Nurse, midwife and patient perspectives and experiences of diabetes management in an acute inpatient setting: a mixed-methods study.

BACKGROUND: In an acute hospital setting, diabetes can require intensive management with medication modification, monitoring and education. Yet little is known about the experiences and perspectives of nursing/midwifery staff and patients. The aim of this study was to investigate diabetes management and care for patients with diabetes in an acute care setting from the perspectives of nursing/midwifery staff and patients. METHODS: A convergent mixed-methods study design. Patients with diabetes (Type 1, Type 2 or gestational diabetes) recruited from a public health service in Melbourne, Australia completed a survey and nurses and midwives employed at the health service participated in focus groups. Descriptive statistics were used to summarise the survey data. Thematic analysis was used for the free-text survey comments and focus group data. RESULTS: Surveys were completed by 151 patients. Although more than half of the patients were satisfied with the diabetes care they had received (n = 96, 67.6%), about a third felt the hospital nursing/midwifery staff had ignored their own knowledge of their diabetes care and management (n = 43, 30.8%). Few reported having discussed their diabetes management with the nursing/midwifery staff whilst in hospital (n = 47, 32.6%) or thought the nurses and midwives had a good understanding of different types of insulin (n = 43, 30.1%) and their administration (n = 47, 33.3%). Patients also reported food related barriers to their diabetes management including difficulties accessing appropriate snacks and drinks (n = 46, 30.5%), restricted food choices and timing of meals (n = 41, 27.2%). Fourteen nurses and midwives participated in two focus groups. Two main themes were identified across both groups: 1. challenges caring for patients with diabetes; and 2. lack of confidence and knowledge about diabetes management. CONCLUSIONS: Patients and nursing/midwifery staff reported challenges managing patients' diabetes in the hospital setting, ensuring patients' optimal self-management, and provision of suitable food and timing of meals. It is essential to involve patients in their diabetes care and provide regular and up-to-date training and resources for nursing/midwifery staff to ensure safe and high-quality inpatient diabetes care and improve patient and staff satisfaction.

A comparison of data sources for the surveillance of seasonal and pandemic influenza in Victoria.

Understanding the characteristics of available influenza or influenza-like illness (ILI) surveillance systems is important for seasonal influenza surveillance and pandemic preparedness. We compared five influenza or ILI data sources in Victoria: notifications of laboratory-confirmed influenza to the Victorian Department of Human Services; hospital emergency presentations and hospital admissions; sentinel general practitioner surveillance; and medical locum service surveillance. Seasonal trends for influenza and ILI activity were similar for all data sources. Community ILI surveillance, operating as sentinel GP, locum service or hospital emergency department surveillance, in conjunction with notification of laboratory-confirmed influenza, would provide adequate inter-pandemic surveillance for influenza in Victoria and, by extension, in any Australian jurisdiction. Other surveillance systems would be needed for early pandemic case or cluster detection, while pandemic monitoring would be better achieved by a more automated system.

Geographic representativeness for sentinel influenza surveillance: implications for routine surveillance and pandemic preparedness.

OBJECTIVE: To review the guidelines for geographic representativeness applied to sentinel influenza surveillance as proposed in the Framework for an Australian Influenza Pandemic Plan (1999). METHODS: The number of sentinel practices, participating general practitioners and their consultation rates per 100,000 population, by region, were described for the Victorian sentinel surveillance system for 2003 and 2004. Influenza-like illness rates per 1,000 consultations were calculated for all participating practices and for a subset of regular participators. Indicators of seasonal influenza activity, set according to predefined thresholds, were compared in the two groups. RESULTS: During these two influenza seasons, a subset of approximately one-quarter (27%) of participating practices provided almost half (45%) of the patient swabs and detected the same level of influenza activity over two influenza seasons as all participating practices. However, this subset of GPs recorded only 0.3% of all GP consultations in Victoria in 2004. CONCLUSIONS: There should be an updated, evidence-based strategy for interpandemic influenza based on the number of general practice consultations. Requirements for surveillance during various pandemic phases also need to be reviewed.

Influenza surveillance in Victoria, 2005.

