Impact of the COVID-19 pandemic on student supervision and education in health care settings: A state-wide survey of health care workers

OBJECTIVE

To investigate student supervisor experiences of supervising students on clinical placements since the onset of the COVID-19 pandemic.

BACKGROUND

Studies on the impact of COVID-19 on student clinical placements have focused largely on student reports and have been specific to individual professions or topic areas. There is a need to investigate student supervisor experiences. This study was conducted in Queensland (Australia) in four regional and rural public health services and four corresponding primary health networks.

METHODS

The anonymous, mixed methods online survey, consisting of 35 questions, was administered to student supervisors from allied health, medicine, nursing and midwifery between May and August 2021. Numerical data were analysed descriptively using chi-square tests. Free-text comments were analysed using content analysis.

RESULTS

Complete datasets were available for 167 respondents. Overall trends indicated perceived significant disruptions to student learning and support, plus mental health and well-being concerns for both students and supervisors. Extensive mask wearing was noted to be a barrier to building rapport, learning and teaching. Some positive impacts of the pandemic on student learning were also noted.

CONCLUSIONS

This study has highlighted the perceived impact of the pandemic on supervisors' mental health, and on the mental health, learning and work readiness of students. This study provides evidence of the pandemic impacts on student clinical placements from a supervisor point of view. Findings can assist in future-proofing clinical education and ensuring that students continue to receive learning experiences of benefit to them, meeting curriculum requirements, in the event of another pandemic.

Perceptions, concerns and reported behaviours in response to the first wave of the coronavirus disease 2019 pandemic across metropolitan, regional, rural and remote Australian communities

Objective

To investigate coronavirus disease 2019 community transmission concerns and adherence to social distancing and hygiene practices across metropolitan, regional, rural and remote areas in Australia.

Design

Cross‐sectional online survey of Australian adults conducted between April and May 2020 through convenience snowball sampling.

Setting

A range of locations across all states and territories of Australia.

Participants

Six hundred and seventy‐seven Australian adults, of which 78.8% lived outside of a metropolitan area.

Main outcome measures

Perceived threat of coronavirus disease 2019; social distancing guidelines and adherence; infection concerns; hygiene practices; frequency of leaving the house; impact of coronavirus disease 2019 on day‐to‐day life.

Results

Almost all respondents perceived the threat of the coronavirus disease 2019 pandemic was serious. There were high levels of support for the Australian Government's social distancing guidelines, although the perception that social distancing guidelines in participants’ communities were ‘too strict’ increased with remoteness area classification. Most respondents reported adherence with Australian Government social distancing guidelines. There was an association between remoteness and risk perception, with non‐metropolitan respondents more likely to feel safe when leaving the house. However, there was no association between geographical remoteness and self‐reported adherence with Australian Government social distancing guidelines.

Conclusions

This study provides an important initial insight into Australian perceptions and behaviours relating to the coronavirus disease 2019 pandemic, and how perceptions and behaviours varied by geographical remoteness. The geographical remoteness of communities should be considered by policy makers to ensure effective communication with the Australian public regarding coronavirus disease 2019 and ongoing adherence with preventative health behaviours.

Implementation of oral health recommendations into two residential aged care facilities in a regional Australian city

Background  Residents of aged care facilities usually have a large number of oral health problems. Residents who suffer from dementia are at particular risk. A systematic review of the best available evidence with regard to maintaining the oral health of older people with dementia in residential aged care facilities provided a number of recommendations. Objectives  The aim of the implementation project was to introduce evidence-based oral hygiene practices for patients with dementia in two publicly funded residential aged care facilities and monitor for changes in nursing awareness, knowledge, documentation and practice to improve patient outcomes and ensure appropriate accreditation standards were met. An additional aim was to identify barriers and strategies to overcome barriers to implementation of evidence-based recommendations. Methods  Two facilities, a 40-bed facility and a 71-bed facility in the health service district of the regional Australian city of Toowoomba, provided the setting. A quality improvement approach was taken, using a number of strategies from the National Health and Medical Research Council guidelines for implementation studies. The implementation involved a number of stages, including project development, interactive oral health education, oral audits of residents, changes to oral hygiene practice via care plans and critical reflection. Results  The multidisciplinary approach to improving oral healthcare appeared to improve knowledge and awareness and move oral health practices in facilities closer to best practice. Specialised training in oral health was provided to a Clinical Nurse Consultant. Regular oral audits were introduced and facility staff were trained in the use of the oral audit tool. Care plans at one facility were of better quality and more comprehensive than before the intervention. Comments made during critical reflection suggested improvements in the oral health of residents, increased use of oral swabs and saliva substitutes, improved care of dentures and mention of the use of mouth props in resident care plans. There was also some evidence that changes brought about by the implementation are sustainable. Conclusion  The majority of recommendations provided in the systematic review of oral healthcare for dementia patients were applicable to the applied context. The importance of day-to-day leaders was highlighted by the apparently varied outcomes across target facilities. The quality improvement approach would appear to have considerable advantages when applied to improving practice in residential aged care.

