Integrative review of older adult loneliness and social isolation in Aotearoa/New Zealand

OBJECTIVE

To conduct an integrative review of empirical studies of loneliness for older people in Aotearoa/New Zealand. Loneliness is a risk factor for older people's poor physical and cognitive health, serious illness and mortality. A national survey showed loneliness rates vary by gender and ethnicity.

METHODS

A systematic search of health and social science databases was conducted. Of 21 scrutinised articles, nine were eligible for inclusion and subjected to independent quality appraisal. One qualitative and eight quantitative research articles were selected.

RESULTS

Reported levels and rates of loneliness vary across age cohorts. Loneliness was significantly related to social isolation, living alone, depression, suicidal ideation, being female, being Māori and having a visual impairment. Qualitatively, older Korean immigrants experienced loneliness and social isolation, along with language and cultural differences.

CONCLUSION

Amongst older New Zealanders loneliness is commonly experienced by particular ethnic groups, highlighting a priority for targetted health and social services.

The condom imperative in anal sex - one size may not fit all: a qualitative descriptive study of men who have sex with men

AIMS AND OBJECTIVES

To explore men who have sex with men's views about condom use when having anal intercourse.

BACKGROUND

Internationally, health promotion campaigns use behavioural change strategies to support men who have sex with men to always use condoms when having anal sex with other men. The health promotion message given to this group is consistent and explicitly stated that 'use a condom every time for anal sex regardless of relationship status'.

DESIGN

Qualitative analysis of data from a cohort of New Zealand men who have sex with men.

METHODS

A total of 960 useable questionnaires were completed: 571 online and 389 in hard copy. Qualitative data were analysed using a thematic data analytic process.

RESULTS

Three themes relating to condom use in men who have sex with men were identified. These are as follows: 'Safer sex is good sex', 'Condom use is good but …' and 'I use condoms sometimes'.

CONCLUSIONS

The range of responses towards condom use for anal sex in men who have sex with men in our sample reveal this as a complex public health issue, with not all men who have sex with men willing to consistently use condoms.

RELEVANCE TO CLINICAL PRACTICE

It is important that nurses do not assume that all men who have sex with men are willing to use condoms for anal sex, and should create opportunities for men who have sex with men to raise any concerns about the use of condoms. In this way, nurses can assist in providing information that may help men who have sex with men to make decisions that will minimise risk of contracting infections associated with sexual activity.

Living in your own home and being socially connected at 95 years and beyond: a qualitative study

BACKGROUND

Being socially connected is linked to positively influencing older people's ability to remain living in their own homes and has shown to support independence and enhance well-being.

AIM

To explore how individuals aged 95 years and older living in their own home remain socially connected.

METHODS

Informed by a critical gerontological approach, semi-structured interviews with eight women and two men aged between 96 and 100 years were undertaken. Following transcription, data were thematically analysed.

RESULTS

Three main themes illuminating social connectedness were identified: "Keeping company: staying connected with family and friends", "Doing things together: engaging with paid and unpaid helpers" and "Having pride and enjoyment: continuing with hobbies and interests".

CONCLUSION

It is important that health professionals and social service providers recognise the importance of social connectedness, and provide a range of options to support continuing social connectedness and community engagement for older people.

Views about HIV/STI and health promotion among gay and bisexual Chinese and South Asian men living in Auckland, New Zealand

Ethnic minority gay, bisexual, and other men who have sex with men (MSM) are considered to have a high risk for HIV infection. The aim of this study was to identify some of the ways Chinese and South Asian MSM talk about and understand issues related to HIV/STI and health promotion, as well as highlighting some of this group's health promoting behaviours. A qualitative study using face-to-face interviews with 44 Chinese and South Asian MSM living in Auckland, New Zealand, was undertaken. Following data analysis, four major themes were identified: the importance of condoms, condom use, HIV/STI practices, and HIV health promotion. The results showed that the men interviewed had a good understanding of the benefits of using condoms for anal sex. They also reported strong recall of the local HIV health promotion campaigns which seek to influence men's behaviours through promotion of a single, unequivocal message to always use a condom for anal sex. The men however did not always report consistent condom use, and a range of reasons why this happened were identified. Among the men who discussed testing practices, regular testing was much more likely to have occurred in men who have lived in New Zealand for more than 5 years. These results suggest that future health promotion initiatives should be tailored to ensure the needs of Chinese and South Asian MSM are appropriately addressed when promoting condom use for anal sex.

