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van Dijk SHB, Brusse-Keizer MGJ, Effing T, van der Valk PDLPM, Ploumen EH, van der Palen J, Doggen CJM, Lenferink A. Exploring Patterns of COPD Exacerbations and Comorbid Flare-Ups. Int J Chron Obstruct Pulmon Dis 2023; 18:2633-2644. [PMID: 38022827 PMCID: PMC10657781 DOI: 10.2147/copd.s428960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Comorbidities are known to complicate disease management in patients with Chronic Obstructive Pulmonary Disease (COPD). This is partly due to lack of insight into the interplay of acute exacerbations of COPD (AECOPD) and comorbid flare-ups. This study aimed to explore patterns of AECOPDs and comorbid flare-ups. Methods Data of increased symptoms were extracted from a 12-month daily symptom follow-up database including patients with COPD and comorbidities (chronic heart failure (CHF), anxiety, depression) and transformed to visualizations of AECOPDs and comorbid flare-up patterns over time. Patterns were subsequently categorized using an inductive approach, based on both predominance (ie, which occurs most often) of AECOPDs or comorbid flare-ups, and their simultaneous (ie, simultaneous start in ≥ 50%) occurrence. Results We included 48 COPD patients (68 ± 9 years; comorbid CHF: 52%, anxiety: 40%, depression: 38%). In 25 patients with AECOPDs and CHF flare-ups, the following patterns were identified: AECOPDs predominant (n = 14), CHF flare-ups predominant (n = 5), AECOPDs nor CHF flare-ups predominant (n = 6). Of the 24 patients with AECOPDs and anxiety and/or depression flare-ups, anxiety and depression flare-ups occurred simultaneously in 15 patients. In 9 of these 24 patients, anxiety or depression flare-ups were observed independently from each other. In 31 of the included 48 patients, AECOPDs and comorbid flare-ups occurred mostly simultaneously. Conclusion Patients with COPD and common comorbidities show a variety of patterns of AECOPDs and comorbid flare-ups. Some patients, however, show repetitive patterns that could potentially be used to improve personalized disease management, if recognized.
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Affiliation(s)
- Sanne H B van Dijk
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marjolein G J Brusse-Keizer
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Tanja Effing
- College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | | | - Eline H Ploumen
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
- Cognition, Data & Education, BMS Faculty, University of Twente, Enschede, the Netherlands
| | - Carine J M Doggen
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, the Netherlands
| | - Anke Lenferink
- Health Technology & Services Research, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
- Clinical Research Centre, Rijnstate Hospital, Arnhem, the Netherlands
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2
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Akinosun AS, Kamya S, Watt J, Johnston W, Leslie SJ, Grindle M. Cardiovascular disease behavioural risk factors in rural interventions: cross-sectional study. Sci Rep 2023; 13:13376. [PMID: 37591952 PMCID: PMC10435574 DOI: 10.1038/s41598-023-39451-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
This study aims to (1) assess the distribution of variables within the population and the prevalence of cardiovascular disease (CVD) behavioural risk factors in patients, (2) identify target risk factor(s) for behaviour modification intervention, and (3) develop an analytical model to define cluster(s) of risk factors which could help make any generic intervention more targeted to the local patient population. Study patients with at least one CVD behavioural risk factor living in a rural region of the Scottish Highlands. The study used the STROBE methodology for cross-sectional studies. Demographic and clinical data of patients (n = 2025) in NHS Highlands hospital were collected at the point of admission for PCI between 04.01.2016 and 31.12.2019. Collected data distributions were analysed by CVD behavioural risk factors for prevalence, associations, and direction of associations. Cluster definition was measured by assignment of a unit score each for the overall level of prevalence and significance of associations, and general logistics modelling for direction and significance of the risk. The mean (SD) age was 69.47(± 10.93) years [95% CI (68.99-69.94)]. The key risk factors were hyperlipidaemia, hypertension, and elevated body mass index (BMI). Approximately 40% of the population have multiple risk factor counts of two. Analytical measures revealed a population risk factor cluster with elevated BMI [77.5% (1570/2025)] that is mostly either hyperlipidaemic [9.43%, co-eff. (17), P = 0.007] or hypertensive [22.72%, co-eff. (17), P = 0.99] as key risk factor clusters. Carefully modelled analyses revealed clustered risk associated with elevated BMI. This information would support a strategy for targeting risk factor clusters in novel interventions to improve implementation efficiency. Exposure to and outcome of an elevated BMI is linked more to the population's socio-economic outcomes rather than to regional rurality or urbanity.