Acceptability of participatory social network analysis for problem-solving in Australian Aboriginal health service partnerships

BACKGROUND

While participatory social network analysis can help health service partnerships to solve problems, little is known about its acceptability in cross-cultural settings. We conducted two case studies of chronic illness service partnerships in 2007 and 2008 to determine whether participatory research incorporating social network analysis is acceptable for problem-solving in Australian Aboriginal health service delivery.

METHODS

Local research groups comprising 13-19 partnership staff, policy officers and community members were established at each of two sites to guide the research and to reflect and act on the findings. Network and work practice surveys were conducted with 42 staff, and the results were fed back to the research groups. At the end of the project, 19 informants at the two sites were interviewed, and the researchers conducted critical reflection. The effectiveness and acceptability of the participatory social network method were determined quantitatively and qualitatively.

RESULTS

Participants in both local research groups considered that the network survey had accurately described the links between workers related to the exchange of clinical and cultural information, team care relationships, involvement in service management and planning and involvement in policy development. This revealed the function of the teams and the roles of workers in each partnership. Aboriginal workers had a high number of direct links in the exchange of cultural information, illustrating their role as the cultural resource, whereas they had fewer direct links with other network members on clinical information exchange and team care. The problem of their current and future roles was discussed inside and outside the local research groups. According to the interview informants the participatory network analysis had opened the way for problem-solving by "putting issues on the table". While there were confronting and ethically challenging aspects, these informants considered that with flexibility of data collection to account for the preferences of Aboriginal members, then the method was appropriate in cross-cultural contexts for the difficult discussions that are needed to improve partnerships.

CONCLUSION

Critical reflection showed that the preconditions for difficult discussions are, first, that partners have the capacity to engage in such discussions, second, that partners assess whether the effort required for these discussions is balanced by the benefits they gain from the partnership, and, third, that "boundary spanning" staff can facilitate commitment to partnership goals.

Attitudes to infant feeding decision-making--a mixed-methods study of Australian medical students and GP registrars

Breastfeeding is an important public health issue. While medical practitioners can have a significant impact on breastfeeding initiation and duration, there are few studies investigating their views regarding women's infant feeding decisions. This mixed-methods study employed qualitative (focus groups and interviews) and quantitative (questionnaire) data collection techniques to investigate the attitudes and views of Australian medical students and GP registrars about infant feeding decision-making. Three approaches to infant feeding decisions were evident: 'the moral choice' (women were expected to breastfeed); 'the free choice' (doctors should not influence a woman's decision); and 'the equal choice' (the outcome of the decision was unimportant). Participants were uncertain about differences between artificial-feeding and breastfeeding outcomes, and there was some concern that advising a mother to breastfeed may lead to maternal feelings of guilt and failure. These findings, the first in an Australian setting, provide a foundation on which to base further educational interventions for medical practitioners.

Barriers to use of information and computer technology by Australia's nurses: a national survey

AIMS AND OBJECTIVES

To support policy planning for health, the barriers to the use of health information and computer technology (ICT) by nurses in Australia were determined.

BACKGROUND

Australia, in line with many countries, aims to achieve a better quality of care and health outcomes through effective and innovative use of health information. Nurses form the largest component of the health workforce. Successful adoption of ICT by nurses will be a requirement for success. No national study has been undertaken to determine the barriers to adoption.

DESIGN

A self-administered postal survey was conducted.

METHOD

A questionnaire was distributed to 10,000 members of the Australian Nursing Federation. Twenty possible barriers to the use of health ICT uptake were offered and responses were given on a five point Likert scale.