An integrative review of the factors related to building age-friendly rural communities

AIM AND OBJECTIVES

To identify the theories and concepts related to building age-friendly rural communities.

BACKGROUND

Global population is rapidly ageing. Creating environments that support active ageing was a catalyst for the World Health Organization to develop Global Age-Friendly Cities guidelines. Although the age-friendly movement has captured the attention of some countries, little is known about the participation of older people in rural settings.

METHOD

An integrative review approach was employed to summarise the research literature on this topic. Using a systematic search strategy, databases including Discover (EBSCO's electronic database system), Web of Science, Scopus, PubMed, CINAHL, PsycINFO, Medline and Google Scholar were searched. Primary, peer-reviewed studies were included if published during 2007-2014 in the English language.

RESULTS

Nine studies were eligible for inclusion. The studies were set predominantly in Canada, with the exception of one from Ireland. The findings were summarised and clustered into main topics which included: theoretical perspectives; geographic and demographic characteristics; collaboration and partnerships; sustainability and capacity; and finally, future research agendas.

CONCLUSIONS

Rural communities are changing rapidly and are becoming increasingly diverse environments. Community characteristics can help or hinder age-friendliness. Importantly, the fundamental starting point for age-friendly initiatives is establishing older peoples' perceptions of their own communities.

RELEVANCE TO CLINICAL PRACTICE

It is important for nurses, working in primary health care settings, to understand the needs of older people in the communities in which they practice. This includes the community characteristics that can be enablers and barriers to older people being able to remain and age within their own communities.

Using internet-based approaches to collect qualitative data from vulnerable groups: reflections from the field

BACKGROUND

Undertaking qualitative research with vulnerable populations is a complex and challenging process for researchers. Traditional and common modes of collecting qualitative data with these groups have been via face-to-face recorded interviews.

METHODS

This article reports on three internet-based data collection methods; email and synchronous online interviews, as well as online qualitative survey.

RESULTS

The key characteristics of using email, sychronous online interviews and an online qualitative survey including the strengths and limitations of each are presented. Reflections and insights on the use of these internet-based data collection methods are provided to encourage researchers to embrace technology and move away from using traditional face-to-face interviews when researching with vulnerable populations.

CONCLUSION

Using the internet to collect qualitative data offers additional ways to gather qualitative data over traditional data collection methods. The use of alternative interview methods may encourage participation of vulnerable participants.

Social marketing campaigns that promote condom use among MSM: a literature review

The turn of the century has seen an increase in reported cases of sexually transmitted infections including the human immunodeficiency virus, particularly in groups of men who have sex with men. Both internationally and in New Zealand the implementation of social marketing human immunodeficiency virus prevention programmes are identified as appropriate mechanisms to promote condom use in men who have sex with men. This paper presents a review of the literature on research-based social marketing initiatives designed to decrease sexually transmitted infections, including the human immunodeficiency virus, through an increase in condom use by men who have sex with men. Eleven quality assured articles met the inclusion criteria and were consequently included in the review. The review presented here strongly supports the utilisation of behaviourally based social marketing campaigns to increase condom use in men who have sex with men. Nurses are frequently first point of contact for consumers of health services. As such they need to have a sound understanding of not only Get it On!, a New Zealand social marketing campaign designed to promote condom use, but also about existing international campaigns. Nurses should also know about social marketing principles if they are to effect positive changes in condom use and address the complex challenges inherent in tackling increased rates of sexually transmitted infections, including the human immunodeficiency virus.

