Rebecca Munt

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.

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 Bourdieus 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.

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

UNLABELLED 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.

Type 1 Diabetes Mellitus (T1DM) Self Management in Hospital; Is It Possible? A Literature Review

Abstract 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 thehospital setting.

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.

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.

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.