International sore throat guidelines and international medical graduates: a mixed methods systematic review.

AIM To examine national and international guidelines on sore throat management and subsequently, to explore the phenomenon of international medical graduates working in general and rural practice in New Zealand. METHOD Two separate systematic reviews were conducted that resulted in a contingent methodology. Contingent methodologies involve syntheses of data that are derived sequentially. The initial review for this study examined international sore throat guidelines and their key points. The results of this initial review resulted in the theory that international medical graduates may be unaware of the New Zealand specific sore throat guidelines and the problem of acute rheumatic fever in this country. The subsequent review examined the phenomenon of international medical graduates working in general or rural practice in New Zealand. Data sources were Medline, Google Scholar, Trip Database, and NHS Evidence, Embase and Scopus. Electronic databases were searched for relevant data published January 2000-December 2013. Additional hand searches found key references from articles and websites. RESULTS International guidelines for the management of sore throats differ from New Zealand guidelines. Of resource rich countries, New Zealand has the second highest number of international medical graduates: they may not use New Zealand specific sore throat guidelines. DISCUSSION Acute rheumatic fever is virtually eradicated in most resource rich countries. Rheumatic fever rates of among indigenous Maori and Pacifika people in New Zealand have failed to reduce over the last three decades. Knowledge and actions of international medical graduates in relation to sore throat management needs investigating. KEYWORDS Sore throats; acute rheumatic fever; clinical guidelines; international medical graduates; mixed methods review.

The role of a sexual health promotion leaflet for 15-18 year olds in catalysing conversations: A constructivist grounded theory.

Following the summer holidays of 2011, twelve girls returned to school pregnant in one high school in Auckland New Zealand (NZ). A health promotion leaflet that folded into.a small square containing a condom and was dubbed the 'teabag' was distributed to 15-18 year olds prior to the summer holiday of 2012, in order to increase their sexual health knowledge. This paper reports on the evaluation of the teabag from the students' perspective. During the first term of 2013, seventeen students from two high schools who had received the teabag were interviewed. Five were male and twelve female. Most (16) were of Pacific Island or Maori (indigenous New Zealanders) descent. Interviews were digitally recorded, transcribed, coded and categorised concurrently, in accordance with grounded theory methods. Theoretical sampling was employed and students who had perceptions of the teabag, that were consistent with evolving constructions from data, were invited by school nurses to be interviewed by the researchers. Interviews were coded line by line by two researchers and these codes collapsed into seven focussed codes. Further analysis resulted in the codes being subsumed into three main categories. These categories revealed that the teabag was, helpful, appropriate and became a talking point. The grounded theory and basic social process the researchers constructed from data were that the teabag catalysed conversations about sexual health. The teabag was an acceptable and appropriate sexual health promotion tool to disseminate information about sexual health.

Maintaining the balance: New Zealand secondary school nurses' perceptions of skin infections in young people--a grounded theory.

The objective of this study was to explore the perceptions of New Zealand secondary school nurses regarding skin infections in young people aged 14-18 years. A constructivist grounded theory method was adopted. Ten non-structured interviews were conducted with secondary school nurses working in Auckland, New Zealand, between January and July 2013. Interviews were audiotaped, transcribed and analysed using all tenets of grounded theory that included writing memos, theoretical sampling and the constant comparative method. Analysis revealed the core category Maintaining the balance, which is presented as a grounded theory model. It represents the constant state of balancing the school nurse undergoes in trying to counter the risk to the student. The nurse attempts to tip the balance in favour of action, by reducing barriers to healthcare, providing youth-friendly, affordable and accessible healthcare, and following up until resolution is achieved. The nurse is aware that failing to monitor until resolution can again tip the fulcrum back to inaction, placing the young person at risk again. It is concluded that nurses are knowledgeable about the risks present in the communities they serve and are innovative in the methods they employ to ensure satisfactory outcomes for young people experiencing skin infections. School nursing is an evolving model for delivering primary healthcare to young people in New Zealand. The grounded theory model 'Maintaining the balance' describes a model of care where nursing services are delivered where young people spend time, and the nurse is immersed in the community. This model of care may be transferable to other healthcare situations.

What is known about the experiences of using CPAP for OSA from the users' perspective? A systematic integrative literature review.