Editorial: Is postgraduate education a luxury or necessity for professional nurses: A trans-Tasman perspective

Abstract  

Perceptions of ageing as an older gay man: a qualitative study

AIMS AND OBJECTIVES

To explore the ageing experiences of gay men in New Zealand over the age of 65 years.

BACKGROUND

An increased acceptance by many people in Western societies towards men who are same-sex attracted is likely to result in a corresponding increase in the number of visible older gay men being the recipients of nursing care. Previous research has shown that nursing has some way to go towards providing a service that is culturally safe and appropriate.

DESIGN

A critical gerontological approach was employed to explore the ageing experiences of gay men in New Zealand over the age of 65 years. This methodology ensured the voices of older gay men were foregrounded in the research.

METHODS

Semi-structured digitally recorded individual interviews with 12 gay men aged between 65-81 years who lived in the community were undertaken. Data were analysed using thematic analysis to identify the repeated patterns across the men's talk.

RESULTS

Three main themes relating to the ageing experiences of these men were identified: 'homophobia', 'being with someone' and 'future care'.

CONCLUSIONS

Resilience was a significant factor in how well older gay men aged even in an environment where homophobia and heterosexism were common. Having a strong social support network was an important factor that contributed to supporting the ageing process. These gay men were wary about having to go into residential care, preferring to age in their own homes.

RELEVANCE TO CLINICAL PRACTICE

Nurses and other healthcare professionals need to ensure healthcare services meet the needs of older gay men. Any interaction with older gay men should occur in a way that is open and respectful. The usage of best practice guidelines will assist organisations to deliver culturally safe and appropriate care to this group.

Delirium and older people: repositioning nursing care

Aims.  To critically examine the nursing care offered to older people who have been delirious. Background.  Delirium occurs as a result of physiological imbalances resulting in an alteration in consciousness and cognitive impairment. Delirium is a prevalent and serious cognitive disorder experienced by older people. While there is a vast number of studies published utilizing quantitative methods, there remains a dearth of research relating to delirium in older people from a qualitative perspective. Design.  A qualitative research design that utilized a critical gerontological framework underpinned this study. This framework drew on aspects of postmodernism and Foucault's understanding of discourse. Methods.  Data sources included published documents on delirium, semi-structured taped interviews with people over the age of 65 years who had been delirious (as well as their clinical notes), family members, Registered Nurses and a hospital doctor. A postmodern discourse analytic approach was used to interrogate the 20 sets of data collected. Findings.  Textual analysis revealed the presence of two major discourses impacting on being an older person with delirium. These were identified as a nursing discourse of delirium and a personal discourse of delirium. A nursing discourse of delirium was largely focussed on the biomedical processes that resulted in a delirious episode. Conversely, a personal discourse of delirium highlights that there are other ways of 'knowing' about delirium through considering the narratives of older adults, and their families, when offering a nursing service to this group of people. Relevance to clinical practice.  Nursing needs to critically examine all aspects of nursing care as it applies to older people who have delirium to ensure the rhetorical claims of the profession become the reality for consumers of health services. The use of critical gerontology provides nurses with the tools to challenge the status quo and uncover the multiple, varied, contradictory and complex representations of delirium in older people. Inherent within a personal discourse of delirium is the importance of incorporating into nursing care communicative and other relational activities, such as forming and maintaining a therapeutic relationship.

