Rajneesh Kaur

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on

BackgroundNursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time.MethodsIn the nascence of the expansion of the role of nurses in Australian general practice (2003–2004) a national survey was undertaken to describe nurse demographics, clinical roles and competencies. This survey was repeated in 2009–2010 and comparative analysis of the datasets undertaken to explore workforce changes over time.ResultsTwo hundred eighty four nurses employed in general practice completed the first survey (2003/04) and 235 completed the second survey (2009/10). Significantly more participants in Study 2 were undertaking follow-up of pathology results, physical assessment and disease specific health education. There was also a statistically significant increase in the participants who felt that further education/training would augment their confidence in all clinical tasks (p < 0.001). Whilst the impact of legal implications as a barrier to the nurses’ role in general practice decreased between the two time points, more participants perceived lack of space, job descriptions, confidence to negotiate with general practitioners and personal desire to enhance their role as barriers. Access to education and training as a facilitator to nursing role expansion increased between the two studies. The level of optimism of participants for the future of the nurses’ role in general practice was slightly decreased over time.ConclusionsThis study has identified that some of the structural barriers to nursing in Australian general practice have been addressed over time. However, it also identifies continuing barriers that impact practice nurse role development. Understanding and addressing these issues is vital to optimise the effectiveness of the primary care nursing workforce.

Understanding Australian healthcare workers' uptake of influenza vaccination: examination of public hospital policies and procedures

BackgroundIn Australia, whether to provide free influenza vaccine to health care workers (HCWs) is a policy decision for each hospital or jurisdiction, and is therefore not uniform across the country. This study explored hospital policies and practices regarding occupational influenza vaccination of HCWs in Australia.MethodsA study using qualitative methodology, which included semi-structured interviews, was undertaken with hospital staff involved with the delivery of occupational influenza vaccination from three states in Australia.ResultsThe 29 participants were responsible for vaccinating staff in 82 hospitals. Major themes in the responses were the lack of resources and the difficulties participants faced in procuring any additional support or funding from their institutions. All study sites provided vaccine free of charge to employees via on-site clinics or mobile carts, and used multiple strategies to inform and educate their staff. In some instances, declination forms had been adopted, however their use was associated with resourcing issues, animosity, and other problems. Participants who were responsible for multiple sites were more likely to recount lower vaccination coverage figures at their hospitals.ConclusionsFrom these interviews, it is clear that hospitals are implementing multiple strategies to educate, promote, and deliver the vaccine to staff. However, resources and support are not always available to assist with the vaccination campaign. The reality for many hospitals is that there is limited capacity to implement the vaccination campaigns at the levels high enough to raise compliance rates. Further research needs to be conducted to quantify the factors contributing to higher uptake in the Australian hospital setting.

Prevalence and determinants of influenza vaccine coverage at tertiary pediatric hospitals

Despite long-standing recommendations, the uptake of influenza vaccination in children with high risk medical conditions is low. This study aimed to examine the uptake of influenza vaccination amongst a cohort of Australian children and factors associated with vaccine acceptance. Three hundred and sixteen parents of children attending outpatient clinics at the two pediatric hospitals in Sydney were recruited. The reported vaccination coverage rate was 41% among children with high risk conditions and 14% among standard risk children. There was a median of three clinic visits per high risk child at which an opportunity to vaccinate was apparently missed. Healthcare worker recommendation, having a high risk condition and parental beliefs about influenza and influenza vaccination were the most important determinants of vaccine uptake. Further studies on the beliefs and practices of doctors in this area will help guide interventions to improve vaccination rates in high risk children.