Influenza activity remained within normal seasonal activity with a well-defined peak at week 29 (beginning 18 July) during the Victorian influenza season from May to September 2005. Surveillance was based on sentinel general practice influenza-like illness (ILI) notifications with laboratory confirmation, medical locum service ILI notifications and laboratory notification of influenza detections. One thousand and eighty-seven consultations for ILI were reported from 38 general practices, while medical practitioners from the locum service reported 317 consultations for ILI. The average weekly rate of ILI from sentinel surveillance was 7.3 per 1,000 consultations. Similar numbers of influenza A subtypes H1N1 and H3N2 were detected; 45 per cent of which were A/California/7/2004-like (H3), 44 per cent were A/New Caledonia/20/99-like (H1) and 11 per cent were A/Wellington/1/2004 (H3). Of the influenza B samples, 67 per cent were B/Hong Kong/330/2001-like and 33 per cent were B/Shanghai/361/2002-like. The influenza vaccine for 2005 contained: A/New Caledonia/20/99(H1N1)-like virus, A/Wellington/ 1/2004(H3N2)-like virus, and B/Shanghai/361/2002-like virus. Although the predominant H3 and B circulating strains were not included in the vaccine, there was reasonable serological cross protection between vaccine and circulating strains.

Influenza and pneumococcal vaccine coverage among a random sample of hospitalised persons aged 65 years or more, Victoria.

This study was undertaken to assess the uptake of influenza and pneumococcal vaccination based on provider records of the hospitalised elderly, a group at high risk of influenza and pneumococcal disease. The study used a random sample of 3,204 admissions at two Victorian teaching hospitals for patients, aged 65 years or more who were discharged between 1 April 2000 and 31 March 2002. Information on whether the patient had received an influenza vaccination within the year prior to admission or pneumococcal vaccination within the previous five years was ascertained from the patient's nominated medical practitioner/vaccine provider. Vaccination records were obtained from providers for 82 per cent (2,804/2,934) of eligible subjects. Influenza vaccine coverage was 70.9 per cent (95% CI 68.9-72.9), pneumococcal coverage was 52.6 per cent (95% CI 50.4-54.8) and 46.6 per cent (95% CI 44.4-48.8) had received both vaccines. Coverage for each vaccine increased seven per cent over the two study years. For pneumococcal vaccination, there was a marked increase in 1998 coinciding with the introduction of Victoria's publicly funded program. Influenza and pneumococcal vaccine coverage in eligible hospitalised adults was similar to, but did not exceed, estimates in the general elderly population. Pneumococcal vaccination coverage reflected the availability of vaccine through Victoria's publicly funded program. A nationally funded pneumococcal vaccination program for the elderly, as announced recently, should improve coverage. However, these data highlight the need for greater awareness of pneumococcal vaccine among practitioners and for systematic recording of vaccination status, as many of these subjects will soon become eligible for revaccination.

Influenza surveillance in Victoria, 2004.

Influenza activity during the traditional Victorian influenza season from May to October 2004 was low with no well-defined peak. Surveillance was based on sentinel general practice influenza-like illness (ILI) notification with laboratory confirmation, locum service ILI notification and laboratory reporting of influenza detections. Eight hundred and fifteen consultations for ILI were reported from 38 general practices and 216 consultations for ILI were reported from the locum service. The average weekly rate of influenza-like-illness from sentinel surveillance was 5.4 cases per 1,000 consultations, representing normal seasonal activity. Influenza A (H3N2) was the predominant circulating sub-type, 88 per cent of which were identified as A/Fujian/411/2002-like and 12 per cent as A/Wellington/1/2004. All influenza B was B/Shanghai/361/2002-like. There was some mismatch with the 2004 influenza vaccine, which contained A/New Caledonia/20/99(H1N1)-like virus, A/Fujian/411/2002(H3N2)-like virus, and B/Hong Kong/330/2001-like virus.

Higher than normal seasonal influenza activity in Victoria, 2003.

Influenza surveillance in Victoria comprises surveillance of patients with influenza-like illness (ILI) from sentinel general practices and laboratory based reporting of influenza detections, predominantly from hospital inpatients. Surveillance of patients with ILI seen by the Melbourne Medical Locum Service (MMLS) was conducted for the first time in 2003, when the influenza season was characterised by a late onset with higher than normal seasonal activity. Influenza A (H3N2) was the predominant circulating influenza virus type, with 99 per cent of sub-typed viruses identified as a drifted strain, A/Fujian/411/2002-like. Sentinel and hospital laboratory surveillance both indicated low levels of circulating influenza A (H1N1) and influenza B. Although the proportion of patients with ILI detected through MMLS surveillance was greater than the proportion from sentinel general practices, the ILI pattern was comparable between the two surveillance systems.