Anna King

Aim and objectives: To describe intensive care unit (ICU) nurses’ physical work activity behavioural patterns over 12 hr using dual accelerometry, following a job demands–recovery framework.Background: Limited studies utilised accelerometry to objectively analyse nurses’ physical workloads. Little is known about intensive care nurses’ physical activity patterns during a 12‐hr shift.Design: A cross‐sectional study was conducted with intensive care nurses from four units in Auckland, New Zealand.Methods: Each participant wore two Axivity AX3 accelerometers to measure physical activity during a 12‐hr day or night shift. An online survey captured participants’ demographic information. R software (version 3.6.1) and SPSS version 26 were utilised for data analysis. The STROBE was followed.Results: A total of 102 nurses were included in this study. A high level of light intensity activity behaviours (standing, dynamic standing, walking) was observed throughout the day shifts, with no higher intensity behaviours identified. Activity levels were highest at the beginning of shifts and followed a consistent pattern, with an additional peak around midday for day shifts and at the end of the shift for night shifts. Observable differences were seen between day and night shifts with a greater prevalence of sitting and lying during night shifts. Standing, dynamic standing, sitting, lying and walking were significant factors in the differences of the physical work behaviours between the day shift nurses and the night shift nurses. Significant differences in dynamic standing and lying were found between ICUs.Conclusions: Intensive care nurses’ physical work activity involved a large amount of standing and dynamic standing during a 12‐hr shift. The overall physical workload during a 12‐hr day shift was significantly higher than that during a 12‐hr night shift.Relevance to clinical practice: Results may help managers attain a better understanding of nurses’ physical workloads during a 12‐hr shift.

Aim and objectives: To assess intensive care nurses' resilience and identify associated personal factors and physical activity behaviours using a job demands–recovery framework.Background: Currently, there is inconsistent evidence as to whether nurse resilience is associated with personal factors or with physical activity at work or during leisure time.Design: A cross‐sectional study was conducted with nurses from four intensive care units in Auckland, New Zealand.Methods: An online survey was conducted to collect nurses' personal information and assess their resilience levels using the Connor–Davidson Resilience Scale 25. Participants were nurses working at least 32 hr fortnightly and providing direct patient care. Physical activity was objectively measured using a pair of accelerometers worn on the back and thigh over four consecutive days (two workdays followed by two nonworkdays). Bivariable and multivariable regression were used to identify personal factors and physical activity behaviours associated with resilience (followed the STROBE checklist).Results: A total of 93 nurses were included in the study. The participants' average resilience level was low. Resilience was positively associated with the objectively measured physical job demands factors: occupational physical activity, moderate‐to‐vigorous physical activity at work and dynamic standing at work. Resilience was negatively associated with one objectively measured recovery factor: sleep during leisure time. In multivariable modelling, being married and moderate‐to‐vigorous physical activity at work were positively associated with resilience, while not having religious beliefs and sleep during leisure time were negatively associated with resilience.Conclusions: Resilient nurses have a greater tolerance to high physical activity at work and lower sleep duration during leisure time. Strategies are needed to improve intensive care nurses' resilience levels.Relevance to clinical practice: Results may help managers gain a better understanding of the ICU nurses' characteristics associated with resilience, leading them to develop strategies for improving ICU nurse resilience.

Nurse-led models of comprehensive geriatric assessment and care coordination can improve health management as well as reduce hospitalisations for high risk community dwelling older people. This study investigated the effect on healthcare utilisation of systematic case finding to identify high risk older people in the community with a subsequent comprehensive assessment and care coordination intervention by a Gerontology Nurse Specialist based in primary care. This was a controlled before-after study design located within primary healthcare practices in Auckland, New Zealand. An intervention model was initiated within two primary healthcare practices and involved a screening tool to identify high risk older people with succeeding gerontology nurse specialist assessment and care coordination. The comparison group included older people who received usual care at three comparable primary healthcare practices. The primary outcome measure was acute hospital admissions. Secondary outcomes included hospital re-admissions, length of stay, emergency department presentations, residential care admissions, and community contacts. A total of 579 older people were posted the screening tool in the intervention group, with 517 completed screens (89% response rate) formulating the intervention group. A total of 101 older people were identified as high risk from these screens (20%). The comparison group comprised 883 older people. Comparing the intervention and comparison group, no statistical differences were found for hospital admissions, emergency department presentations, hospital re-admissions, length of stay, or residential care admission. Community physiotherapy showed a statistically significant increase for the intervention compared to the comparison group (p = 0.03). Non-significant findings revealed decreased risk of entering residential care and fewer frequent hospital re-admissions for the intervention group when compared with the comparison group. This specialist nurse-led intervention involving comprehensive assessment and care coordination care did not appear superior to usual care, however, there is benefit to exploring a more robust randomised controlled trial design. Retrospectively registered on 18/09/2017 with the Australian New Zealand Clinical Trials Registry (ANZCTR). Registration number ACTRN12617001332314