Health education and health screening in a sample of older men: a descriptive survey

Internationally, the number of people aged over 65 is increasing, in both absolute and relative terms. There is little doubt that a healthy lifestyle, and participation in health education and health screening activities, contribute to longevity. Gender is also considered to be a strong indicator of health and longevity, as women tend to live longer and healthier lives than men. There is abundant literature on older people's health but a significant lack of research specifically on older men. This study involved 59 community dwelling men aged 65 years or over, living in Wanganui (a city located in the North Island of New Zealand). The aim of the study was to describe the health education and health screenings older men living in Wanganui attended, and to ascertain the barriers and/or benefits of healthy lifestyle choices. Data were collected via a self-administered questionnaire. Findings from the study were that the majority of men reported good or excellent health. On average, men had participated in 1.6 health education programmes and attended 3.1 health screenings during the previous 12 months. Most considered there were no barriers to following a healthy lifestyle and on average identified four benefits to living a healthy lifestyle. The most common benefit reported was increased opportunities for socialisation. While it is acknowledged that more substantive research is required with a larger heterogeneous group of older men, this study provides useful baseline data on participation in health education and health screening programmes. The study also highlights that nurses need to facilitate and provide health education and health promoting activities that support healthy lifestyle choices in older men. The findings also suggest that the Older Men's Health Program and Screening Inventory questionnaire would need significant adaptation before it could be used with a representative sample of older New Zealand men.

Registered nurse perspectives on delayed or missed nursing cares in a New Zealand Hospital

Nurses have an essential role to play in ongoing patient surveillance. The quality of nursing care patients receive has implications for both their recovery and long term health outcomes. Currently, due to a number of factors, nurses are facing increasing challenges to meeting the care needs of hospital patients. These include fluctuations in nursing skill mix and staffing levels, inconsistent availability of equipment and supplies, and higher patient acuity. The additional impact of healthcare restructuring on nursing has been reflected in the demand to do more with less. Consequently nurses are constantly forced to prioritise certain aspects of nursing care as being less important than others, resulting in some nursing cares being delayed or missed. In this study the concept of "missed care" was explored using a qualitative descriptive approach. Five registered nurses working within a New Zealand hospital were interviewed and the data obtained analysed using a general inductive approach. Two of the main categories were identified: 'the types of care that were regularly delayed or missed', and 'the reasons for regularly delaying or missing care'. The third main category identified was 'moral distress'. This related to the feelings of guilt and frustration experienced by the nurses as a result of delaying or missing care. It is argued that by understanding issues affecting direct care delivery to patients, registered nurses will be more able to effect constructive change in their work environments. This will have the benefit of enhancing both the quality of the nurses' work environment and the quality of care delivered to patients.

Is anybody listening? A qualitative study of nurses' reflections on practice

AIM AND OBJECTIVES

To explore nurses' perceptions of the reality of practice based on data from the Nurses and Midwives e-cohort Study which examined the workforce characteristics, work-life balance and health of nurses.

BACKGROUND

Recruitment and retention of the nursing workforce is of international concern as demands increase due to demographic changes, political pressure and community expectations, in a climate of economic constraint.

DESIGN

Qualitative analysis of data from a cohort of Australian, New Zealand and UK nurses.

METHOD

Of the 7604 participants in the electronic cohort, 1909 provided qualitative comments of which 162 related to nursing practice; thematic analysis resulted in four high order themes. The analytical discussion is structured around 'care' as the organising construct.

RESULTS

Four themes emerged: 'embodied care' which discusses the impact of work on the nurse's physical and emotional health; 'quantity/quality care' which addresses increasing pressures of work and ability to provide quality care; 'organisational (non)care' raising the seeming lack of support from management; and '(un)collegial/self care' where bullying and professional relationships were raised.

CONCLUSIONS

Issues raised by participants have been discussed in the nursing literature for several years yet nurses still experience these negative aspects of nursing. It appears there is a significant gap between what is known about the practice environment, recommendations for change and change occurring: the management equivalent of the theory-practice gap, resulting in nurses intending to leave the profession.

RELEVANCE TO CLINICAL PRACTICE

Research demonstrates that a well-qualified, stable nursing workforce improves quality of health care and health outcomes. Changing the work environment and fostering a positive workplace culture seems fundamental to supporting the retention of nurses, that this is not occurring in some areas in the current climate is a concern for the profession and those responsible for the provision of care.