RESULTS

Work demands, access to computers and lack of support were the principal barriers faced by nurses to their adoption of the technology in the workplace. Factors that were considered to present few barriers included age and lack of interest. While age was not considered by the respondents to be a barrier, their age was positively correlated with several barriers, including knowledge and confidence in the use of computers.

CONCLUSIONS

Results indicate that to use the information and computer technologies being brought into health care fully, barriers that prevent the principal users from embracing those technologies must be addressed. Factors such as the age of the nurse and their level of job must be considered when developing strategies to overcome barriers.

RELEVANCE TO CLINICAL PRACTICE

The findings of the present study provide essential information not only for national government and state health departments but also for local administrators and managers to enable clinical nurses to meet present and future job requirements.

Exploring the influence of psychological factors on breastfeeding duration, phase 1: perceptions of mothers and clinicians

Breastfeeding duration rates in Australia are low, prompting a search for modifiable factors capable of increasing the duration of breastfeeding. In this study, participants were asked which psychological factors they believed influence breastfeeding duration. Participants included 3 groups of mothers who had breastfed for varied lengths of time (n = 17), and 1 group of breastfeeding clinicians (n = 4). The nominal group technique was employed, involving a structured group meeting progressing through several steps. Analyses included collation of individual and group responses, group comparisons, and a thematic analysis of group discussions. Forty-five psychological factors thought to influence the duration of breastfeeding were identified. Factors considered most important included the mother's priorities and mothering self-efficacy, faith in breast milk, adaptability, stress, and breastfeeding self-efficacy. In addition to informing the design of phase 2 of this study, these results add to our knowledge of this emerging research area.

Aged care nursing in Queensland ? the nurses? view

AIMS AND OBJECTIVES

Through comparison of two studies undertaken three years apart the opinions of nurses working in aged care facilities in Queensland were determined. Results will support policy planning for the Queensland Nurses Union.

BACKGROUND

An ageing population in Australia is placing increased demands on residential aged care facilities. In Queensland, the national situation is exacerbated by an influx of retirees from other states and territories. The ongoing problem of shortages of nurses in the workforce may be addressed by gaining further insight into the nurses' own views of their conditions and experiences.

METHODS

One thousand nurses working in public and privately owned residential aged care facilities were surveyed by postal questionnaire in 2004. Results were compared with data collected in an identical study in 2001.

RESULTS

Respondents offered their opinions on working hours and conditions, professional development and experiences in nursing. The predominately female aged care nursing workforce is ageing. Reported workplace violence has increased substantially since 2001. Some improvements are reported in staff numbers, skill mix and workplace policies. Nurses expressed very serious concerns about pay, workload, stress, physical and emotional demands and staff morale.

CONCLUSION

Working conditions for nurses in the residential aged care sector in Queensland must be addressed to retain the current nurses and to encourage new nurses to replace those that retire.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study provide information not only for the Queensland Nurses Union but also policy makers and nurse managers both nationally and internationally on areas that need to be addressed to maintain the required workforce within the aged care sector.

Nurse discharge planning in the emergency department: a Toowoomba, Australia, study

AIM

This study aimed to ascertain whether a model of risk screening carried out by an experienced community nurse was effective in decreasing re-presentations and readmissions and the length of stay of older people presenting to an Australian emergency department.

OBJECTIVES

The objectives of the study were to (i) identify all older people who presented to the emergency department of an Australian regional hospital; (ii) identify the proportion of re-presentations and readmissions within this cohort of patients; and (iii) risk-screen all older patients and provide referrals when necessary to community services.

DESIGN

The study involved the application of a risk screening tool to 2,139 men and women over 70 years of age from October 2002 to June 2003. Of these, 1,102 (51.5%) were admitted and 246 (11.5%) were re-presentations with the same illness. Patients presenting from Monday to Friday from 08:00 to 16:00 hours were risk-screened face to face in the emergency department. Outside of these hours, but within 72 hours of presentation, risk screening was carried out by telephone if the patient was discharged or within the ward if the patient had been admitted.