UNLABELLED: Economic, social and personal costs of untreated obstructive sleep apnoea (OSA) are high. Continuous positive airway pressure (CPAP) is recommended and cost effective. Increasing OSA prevalence may accompany predicted globally increasing obesity. OBJECTIVE: To synthesise international evidence regarding personal experiences using CPAP for OSA. METHODS: A systematic integrative literature review was conducted and quality assessment criteria applied. RESULTS: 22, of 538, identified papers met inclusion criteria. Thematic analysis identified three themes: 1) users' beliefs about CPAP influence users' experiences of CPAP; 2) CPAP users are primed to reflect negatively on experiences of CPAP; and 3) spouse and family influence users' experiences of CPAP. Personality and attitude impact expectations about CPAP prior to use, whilst engagement of spouse and family also influence experiences. Analysis highlighted that users' reporting of CPAP experiences is constrained by investigator defined assessment methods. Overall, research relating to experiences using CPAP is limited. CONCLUSION: Users' perspectives of CPAP are constrained by researchers' concern with non-compliance. Typically experiences are not defined by the user, but from an 'expert' healthcare perspective, using words which frame CPAP as problematic. Family and social support is a significant, but neglected area of experiencing CPAP warranting further investigation. More information from users is required to determine how CPAP can be managed successfully.

Skin infections in young people (aged 14-18 years): an integrative review.

Skin infections are a major cause of preventable hospitalization, with young people being particularly susceptible. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection typically presents as skin infection. CA-MRSA infection rates have increased rapidly in the past decade. Exploration of literature specific to young people aged 14-18 years is therefore timely. Integrative review using the methods described by Whittemore and Knafl was undertaken. Electronic databases of Medline, CINAHL, Scopus, Cochrane Database of Systematic Reviews, and Google databases were searched for English-language articles published after 1990. Twenty primary studies were included and the findings are reported here. Data analysis revealed factors influencing skin infections in young people may be host-, transmission-, or pathogen-specific. Strategies to address host and transmission factors may be effective in controlling skin infection rates in young people.

New graduate nurses as knowledge brokers in general practice in New Zealand: a constructivist grounded theory.

Practice nursing in New Zealand is not well described in the literature. One survey illustrated that most of the New Zealand practice nurses sampled did not know of the country's two premier evidence-based health websites. A recent review compared general practice in the UK, New Zealand and Australia and found that whereas there had been significant developments in empowering the practice nurse workforce to run nurse-led clinics in the UK, New Zealand and Australia lagged behind. The aim of this reported constructivist grounded theory study was to investigate practice nurses' use of information. Conducted in Auckland, New Zealand, data were collected through ethnographic techniques in one general practice between September 2009 and January 2010 to enhance theoretical sensitivity to the area of information use. Subsequently, six experienced practice nurses (one twice after moving jobs) and five new graduate nurses from five different general practices were interviewed, using open-ended questions, between January 2010 and August 2011. Concurrent data collection and analysis occurred throughout the study period. The use of memos, the constant comparative method, data categorisation and finally, data abstraction resulted in the final theory of reciprocal role modelling. Experienced practice nurses role modelled clinical skills to new graduate nurses. Unexpectedly, new graduate nurses were unconscious experts at sourcing information and role modelled this skill to experienced practice nurses. Once this attribute was acknowledged by the experienced practice nurse, mutual learning occurred that enabled both groups of nurses to become better practitioners. Graduate nurses of the millennial generation were identified as a resource for experienced practice nurses who belong to the baby boomer generation and generation X.

Sifting, sorting and saturating data in a grounded theory study of information use by practice nurses: a worked example.

The terminology used to analyse data in a grounded theory study can be confusing. Different grounded theorists use a variety of terms which all have similar meanings. In the following study, we use terms adopted by Charmaz including: initial, focused and axial coding. Initial codes are used to analyse data with an emphasis on identifying gerunds, a verb acting as a noun. If initial codes are relevant to the developing theory, they are grouped with similar codes into categories. Categories become saturated when there are no new codes identified in the data. Axial codes are used to link categories together into a grounded theory process. Memo writing accompanies this data sifting and sorting. The following article explains how one initial code became a category providing a worked example of the grounded theory method of constant comparative analysis. The interplay between coding and categorization is facilitated by the constant comparative method.

Dancing with data: an example of acquiring theoretical sensitivity in a grounded theory study.

Glaser suggested that the conceptual route from data collection to a grounded theory is a set of double back steps. The route forward inevitably results in the analyst stepping back. Additionally sidestepping through, leading participants down lines of inquiry and following data threads with other participants, is also characteristic of acquiring theoretical sensitivity, a key concept in grounded theory. Other ways of acquiring theoretical sensitivity comprise: reading the literature, open coding, category building, reflecting in memos followed by doubling back on data collection once further lines of inquiry are opened up. This paper describes how we 'danced with data' in pursuit of heightened theoretical sensitivity in a grounded theory study of information use by nurses working in general practice in New Zealand. Providing an example of how analytical tools are employed to theoretically sample emerging concepts.