Practice nurse use of evidence in clinical practice: a descriptive survey

The role of practice nurses is a specific feature of the modernisation agenda of the New Zealand health service. Increasing importance is being placed on service improvement through effective decision making and enhanced clinical performance. To contribute to the development of primary health care it is crucial that nurses have the skills to appropriately implement research based and other evidence in practice. This study involved 55 West Auckland practice nurses working in the general practice setting. The aim of the study was to describe nurses' perceptions of their use of evidence-based practice, attitudes toward evidence-based practice and perceptions of their knowledge/skills associated with evidence-based practice. An additional aim was to determine the effect of educational preparation on practice, attitudes and knowledge/skills toward evidence-based practice. A descriptive survey design was selected for this study. The results demonstrated that nurses' attitudes toward evidence-based practice, knowledge and skills relevant to the implementation of evidence-based practice and the educational preparation of the nurses were important factors influencing the effective utilisation and application of research results in practice. Educational interventions are identified as an integral aspect of implementing evidence-based practice and enhancing practice nurses' knowledge and skill relevant to the use of evidence in practice. Further research is needed to assess the contextual factors which can inhibit or promote achievement of evidence-based practice by practice nurses.

Women over the age of 85 years who live alone: a descriptive study

New Zealand as a society is ageing. This translates to an increasing number of people particularly women, over the age of 85 years. Despite many older women living alone, they are often perceived by both society and health professionals as frail and dependent. This qualitative study was designed to explore and describe experiences of older women who lived alone in the community. A qualitative descriptive methodology underpinned the study. A sample of five older women who lived alone in their own homes was interviewed. Data were analysed using a general inductive approach. Three themes emerged which reflected the reality of living by themselves: "active participation", "keeping control", and" healthy living". The information gained from describing the lives of this group of women suggests that many older women are able to live full and successful independent lives in the community. This research provides nursing with a better understanding of the realities for older women who live alone. Finally, this paper will provide nurses with some ideas about how best to support this group of people as they age.

Condom use in men who have sex with men: a literature review

The aim of this paper is to present a review of the literature on the key issues impacting on the decisions, by men who have sex with men, to use, or not use, condoms for anal intercourse. 250 publications were accessed, reviewed, read and sorted; 200 of these were research based and 50 were opinion pieces of work. In addition, 240 of the 250 had undergone a peer review process. The review presented here shows that men who have sex with men communities are a heterogeneous group and their reasons for engaging in unprotected anal intercourse are inter-related and diverse. Six main themes related to sexual risk behaviour and condom use were identified: the availability of HIV treatments, physical issues, psychosocial issues, intentional practices, internet and substance use. Nurses need to understand these factors if they are to effect positive changes in condom use and address the complex challenges inherent in tackling increased rates of HIV infection.

Men who have sex with men account for nonuse of condoms

Despite several decades of health promotion activity targeted at men who have sex with men (MSM), rates for nonuse of condoms for anal sex among MSM worldwide and in New Zealand have been increasing in recent times. In this article we report on the first local qualitative investigation undertaken in Auckland, New Zealand, of how members of a particular group of MSM account for nonuse of condoms for anal sex with other men. We collected qualitative data from 22 MSM (17 face-to-face interviews, and three online interviews involving 5 men). Thematic analysis led to the identification of five patterns that account for the nonuse of condoms: (a) substance use, (b) psychological aspects, (c) difficulties using condoms, (d) condoms in relationships, and (e) managing risk. We conclude that although this information generally confirms the findings in the wider research literature, it is also important in the local context as the first research that can be used with confidence in developing and refining health promotion initiatives to address this issue.