RESULTS

There was a 16% decrease in the re-presentation rate of people over 70 years of age to the emergency department. Additionally during this time there was a 5.5% decrease in the readmission rate (this decrease did not reach significance). There was a decrease in the average length of stay in hospital from 6.17 days per patient in October 2002 to 5.37 days per patient in June 2003. An unexpected finding was the decrease in re-presentations in people who represented to the emergency department three or more times per month (known as 'frequent flyers').

CONCLUSIONS

Risk screening of older people in the emergency department by a specialist community nurse resulted in a decrease of re-presentations to the emergency department. There was some evidence of a decreased length of stay. It is suggested that the decrease in re-presentations was the result of increased referral and use of community services. It appears that the use of a specialist community nurse to undertake risk screening rather than the triage nurse may impact on service utilization.

RELEVANCE TO CLINICAL PRACTICE

It is apparent that older people presenting to the emergency department have complex care needs. Undertaking risk screening using an experienced community nurse to ascertain the correct level of community assistance required and ensuring speedy referral to appropriate community services has positive outcomes for both the hospital and the patient.

SEAM--improving the quality of palliative care in regional Toowoomba, Australia: lessons learned

INTRODUCTION

The proliferation of professional palliative care services in recent years has increased access for people with palliative care needs; however, gaps in services continue to exist, particularly in rural and remote areas of Australia. In order to address one gap in rural health service delivery, the Support, Education, Assessment, and Monitoring (SEAM) Service for regional and rural people in Toowoomba, Queensland, Australia, was introduced. This new model of service delivery aimed to provide palliative services to patients and their families who live in the regional city of Toowoomba and its rural catchment area. It also aimed to facilitate education, support and networking among health-care professionals, particularly general practitioners and nurses employed in general practice (practice nurses).

METHOD

The evaluation involved twenty face-to-face interviews with a variety of health professionals who had contact with the SEAM service from June 2003 to June 2004. Qualitative data analysis of the transcribed interviews provided the basis for the evaluation. The emergent themes regarding the SEAM service included: satisfaction and benefit of the SEAM service; knowledge of and contact with the SEAM service; the SEAM role; and expansion of the role.

RESULTS

The data indicate that the majority of health professionals who had contact with the SEAM service were satisfied with the service and found it to be of benefit to them and their clients. Participants commented on the extensive networking and support work established by the SEAM nurse with other health service providers. Difficulties experienced with the SEAM service included poor utilisation by GPs and, therefore, clients in need of palliative support. This was predominately due to lack of knowledge of the service as well as limited understanding of the SEAM nurse role.

CONCLUSION

The SEAM service has resulted in increased links between health professionals providing palliative care to rural clients. The most successful strategy was the use of multidisciplinary case conferencing which not only built links among health professionals caring for individual clients, but also resulted in improved care for those clients. As a result of better integration and communication, palliative care services to rural people have been improved. However, with regard to the delivery of direct patient care, or in the support of GPs for the management of palliative care patients, it was apparent that the service did not meet its objectives. The lack of use by GPs and patients appears to be related to a lack of awareness of the existence of the service. A positive outcome of this poor utilisation is, however, that the model has allowed the identification of factors that work as barriers to GPs and client/family utilisation of rural palliative care services.

Australian nurses access and attitudes to information technology--a national survey

Competencies by nurses in information technology (IT) are essential to health care in Australia yet data suggest deficiencies in access and use. A study commissioned by the Australian Government aimed to determine the extent of access and use and the barriers to the use of IT among nurses across Australia. A survey was distributed to 10,000 members of the Australian Nursing Federation with a 43% overall response rate. Fewer than 15% of nurses did not use computers as part of their work. The greatest use was for client records, patient pathology and radiology results and professional development. IT uptake in health is supported by nurses who are, however frustrated by limitations to access and software that is not fit for purpose. A lack of confidence in using IT was noted by many nurses. Fewer than 20% had received pre-registration training in any aspect of IT and only 30% post registration. In addition to training, high work load, numbers of computers and inadequate technical support were the major barriers to computer use.

Evaluating systems of care for children: utility of the clinical case conference

A clinical assessment of the Mental Health Services Program for Youth, a national initiative to integrate systems and coordinate care for severely emotionally disturbed children, was designed to augment and enrich the larger evaluation of program structure. Case conferences were used as a method of examining the effects of collaborative systems of care on vulnerable individuals and of generating clinical insight and understanding. Case vignettes are presented and discussed in terms of the contributions and shortcomings of current system-of-care efforts.