The role of Government policy in supporting nurse-led care in general practice in the United Kingdom, New Zealand and Australia: an adapted realist review.

AIM: This article is a report on a review that examined the role of Government policy in primary care and its association with nurse-led care in the United Kingdom, New Zealand and Australia between 1998 and 2009. BACKGROUND: The United Kingdom, New Zealand and Australia share a similar model of first point access to the healthcare system via general practitioners. General practice is synonymous with the term primary care. DATA OURCES: Medline, CINAHL, EMBASE, Scopus, PsychInfo, Google, Department of Health, England (United Kingdom), Ministry of Health, New Zealand, Department of Health and Ageing, Australia. Searches of electronic databases from 1998 to December 2009 and hand searches of identified leads and key journals. Historical papers accessed to describe the genesis of practice nursing and historical Government policy documents prior to 1998, were examined. REVIEW METHODS: A modified realist review was used to synthesize research and policy documents relating to government policies pertaining to nurse-led care. In addition, a systematic review was used to identify literature that described practice nurse-led care. Results. Nurse-led primary care services are well described in the United Kingdom with a total of 45 studies meeting the inclusion criteria for the second review. There are no published studies from New Zealand, and only two from Australia describing nurse-led primary care. CONCLUSION: New Zealand and Australia lag behind the United Kingdom in practice nurse development. Implementation of clinical governance was fundamental to the development of nurse-led care in the UK.

A baby presenting with failure to thrive in primary care: a case report.

BACKGROUND: A nine month old baby (A) presented to primary care with an episode of diarrhoea. Initially treated at home, he subsequently required admission to hospital for management of dehydration. During and following a 24 hour period of hospitalisation, his mother became severely depressed. CASE PRESENTATION: A was examined in primary care at aged 11 months, after a referral was received from the well child nurse. A's weight had traversed downwards across four percentile lines and his development had regressed to the age of a 5 - 6 month old. CONCLUSION: Incomplete communication between health professionals and lack of follow-up and overall responsibility for A's family resulted in a serious insult to A's physical growth and development. New Zealand needs to adopt a system where one health professional case manages infants and young children in primary care.

Evidence-based resource use by practice nurses in the Greater Auckland region of New Zealand.

AIM: To determine self-reported use of New Zealand's Guidelines Group (NZGG) and BPAC resources by practice nurses (PNs) in the Greater Auckland area of New Zealand. METHOD: A postal survey of all PNs registered on the University of Auckland's Department of General Practice and Primary Health Care's database. RESULTS: A total of 419 of 917 (46%) PNs working in 280 general practices returned completed questionnaires. The majority of PNs did not use either the NZGG (53%) or BPAC guidelines (57%) and 35% did not use any evidence resources. The main reason these resources were not used was lack of knowledge about them, one-third of PNs had never heard of NZGG guidelines and 42% had never heard of BPAC guidelines. Of those who knew of NZGG guidelines, 74% found them useful, (a 'fair amount' or 'very') and 94% found BPAC guidelines useful (a 'fair amount' or 'very'). When PNs knew of these resources, 74% used NZGG guidelines and 69% used BPAC guidelines for patient care. CONCLUSION: PNs who knew of New Zealand Guidelines and BPAC found them useful in patient management. Practice nurses are not routinely on the mailing list of these two organisations. Strategies to increase PN awareness of these publicly funded evidence-based resources may increase their use and thus contribute to the reduction in health inequalities between ethnic groups in New Zealand.

The place for children's centres for New Zealand children.

This paper examines the experience of poverty and child maltreatment among New Zealand's children as compared with international statistics. New Zealand was a signatory to the United Nations Convention on the Rights of the Child in 1993, yet indicators suggest that implementation of the Articles of the Convention is limited. In the league of Organisation for Economic Co-operation and Development countries it ranks 23rd out of 26 for child poverty and 24th out of 27 for the child maltreatment death rate. A case will be made for coordination of existing and new services for children and families through a dedicated children's centre, modelled on the United Kingdom's Sure Start and Children's Centre program that was modelled in part on the Head Start program of the United States. The paper reports on Wellsford, a rural community north of Auckland, which has embraced the children's centre concept and is investigating ways to obtain funding to implement the idea.