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Affiliation(s)
- Adewale Samuel Akinosun
- Digital Health, Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness, UK.
| | - Sylvia Kamya
- Cardiology Unit, Raigmore Hospital, NHS Highland, Inverness, Scotland, UK
| | - Jonathan Watt
- Cardiology Unit, Raigmore Hospital, NHS Highland, Inverness, Scotland, UK
| | - William Johnston
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Stephen J Leslie
- Cardiology Unit, Raigmore Hospital, NHS Highland, Inverness, Scotland, UK
| | - Mark Grindle
- Digital Health, Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness, UK
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3
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Rosa M, Antunes R, Marques P, Coelho R, Mendes P, Frontini R. A narrative exploratory study on the perspectives about physical exercise practise in a sample of Portuguese elderly. QUALITY & QUANTITY 2023; 57:991-1009. [PMID: 35465024 PMCID: PMC9016126 DOI: 10.1007/s11135-022-01380-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022]
Abstract
The overall prevalence of inactivity among individuals aged 55 or older in Portugal is the highest in Europe therefore it's important to develop effective strategies to increase adherence to structured exercise programs by older adults (Picorelli et al., 2014a). The purpose of this paper is to characterise different perspectives on barriers and facilitators to the practise of physical exercise in a sample of the Portuguese elderly. Two groups of enrolled and non-enrolled in a community exercise program were recruited. Each group had 6 participants that were included in the study if they were ≥ 60 years of age. Two focus groups were conducted via Zoom and lasted ≤ 60 min. Participants were asked about five domains regarding physical exercise. Data analysis occurred in three phases by 2 trained and experienced examiners. While the enrolled group highlighted benefits (n = 6) and facilitators (n = 6), and shared strategies to overcome some barriers (n = 2) the non-enrolled group focused on the barriers (n = 6) instead and shared more excuses to justify their non-practice of physical exercise (n = 3). To overcome the barriers considered by the participants in the non-enrolled group, some education strategies focused on physical literacy might be crucial. The high number of barriers felt by the less active older people makes it more complicated for them to adopt and maintain an exercise program. Narratives-based methodologies are interesting methodologies to collect patient-centred perspectives about exercise practise and therefore design adequate programs.
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Affiliation(s)
- Marlene Rosa
- School of Health Sciences, Polytechnic of Leiria, 2411 Leiria, Portugal
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411 Leiria, Portugal
| | - Raúl Antunes
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411 Leiria, Portugal
- CIEQV - Life Quality Research Centre, Polytechnic of Leiria, 2411 Leiria, Portugal
- ESECS, Polytechnic of Leiria, 2411 Leiria, Portugal
| | - Pedro Marques
- School of Health Sciences, Polytechnic of Leiria, 2411 Leiria, Portugal
| | - Rúben Coelho
- School of Health Sciences, Polytechnic of Leiria, 2411 Leiria, Portugal
| | | | - Roberta Frontini
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411 Leiria, Portugal
- CIEQV - Life Quality Research Centre, Polytechnic of Leiria, 2411 Leiria, Portugal
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Sykes K, McGeechan GJ, Crawford H, Giles EL. Factor influencing women with learning disabilities deciding to, and accessing, cervical and breast cancer screening: Findings from a Q methodology study of women with learning disabilities, family and paid carers. Eur J Cancer Care (Engl) 2022; 31:e13702. [PMID: 36094022 PMCID: PMC9786864 DOI: 10.1111/ecc.13702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To understand knowledge of, attitudes towards and decision-making around cervical and breast cancer screening in women with learning disabilities, family carers and paid carers. METHODS A Q methodology study involving 13 women with learning disabilities, three family carers and five paid care workers, from the North-East of England. A Q-sort of 28 statements was completed with all participants completing a post-Q-sort interview to understand the reason behind the card placements. Factor analysis was completed using PQMethod and interpreted using framework analysis. RESULTS Factor 1, named 'Personal choice and ownership', explores how women with learning disabilities want to be supported to make their own decision to attend cancer screening and explored their preferred support needs. Factor 2, named 'Protecting vs. enablement', portrayed the battle family carers and paid care workers felt to protect women with learning disabilities from harm, whilst feeling that they were supporting women with learning disabilities to decide to attend cancer screening. Eight consensus statements were identified indicating a shared perspective. CONCLUSIONS Cancer screening services should ensure that women with learning disabilities are supported to make informed decisions to attend cancer screening and then be further supported throughout the cancer pathway.