Bridging the gap between service need and service utilization: a school-based mental health program

In an effort to bridge the gap between service need and service utilization, an urban based, university affiliated children's psychiatric outpatient clinic has implemented a program which provides mental health services in inner city schools. When compared with the central clinic populations (N = 304), the school sample (N = 44) was markedly socioeconomically disadvantaged, minority, and as psychiatrically impaired as the central clinic population. School based mental health services have the potential for bridging the gap between need and utilization by reaching disadvantaged children who would otherwise not have access to these services. Implications for such services are discussed.

Determinants of reliability in psychiatric surveys of children aged 6-12

The reliability of young children's self reports of psychiatric information is a concern of epidemiologists and clinicians alike. This paper explores the determinants of test-retest reliability in a sample of children from the general population using reliability coefficients constructed from a kappa statistic. Age, cognitive ability, and gender are related to consistency of reports in a test-retest paradigm. Controlling for age, cognitive ability and gender, children report more reliably on observable behaviors, and less reliably on questions involving unspecified time, reflections of one's own thoughts, and comparison of themselves with others. The reliability of reports of emotions lies between these two extremes. Surprisingly, sentence length of up to 40 words and psychiatric impairment of the child as measured by the Child Global Assessment Scale did not influence reliability. As might be expected, parents' reports of their children are more reliable than their children's reports.

Clinical, sociodemographic, and systems risk factors for attrition in a children's mental health clinic

Clinical, sociodemographic, and systems risk factors for attrition at a child guidance clinic were identified. All patients who completed the intake process were followed through various clinic phases. Lower socioeconomic status and low family cohesion predicted dropout. Dropouts and continuers were equally psychiatrically impaired. The Family Environment Scale was the only standardized measure that distinguished between dropouts and continuers.

Reliability of diagnostic reporting for children aged 6-11 years: a test-retest study of the Diagnostic Interview Schedule for Children-Revised

OBJECTIVE

This study examined the reliability of symptom reporting by community children of elementary school age and their parents on a version of the Diagnostic Interview Schedule for Children-Revised (DISC-R).

METHOD

A sample of 109 children aged 6-11 years from an ongoing epidemiologic study were recruited for retest DISC-R interviews after completion of the study protocol. Retest interviews took place 7-18 days after the first interview and were conducted by interviewers who had no prior information about the subjects. Test-retest reliability for five common childhood psychiatric diagnoses was evaluated with the kappa statistic; the intraclass correlation coefficient was used to evaluate test-retest reliability of symptom scales.

RESULTS

The reliability of the parents' reports on the DISC-R was good to excellent for attention deficit hyperactivity disorder and separation anxiety disorder; it was fair for overanxious disorder, oppositional defiant disorder, and conduct disorder. The children reported many fewer symptoms than the parents except for separation anxiety disorder; reliability was fair for separation anxiety disorder and poor for attention deficit hyperactivity disorder. The children were particularly unreliable in reporting about time factors, such as duration and onset of symptoms. When symptoms were considered without duration and onset, children's reports reached fair reliability for separation anxiety disorder, overanxious disorder, and attention deficit hyperactivity disorder but remained poor for oppositional defiant disorder.

CONCLUSIONS

The results suggest that highly structured diagnostic interviews such as the DISC-R may not be appropriate for use with younger children of elementary school age in community-based studies.

Nurses' attitudes toward homeless women: a barrier to change

Close to a third of the almost 4 million homeless persons in the United States are women. They have multiple physical and mental health problems directly attributable to their homelessness. Studies have indicated that their failure to seek health care is partially a function of the barrier created by negative attitudes of nurses toward homeless women. Strategies for changing nurses' attitudes, built on attitude change theory, include methods for increasing knowledge and experience in the treatment of homeless women.

Congenital hypertrophy of retinal pigment epithelium in patients with colonic polyps associated with cancer family syndrome

Congenital hypertrophy of retinal pigment epithelium (CHRPE) has been shown to be a frequent extracolonic manifestation of adenomatous polyposis coli (APC). The presence of CHRPE in patients with adenomatous polyps from families with cancer family syndrome suggests possible involvement of the APC gene locus in syndromes associated with less florid polyp formation than seen in APC. It also emphasises that caution must be exercised in using the presence of CHRPE clinically as a marker for APC in isolated at-risk individuals.