Work-role transition: from staff nurse to clinical nurse educator

This article presents the findings of a study describing Clinical Nurse Educators' experiences, as they recall their transition from staff nurse to the Clinical Nurse Educator role, within a New Zealand District Health Board. Nurse Educator roles influence clinical practice and professional development of nurses, and although designated as a senior role nationally, the complexities and size of the role are poorly understood. A qualitative descriptive methodology utilising transition theory as a conceptual framework underpinned the study. A sample of eight Clinical Nurse Educators from a New Zealand District Health Board were interviewed about their transition from experienced staff nurse to inexperienced senior nurse. Data were analysed using a general inductive approach. Participants found the Clinical Nurse Educator role was more complex than anticipated, with no preparation for the role and sub-optimal orientation periods being provided by the District Health Board. As a result, signs of stress were evident as the enormity of the role became apparent. Consequently, employers need to ensure that appropriate orientation programmes and mentorship are inherent in health care organisations.

The constitution of 'lavender families': a LGB perspective

AIM

To explore and describe lesbian, gay and bisexual people's families of origin and families of choice.

BACKGROUND

As a family group lesbian, gay and bisexual people engage with nurses when they interface with any health care service. All health practitioners need to be aware of the existence and constitution of lesbian, gay and bisexual families to provide appropriate health care, including health promotion and education.

DESIGN

Survey.

METHOD

From April to July 2004 a national survey of lesbian, gay and bisexual persons was carried out. Participants were recruited through mainstream and lesbian, gay and bisexual media and venues. A total of 2269 participants completed the survey instrument either electronically or via hard copy. The 133-item instrument included a range of closed-response questions in a variety of domains of interest. The article reports on results from the family and relationships domain.

RESULTS

Findings identified that lesbian, gay and bisexual families present with a variety of both constructed and biological kinship ties and relationships. These relationships vary from supported to estranged in terms of biological family and exclusivity through to non-exclusivity with regard to partners. Variations also exist in relation to the presence or absence of children and whether these were born before or after 'coming out'.

CONCLUSIONS

Lesbian, gay and bisexual families bring with them to health care services a wide array of life experiences. Therefore it is vital that when interacting with this group of people nurses avoid making assumptions about how gay, lesbian and bisexual people construct their identities and relationships. Furthermore, it may be difficult to ascertain a person's sexual identity when meeting them for the first time.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to ensure that they do not assume families seeking healthcare are heterosexual. Providing lesbian, gay and bisexual families with opportunities to disclose sexual identity without fear of disapproval or prejudice is integral to providing a quality and appropriate health service.

Health promotion impact evaluation: 'Healthy Messages Calendar (te maramataka korero hauora)'

A health promotion intervention, the 'Healthy Messages Calendar (Te Maramataka Korero Hauora)', was produced by the combined efforts of a number of community groups and provided free to every household in Tairawhiti. The purpose of the present study was to evaluate the project to determine if it was an effective health promotion tool for the dissemination of health information. Qualitative data were obtained from five focus groups; four of which were selected cohorts in the community and one from the stakeholders or key players in the development of the calendar. Data were analysed using a general inductive approach as offered by Thomas (2004). Results indicated the calendar was a valuable health promotion tool that provided appropriate health information to the people of Tairawhiti. Focus group feedback showed an overwhelmingly positive community response to the calendar. Local production and use of children's artwork and Maori translations to promote messages ensured that the calendar was well received by the local community. The results highlighted the positive link between health promotion practices and the health needs of a local community.

Guiding BMP adoption to improve water quality in various estuarine ecosystems in Western Australia