Aims and objectives: To explore an innovative primary healthcare gerontology nurse specialist role from the perspectives of older people and health professionals.Background: Primary care is struggling to meet the needs and demands of complex older people. New models which incorporate holistic assessment and care coordination are necessary.Design: A qualitative descriptive general inductive design was used.Methods: Older people at risk of health and functional decline were identified and received a comprehensive gerontology assessment and care coordination. Older adults (75 years+) enrolled within one of three primary healthcare practices in Auckland, New Zealand were eligible. Healthcare professionals directly involved with the primary healthcare gerontology nurse specialist model were invited for study participation. Face‐to‐face interviews were held with five older people and six health professionals were interviewed by telephone. A semistructured interview guide was used for all interviews. A general inductive approach was undertaken for analysis to systematically identify codes and themes.Results: Data analysis revealed two central themes from the older people perspective: “holistic expertise” and “communication.” Two main themes were identified from the health professional perspective: “competency” and “service delivery.” Results showed the gerontology nurse specialist role was highly regarded by both older people and the health professionals. The in‐home comprehensive geriatric assessment was identified as greatly beneficial.Conclusions: The competence and care coordination of the gerontology nurse specialist reduced fragmentation and were deemed immensely valuable. Care coordination should be recognised as a key component to meeting the complex needs of at‐risk older people in the community.Relevance to clinical practice: The expert knowledge of the gerontology nurse specialist and in‐home comprehensive geriatric assessment were crucial aspects of the new model. Equally important was the assimilation of primary and secondary care infrastructure to upskill and deliver mentorship to the gerontology nurse specialist.

Objectives: To describe implementation of an innovative gerontology nurse specialist role within one primary health organisation in Auckland, New Zealand. Quantitative outcomes of the screening tool as well as the nurse specialist assessment will be presented. Method: The intervention involved use of the Brief Risk Identification for Geriatric Health Tool (BRIGHT) to identify high-needs older people with subsequent comprehensive geriatric assessment (CGA) performed by the gerontology nurse specialist. Results: A total 384 of the 416 BRIGHTs were completed (92% response rate) and 15% of these were identified as high risk (n = 57). The BRIGHTs for high-risk older people revealed the highest scoring question was ‘needing help with housework’ (26%). The most frequent intervention by the gerontology nurse specialist was education (30%). Conclusions: The primary health care gerontology nurse specialist model delivers a proactive case finding and specialist gerontology intervention for older people at high risk of functional or health decline.

Due to the ageing population, there is an increased demand for home care services. Restorative care is one approach to improving home care services, although there is little evidence to support its use in the community setting. The objective of this trial was to evaluate the impact of a restorative home care service for community‐dwelling older people. The study was a cluster randomised controlled trial undertaken at a home care agency in New Zealand. The study period was from December 2005 to May 2007. Older people were interviewed face‐to‐face at baseline, four and 7 months. A total of 186 older people who received assistance from a home care agency participated in the study, 93 received restorative home care and 93 older people received usual home care. The primary outcome measure was change in health‐related quality of life (measured by the Short Form 36 [SF36] Health Survey). Secondary outcomes were the physical, mental, and social well‐being of older people (Nottingham Extended Activities of Daily Living, Timed Up and Go, Mastery scale, Duke Social Support Index). Findings revealed that compared with usual care, the intervention demonstrated a statistically significant benefit in health‐related quality of life (SF36) at 7 months for older people (mean difference 3.8, 95% CI −0.0 to 7.7, P = 0.05). There were no changes in other scale measurements for older people in either group over time. There was a statistically significant difference in the number of older people in the intervention group identified for reduced hours or discharge (29%) compared with the control group (0%) (P < 0.001). In conclusion, a restorative home care service may be of benefit to older people, and improves home care service efficacy.

Paid caregivers possess an essential role in home care services. However, recruitment and retention issues are extensive within this workforce, largely in relation to poor working conditions. This article primarily focuses on the qualitative data extracted from a large randomised controlled trial in New Zealand and is supported by some quantitative findings. The aim was to explore paid caregiver perceptions of a restorative home care intervention in comparison with usual home care. The purpose of the qualitative exploration was to gather rich descriptive data that highlight differences between the two services with an emphasis on the workforce viewpoint. Four focus groups were undertaken with paid caregivers, two at baseline (4 and 5 participants in the control and intervention groups, respectively) and two at 14 months (eight participants in each focus group). Focus group data were collected in December 2005 and February 2007. A general inductive approach was used to analyse focus group transcripts. Two themes emerged from both the control and intervention focus groups: relationship with older people and issues with home care service delivery. A further two themes were pertinent to the intervention group: job satisfaction and preintervention. Findings revealed the intervention had a substantial positive impact on paid caregiver job satisfaction in comparison with usual care. This appeared to be due to improved training, increased support and supervision, and more flexibility. The intervention resulted in positive changes from the paid caregiver perspective and substantially reduced turnover in comparison with usual home care. However, both groups identified the need for further improvements to their working conditions. In addition, the need to regulate this vulnerable workforce is discussed.

To evaluate two case-management models of respite relief care at Waitemata District Health Board. The evaluation consisted of semi-structured interviews and postal surveys for clients utilising respite care and staff members involved in both the North/West and Rodney models of respite care in Auckland, New Zealand. Across the two regions, a total of 2 older people and their informal caregivers, 2 respite coordinators, and the Needs Assessment Service Coordination (NASC) Manager were interviewed. In addition, postal surveys were received from 21 older people, 36 informal caregivers, 11 NASC workers, and 3 allied health professionals. Findings revealed there was generally high satisfaction with both the respite models. Caregivers believed the respite service did give them a break, although it was insufficient. Caregivers reported concerns regarding how respite facilities could improve and the older person's deterioration post respite. Staff identified improvements for each of the models. The respite models are flexible and provide control in decision-making for informal caregivers leading to an increase in choice for home-based respite. Case-managers need to form strong partnerships with caregivers to ensure that the needs of both the informal caregiver and older person are met. Short-term placement in residential respite facilities for respite care may be linked to worsening functional ability of the older person.