Improving the uptake of pre-travel health advice amongst migrant Australians: exploring the attitudes of primary care providers and migrant community groups

BackgroundMigrant travellers who return to their country of origin to visit family and friends (VFR) are less likely to seek travel-related medical care and are less likely to adhere to recommended medications and travel precautions. Through this study, we aimed to get an understanding of the views of stakeholders from community migrant centres and primary care providers on barriers for migrants, particularly from non-English speaking backgrounds, in accessing travel health advice and the strategies that could be used to engage them.MethodsA qualitative study involving 20 semi-structured interviews was undertaken in Sydney, Australia between January 2013 and September 2014. Thematic analysis was undertaken.ResultsLanguage barriers, a lower perceived risk of travel-related infections and the financial costs of seeking pre-travel health care were nominated as being the key barriers impacting on the uptake of pre-travel health advice and precautions. To overcome pre-existing language barriers, participants advocated for the use of bilingual community educators, community radio, ethnic newspapers and posters in the dissemination of pre-travel health information.ConclusionsTravel is a major vector of importation of infectious diseases into Australia, and VFR travellers are at high risk of infection. Collaboration between the Government, primary care physicians, migrant community groups and migrants themselves is crucial if we are to be successful in reducing travel-related risks among this subgroup of travellers.

Facilitators and barriers around teaching concepts of hand hygiene to undergraduate medical students

BACKGROUND Currently, there is limited literature examining the impact and appropriateness of the educational approaches used to teach medical students concepts around hand hygiene (HH). AIM To explore: (i) the perspectives of key academics and medical students towards HH and factors influencing compliance; (ii) the current teaching practices around HH in the medical school. We also aimed to examine options for new teaching and learning approaches to help improve student knowledge and attitudes towards HH. METHODS Individual, in-depth interviews were conducted with key academics and medical students. Transcripts were analysed thematically. FINDINGS Participants felt that students do not value the teaching around HH, nor do they find it interesting, especially in comparison to other subjects taught in the medical programme. The use of professional modelling, assessment tasks and feedback from patients and colleagues were the major educational recommendations; these could be implemented to help improve the attitudes of medical students towards HH and hopefully their compliance. Regular, small, group-scenario-based and/or practical hands-on sessions were also proposed. The need for a culture change was the overarching theme to foster sustainable HH practices among medical students. CONCLUSION Assessment and scenario-based learning and teaching approaches should be considered to help improve HH behaviours among medical students. Sustainability of these practices is likely to require role models and culture change around infection control.

‘I don’t want to cause any trouble’: the attitudes of hospital patients towards patient empowerment strategies to reduce healthcare-acquired infections

Background: Patients have, traditionally, been assumed to be the passive party in the healthcare-associated infections equation, with relatively little research focused on the patients’ perspective. This study aimed to explore the attitudes of hospital patients towards patient empowerment as one of the key components of patient engagement. Methods: Semi-structured interviews were undertaken with surgical patients from a major public hospital in Sydney, Australia. Findings: While participants acknowledged that patients could play a role in preventing infections while in hospital, that role was largely associated with maintaining their own personal hygiene. No reference was made to patients interacting with staff members. Some participants said that they would feel comfortable and happy to engage with staff, while others voiced concerns. Some about not wanting to ‘cause trouble or start fires’ and therefore would not tell staff members to perform hand hygiene. Some participants articulated a fear that their care may be negatively affected if they directly engaged or confronted clinicians about their behaviours. Conclusion: We found that patient engagement remains an underused method of preventing healthcare-associated infections, and the deep-seated public fears about individual vulnerabilities still need to be addressed.

Empowering patients in the hospital as a new approach to reducing the burden of health care–associated infections: The attitudes of hospital health care workers

BACKGROUND Any approach promoting a culture of safety and the prevention of health care-associated infections (HCAIs) should involve all stakeholders, including by definition the patients themselves. This qualitative study explored the knowledge and attitudes of health care workers toward the concept of patient empowerment focused on improving infection control practices. METHODS Semi-structured interviews were undertaken with 29 staff from a large hospital in Sydney, Australia. RESULTS There was virtually unanimous agreement among the participants that patients should be thought of as a stakeholder and should have a role in the prevention of HCAI. However, the degree of patient responsibility and level of system engagement varied. Although very few had previously been exposed to the concept of empowerment, they were accepting of the idea and were surprised that hospitals had not yet adopted the concept. However, they felt that a lack of support, busy workloads, and negative attitudes would be key barriers to the implementation of any empowerment programs. CONCLUSION Although the World Health Organization has recommended that patients have a role in encouraging hand hygiene as a means of preventing infection, patient engagement remains an underused method. By extending the concept of patient empowerment to a range of infection prevention opportunities, the positive impact of this intervention will not only extend to the patient but to the system itself.