The Australian Government's Coastal Catchment Initiative (CCI) seeks to achieve targeted reductions in nutrient pollution to key coastal water quality hotspots, reducing algal blooms and fish kills. Under the CCI a Water Quality Improvement Plan (WQIP) is being prepared for targeted estuaries (Swan-Canning, near Perth, and the Vasse-Geographe, 140 km south of Perth) to address nutrient pollution issues. A range of projects are developing, testing and implementing agricultural Best Management Practices (BMPs) to reduce excessive loads of nutrients reaching the receiving waters. This work builds on progress-to-date achieved in a similar project in the Peel-Harvey Catchment (70 km south of Perth). It deals with the necessary steps of identifying the applicability of BMPs for nutrient attenuation, developing and promoting BMPs in the context of nutrient use and attenuation on farm and through catchments and estimating the degree to which BMP implementation can protect receiving waters. With a range of BMPs available with varying costs and effectiveness, a Decision Support System (DSS) to guide development of the WQIP and implementation of BMPs to protect receiving waters, is under development. As new information becomes available the DSS will be updated to ensure relevance and accuracy for decision-making and planning purposes. The DSS, calibrated for application in the catchments, will play a critical role in adaptive implementation of the WQIP by assessing the effect of land use change and management interventions on pollutant load generation and by providing a tool to guide priority setting and investment planning to achieve agreed WQIP load targets.

Personal autonomy for older people living in residential care: an overview

Autonomy has significance for everyone, including those in long-term residential care. This article looks at the concept of autonomy particularly in relation to the population of older persons living in residential care settings. It examines the values underpinning the exercise of personal autonomy and notes how an individual's autonomy may be enhanced or restricted. The implications for gerontological nursing practice are outlined and suggestions offered as to how personal autonomy for older persons living in residential care may be preserved and promoted.

Perceptions of lesbian, gay and bisexual people of primary healthcare services

AIM

This paper reports a study exploring people's perceptions of disclosure about lesbian, gay and bisexual identity to their primary healthcare providers.

BACKGROUND

Disclosure of sexual identity to healthcare professionals is integral to attending to the health needs of lesbian, gay and bisexual populations, as non-disclosure has been shown to have a negative impact on the health of these people. For example, an increased incidence of suicide, depression and other mental health problems have been reported.

METHOD

From April to July 2004, a national survey of lesbian, gay and bisexual persons was carried out in New Zealand. Participants were recruited through mainstream and lesbian, gay and bisexual media and venues, and 2,269 people completed the questionnaire, either electronically or via hard copy. The 133-item instrument included a range of closed-response questions in a variety of domains of interest.

RESULTS

In this paper, we report results from the health and well-being domain. More women than men identified that the practitioner's attitude toward their non-heterosexual identity was important when choosing a primary healthcare provider. Statistically significantly more women than men reported that their healthcare provider usually or always presumed that they were heterosexual and in addition more women had disclosed their sexual identity to their healthcare provider.

CONCLUSION

Nurses need to reconsider their approach to all users of healthcare services by not assuming everyone is heterosexual, integrating questions about sexual identity into health interviews and ensuring that all other aspects of the assessment process are appropriate and safe for lesbian, gay and bisexual people.

Lavender Islands: the New Zealand study

Lavender Islands: Portrait of the Whole Family is the first national strengths-based study of lesbian, gay, and bisexual (LGB) people in New Zealand. The 133-item survey was made available both by website and paper copy from April to July 2004. Multidisciplinary interest areas were developed by a community reference group, and included identity and self-definition, families of origin, relationships and sexuality, families of choice, immigration and internal migration, wellbeing, politics, income and spending, education, careers and leisure, community connections, challenges, and spirituality. A four-axis model of sexual identity was also tested; 2,269 responses were received. Of these 83% were from the website; 45% of responses were from women and 54% from men. Responses identified a robust, highly educated, relatively high-income, politically active LGB community. Male and female respondents experienced same-sex relationships and identity in significantly different ways.

The relationship between student nurse and nurse clinician: impact on student learning

Student nurse learning within a clinical environment is an essential component of Bachelor of Nursing curricula in New Zealand. During clinical experiences, student nurses rely on nurse clinicians for day-to-day facilitation of their learning. The purpose of this descriptive interpretive study was to explore relationships between student nurses and nurse clinicians. Eleven student nurses at the end of a three year Bachelor of Nursing programme in one institution participated in focus group interviews. Data gathered from the three focus groups were analysed using an inductive approach. Five categories, namely 'being invisible in the relationship', 'not stepping on toes', 'lost opportunities for learning', 'nurturance' and 'reciprocity' emerged from data analysis. These are presented with appropriate quotes to demonstrate the essence of participant experiences. Findings indicated that when students experienced relationships with clinicians as not being positive, this inhibited learning. Conversely, when students saw the clinician as participating actively and positively in the student/clinician relationship then student learning was enhanced. This evidence forms the basis for recommending further complementary research into the clinician's attitudes and perceptions related to their teaching role.

