland, New South Wales, Western Australia, Victoria and Tasmania).nnnMETHODSnData were collected from nursing students using two validated instruments (Pressure Ulcer Knowledge Assessment Instrument and Attitude Toward Pressure Ulcer Prevention Instrument), to measure students pressure injury prevention knowledge and attitudes.nnnRESULTSnStudents reported relatively low pressure injury prevention knowledge scores (51%), and high attitude scores (78%). Critical issues in this study were nursing students lack of knowledge about preventative strategies to reduce the amount and duration of pressure/shear, and lower confidence in their capability to prevent pressure injury. Level of education and exposure to working in a greater number of different clinical units were significantly related to pressure injury prevention knowledge and attitude scores.nnnCONCLUSIONnThe study findings highlight the need to implement a comprehensive approach to increasing Australian nursing students pressure injury prevention and management knowledge, as well as ensuring that these students have adequate experiences in clinical units, with a high focus on pressure injury prevention to raise their personal capability.

Dual degree destinations: Nursing or Midwifery?

Midwifery bodies have expressed concern that the competing ideologies of nursing science, which is closer to a medical model of care, and of midwifery can be confusing for students and counterproductive to their education as effective midwives. Proponents of dual nursing and midwifery degrees, however, argue that there is a need in rural and regional areas of Australia for graduate nurses and midwives who understand both of these ideologies and ways of working and are able to apply them both, in context, to practice in rural and regional areas. Until midwifery led model of care options become more readily accessible in rural areas, this dual nursing/midwifery qualification serves these areas well. Anecdotally, students enrolled in this dual degree appear to be focussed on careers as midwives. n nThis study is uses a cross-sectional survey design to survey students enrolled in years one and four of two different four year dual nursing and midwifery degrees to ascertain preferences for practice area at these two stages of the course and graduates of the program at 12-36 months post-graduation to ascertain place/field of employment at this time frame. Cross sectional survey design allows data to be collected from different cohorts at varying times on the student and graduate trajectory at the same time. HREC approval is in place. n nData will be downloaded and subjected to simple descriptive analyses using SPSS. Responses from each cohort will be compared to ascertain differences between proposed career trajectories of each of the student cohorts against actual positions of the graduate cohort. n nThis study aims to provide a better understanding of students motivations and intentions in studying a Bachelor of Nursing Science/Bachelor of Midwifery dual degree. This information is useful when considering implications for the nursing and midwifery workforces, particularly in relation to the issue of maldistribution.