Ask, speak up, and be proactive: Empowering patient infection control to prevent health care-acquired infections.

BACKGROUND Over the last decade, there has been a slow shift toward the more active engagement of patients and families in preventing health care-associated infections (HCAIs). This pilot study aimed to examine the receptiveness of hospital patients toward a new empowerment tool aimed at increasing awareness and engagement of patients in preventing HCAI. METHODS Patients from the surgical department were recruited and randomized into 2 groups: active and control. Patients in the active arm were given an empowerment tool, whereas control patients continued with normal practices. Pre- and postsurveys were administered. RESULTS At the baseline survey, just over half of the participants were highly willing to assist with infection control strategies. Participants were significantly more likely to be willing to ask a doctor or nurse a factual question then a challenging question. After discharge, 23 of the 60 patients reported discussing a health concern with a staff member; however, only 3 participants asked a staff member to wash their hands. CONCLUSION Our results suggest that patients would like to be more informed about HCAIs and are willing to engage with staff members to assist with the prevention of infections while in the hospital setting. Further work is going to need to be undertaken to ascertain the best strategies to promote engagement and participation in infection control activities.

Exploring the approaches used to teach concepts of hand hygiene to Australian medical students

Background: Recent audit data has revealed that the hand hygiene (HH) rates of Australian medical students is suboptimal. It has been suggested that new approaches are needed to teach students about infection control. As a first step, we undertook a study to determine the current educational approaches used to teach Australian medical students about HH. Secondly, this study aimed to explore the perceived barriers and to explore what other teaching approaches could be used to improve the levels of knowledge and compliance. Methods: A self-administered questionnaire was sent to the Dean of Medical Education at each of the medical schools in late 2012. Results: Of the 19 medical schools in Australia, 17 agreed to participate. The most commonly reported approaches currently used to teach students about HH are skills stations (17/17) and case scenarios/lectures (15/17). Clinical practical exams (15/17) and competency checks (11/17) are mostly used to assess the HH practices of medical students. Participants nominated the following as barriers to improving HH compliance: negative role modelling by senior doctors, and negative attitudes of students. Practical exercises (15/17), online teaching (12/17) and reflection (12/17) were suggested as other useful approaches that could be used to teach these concepts. Conclusion: Practical laboratory-based approaches were suggested as the most useful teaching and learning approach. Given the trend towards blended learning, universities may want to consider new HH teaching approaches that combine campus-based learning with online components and reflection. Early exposure and the continued reinforcement of HH concepts through the student’s medical degree are essential.

Psychosocial and behavioral impact of breast cancer risk assessed by testing for common risk variants: protocol of a prospective study

BackgroundThe ‘common variant, common disease’ model predicts that a significant component of hereditary breast cancer unexplained by pathogenic variants in moderate or high-penetrance genes is due to the cumulative effect of common risk variants in DNA (polygenic risk). Assessing a woman’s breast cancer risk by testing for common risk variants can provide useful information for women who would otherwise receive uninformative results by traditional monogenic testing. Despite increasing support for the utility of common risk variants in hereditary breast cancer, research findings have not yet been integrated into clinical practice. Translational research is therefore critical to ensure results are effectively communicated, and that women do not experience undue adverse psychological outcomes.MethodsIn this prospective study, 400 women with a personal and/or high risk family history of breast cancer will be recruited from six familial cancer centers (FCCs) in Australia. Eligible women will be invited to attend a FCC and receive their personal polygenic risk result for breast cancer. Genetic health professionals participating in the study will receive training on the return of polygenic risk information and a training manual and visual aids will be developed to facilitate patient communication. Participants will complete up to three self-administered questionnaires over a 12-months period to assess the short-and long-term psychological and behavioral outcomes of receiving or not receiving their personal polygenic risk result.DiscussionThis is the world’s first study to assess the psychological and behavioral impact of offering polygenic risk information to women from families at high risk of breast cancer. Findings from this research will provide the basis for the development of a new service model to provide polygenic risk information in familial cancer clinics.Trial registrationThe study was retrospectively registered on 27th April 2017 with the Australian and New Zealand Clinical Trials Group (Registration no: ACTRN12617000594325; clinical trial URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372743).