Cloning and characterization of a gene encoding pig epidermal growth factor

A portion of the pig epidermal growth factor (EGF) gene has been isolated and characterized. The nucleotide sequencies of exons 20 and 21, which encode the EGF region of the precursor protein, show 85% similarity with the human EGF gene sequence. In addition, conservation of the intron-exon boundaries between the two species was generally observed. Although the pig exon 21 appeared to lack a single nucleotide at its 5' end relative to the human gene, sequences obtained by direct amplification of the genomic DNA around the 5' end of this exon using the polymerase chain reaction, and from a pig EGF cDNA recombinant isolated from a kidney library, indicated that the deletion was probably a cloning artifact. Comparison of the predicted amino acid sequence of pig EGF with that of EGF from other species, as well as with several other polypeptides which bind to the EGF receptor, indicated conservation of Gly18, Tyr37, Gly39 and Arg41 in addition to all six cysteine residues and Leu47, which are known to be critical for biological activity. A synthetic gene encoding the predicted amino acid sequence of pig EGF was expressed in yeast. The recombinant polypeptide was shown to compete with 125I-labelled mouse EGF for binding to cells and to stimulate DNA synthesis in quiescent monolayers of Swiss 3T3 cells.

Respiratory effect on the blood volume of pulmonary capillaries

We measured the density variations of aortic blood from rabbits ventilated by a positive end inspiratory pressure of 6 mmHg or a negative box pressure of the same magnitude. When calculated from the density variations, the fluctuations in blood volume of the pulmonary capillaries within one cycle as induced by an intermittent positive pressure ventilation were found to be similar to the ones induced by an intermittent negative pressure ventilation. Using these volumetric fluctuations as a means to assess the transpulmonary pressure and the transmural pressure across the pulmonary capillaries, we conclude that the switching of the ventilation method did not alter the cyclic fluctuations of these pressures.

Plasma adenosine and hypoxemia in patients with sleep apnea

Severe hypoxemia causes ATP depletion and increased adenosine production in many body tissues. Therefore we hypothesized that patients with sleep apnea and severe hypoxemia during sleep have higher adenosine production and higher plasma adenosine levels than patients without hypoxemia. Twelve patients with sleep apnea and six normal volunteers had plasma adenosine levels measured by high-performance liquid chromatography. Each patient with sleep apnea had a polysomnograph sleep study with oxyhemoglobin saturation continuously recorded. Five of 12 patients with sleep apnea had both sleep apnea and severe hypoxemia during sleep. These patients with severe nocturnal hypoxemia had significantly higher plasma adenosine levels (means +/- SD 9.7 +/- 5.5 X 10(-8) M) than either a group of six normal volunteers (3.5 +/- 0.7 X 10(-8) M) or a group of seven patients with sleep apnea without hypoxemia at night (3.1 +/- 1.5 X 10(-8) M) (P less than 0.01). In addition plasma adenosine levels were significantly correlated with two indexes of nocturnal hypoxemia (desaturation index rs = 0.79, and median oxyhemoglobin saturation during sleep rs = -0.75, P less than 0.01). Plasma adenosine markedly fell to a normal level in the only two patients with sleep apnea who had successful treatment of their multiple apneas and accompanying severe hypoxemia during sleep.

Telangiectases [corrected] of the anterior chest in homosexual men

Physical examination by a single clinician showed that 17 of 51 asymptomatic homosexual men and 19 of 26 men with persistent lymphadenopathy had linear telangiectasias in a broad, crescent distribution across the chest. The telangiectasias were commonly associated with erythema in the same distribution. Of the 36 men with telangiectasias, 25 were positive for serum antibody to the human immunodeficiency virus (HIV), whereas only 15 of 41 men without telangiectasias were seropositive (p = 0.001). Biopsy studies of supraclavicular skin from 6 of the men with HIV antibody and telangiectasias showed a characteristic pattern of dilated blood vessels with a perivascular small-cell infiltrate; no endothelial proliferation was noted. This histopathologic pattern was not consistently observed in HIV-seronegative men regardless of whether they had telangiectasias. These data show that telangiectasias of the upper chest are a relatively common finding in homosexual men and that they are significantly, although not exclusively, associated with HIV infection.