External quality assurance of molecular analysis of haemochromatosis gene mutations

BACKGROUND

The Royal College of Pathologists of Australasia Quality Assurance Programs has conducted an external quality assurance programme for the testing of the haemochromatosis gene (HFE) mutations C282Y and H63D.

METHODS

A total of 10 surveys have been undertaken over a period of 6 years from 2000 to 2005.

RESULTS

Of the 3016 responses received, the overall success rate was found to be 99.47% (3000/3016). A total of 16 errors were found, 6 for C282Y and 10 for H63D. Only one sample was associated with more than one error, in which 2 of 23 respondents classified a normal sample as heterozygotic for H63D. Overall performance was observed to vary minimally between surveys, from a low of 91.3% correct (21/23 responses) for a normal sample to 100% correct in most (85/100) samples. Of the 10 complete surveys, four returned a 0% error rate. In one survey in 2004, seven incorrect responses were returned by one laboratory, all of which were secondary to transcriptional errors. Overall success rates per assay were 99.61% (1532/1538) for C282Y and 99.32% (1468/1478) for H63D. Over a period of 6 years from 2000 to 2005, the proportion of respondents using polymerase chain reaction (PCR) and restriction enzyme analysis fell from 85% to around 30%, whereas the proportion of laboratories using real-time PCR rose from 5% to around 55%, as indicated by the questionnaire surveys of methods used by participants.

DISCUSSION

Encouraging levels of testing proficiency for two common genetic mutations are indicated by these data, but they also confirm the need for participation of molecular diagnostic laboratories in external quality assurance programmes to ensure the ongoing provision of high-quality genetic testing services.

Effect of cataract extraction on frequency doubling technology perimetry in patients with glaucoma

AIM

To evaluate the effect of cataract surgery on frequency doubling technology (FDT) perimetry in patients with co-existing cataract and glaucoma.

METHODS

In this consecutive prospective cohort study 27 patients with open angle glaucoma scheduled for cataract extraction alone or combined with trabeculectomy were enrolled. All patients underwent FDT threshold C-20 visual fields within 3 months before and 3 months after surgery. Changes in mean deviation (MD) and pattern standard deviation (PSD) were evaluated. Additionally, changes in best corrected logMAR visual acuity (VA), intraocular pressure (IOP), and number of glaucoma medications were also studied.

RESULTS

22 patients completed the study. VA improved after surgery, from 0.47 (SD 0.19) to 0.12 (0.17) (p<0.001). The visual indexes changed after cataract extraction: MD improved (from -10.9 (SD 4.6) dB to -7.0 (4.6) dB; p<0.001) while PSD worsened (from 7.1 (SD 3.5) dB to 8.5 (3.8) dB; p = 0.001).

CONCLUSION

In patients with co-existing cataract and glaucoma, examined with FDT, MD improved and PSD worsened after cataract surgery. Global indexes of FDT should be interpreted with caution in patients with glaucoma and cataracts.

Independence and well-being in later life: three New Zealand studies

This paper argues that social gerontology is an appropriate methodological lens to investigate independence and well-being in later life and goes on to overview three diverse and independent pieces of research which cross disciplinary boundaries, geographic locations and philosophical terrains. A comparative analysis of the results from these studies identifies that health, economic status and social support influence the concepts of independence and well-being in older people. Nurses, particularly those working in primary health care, are likely to be the first point of contact for many older adults and need to operationalise a holistic assessment framework in order to address all components of ageing that influence independence and well-being in this group of people.