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Affiliation(s)
- Kate Sykes
- Northumbria UniversityNewcastle upon TyneUK
| | - Grant J. McGeechan
- School of Social Sciences, Humanities and LawTeesside UniversityMiddlesbroughUK
| | - Hannah Crawford
- Tees, Esk and Wear Valleys NHS Foundation TrustMiddlesbroughUK
| | - Emma L. Giles
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
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Chowdhury D, Baiocco-Romano L, Sacco V, El Hajj K, Stolee P. Cultural Competence Interventions for Health Care Providers Working With Racialized Foreign-born Older Adults: Protocol for a Systematic Review. JMIR Res Protoc 2022; 11:e31691. [PMID: 35881433 PMCID: PMC9364170 DOI: 10.2196/31691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 05/02/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Integrating culturally competent approaches in the provision of health care services is recognized as a promising strategy for improving health outcomes for racially and ethnically diverse populations. Person-centered care, which ensures patient values guide care delivery, necessitates cultural competence of health care providers to reduce racial/ethnic health disparities. Previous work has focused on interventions to improve cultural competence among health care workers generally; however, little investigation has been undertaken regarding current practices focused on racialized foreign-born older adults. OBJECTIVE We seek to synthesize evidence from existing literature in the field to gain a comprehensive understanding of interventions to improve the cultural competence of health professionals who care for racialized foreign-born older adults. The aim of this paper is to outline a protocol for a systematic review of available published evidence. METHODS Our protocol will follow the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols) for systematic review protocols. We will conduct a systematic search for relevant studies from four electronic databases that focus on health and social sciences (PubMed, CINAHL, Scopus, and Cochrane Database). After selecting relevant papers using the inclusion and exclusion criteria, data will be extracted, analyzed, and synthesized to yield recommendations for practice and for future research. RESULTS The systematic review is currently at the search phase where authors are refining the search strings for the selected databases; the search strings will be finalized by July 2022. We anticipate the systematic review to be completed by December 2022. CONCLUSIONS This study will inform the future development and implementation of interventions to support culturally competent, person-centered care of racialized foreign-born older adults. TRIAL REGISTRATION PROSPERO CRD42021259979; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259979. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/31691.
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Affiliation(s)
| | | | | | | | - Paul Stolee
- University of Waterloo, Waterloo, ON, Canada
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Co-Creating Descriptors and a Definition for Person-Centred Coordinated Health Care: An Action Research Study. Int J Integr Care 2021; 21:11. [PMID: 33716594 PMCID: PMC7934796 DOI: 10.5334/ijic.5575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to co-create a definition and generic descriptors for person-centred coordinated care for Ireland generated from service users’ narratives. An overarching action research approach was used to engage and empower people to tangibly impact health policy and practice. Through focus groups and a qualitative survey, primary data were collected from a national sample of health services users, caregivers and health care service users’ representative groups. Thematic analysis was used to analyse the data. Three major themes were co-produced as essential care elements. These were: ‘My experience of healthcare’, ‘Care that I am confident in’ and ‘My journey through healthcare’. Through an IPPOSI partner project steering group and their membership groups’ contribution, these themes were further refined into a definition of person-centred coordinated care and nineteen related generic descriptors. Key findings demonstrate that within complex, fragmented healthcare systems, the subjective expectations of service users should be integrated into care delivery, with a scaffolding of services to meet service users’ needs between care settings and disciplines and over time.
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McCance T, Dickson CAW, Daly L, Boomer CA, Brown D, Lynch B, MacArthur J, Mountain K, McCormack B. Implementing person-centred key performance indicators to strengthen leadership in community nursing: A feasibility study. J Nurs Manag 2021; 28:1443-1452. [PMID: 33448509 DOI: 10.1111/jonm.13107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
AIMS To explore the utility and feasibility of implementing eight person-centred nursing key performance indicators in supporting community nurses to lead the development of person-centred practice. BACKGROUND Policy advocates person-centred health care, but few quality indicators exist that explicitly focus on evaluating person-centred practice in community nursing. Current quality measurement frameworks in the community focus on incidences of poor or missed opportunities for care, with few mechanisms to measure how clients perceive the care they receive. METHODS An evaluation approach derived from work of the Medical Research Council was used, and the study was underpinned by the Person-centred Practice Framework. Participatory methods were used, consistent with person-centred research. RESULTS Data were thematically analysed, revealing five themes: giving voice to experience; talking the language of person-centredness; leading for cultural change; proud to be a nurse; and facilitating engagement. CONCLUSIONS The findings suggest that implementing the eight person-centred nursing key performance indicators (KPIs) and the measurement framework is feasible and offers a means of evidencing person-centredness in community nursing. IMPLICATIONS FOR NURSING MANAGEMENT Person-centred KPI data, used alongside existing quality indicators, will enable nurse managers to evidence a high standard of care delivery and assist in the development of person-centred practice.
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Affiliation(s)
- Tanya McCance
- Nursing Research & Development, School of Nursing/Institute of Nursing & Health Research, Ulster University, Newtownabbey, UK
| | - Caroline A W Dickson
- Community Nursing, Centre for Person-centred Practice Research, Queen Margaret University, Musselburgh, UK
| | - Laura Daly
- Queen Margaret University, Musselburgh, UK
| | - Christine A Boomer
- South Eastern Health and Social Care Trust, Newtownabbey, UK.,School of Nursing/Institute of Nursing & Health Research, Ulster University, Newtownabbey, UK
| | - Donna Brown
- School of Nursing/Institute of Nursing & Health Research, Ulster University, Newtownabbey, UK
| | - Brighide Lynch
- School of Nursing/Institute of Nursing & Health Research, Ulster University, Newtownabbey, UK
| | - Juliet MacArthur
- Research and Development, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Brendan McCormack
- Division of Nursing, Occupational Therapy & Arts Therapies, Centre for Person-centred Practice Research, Queen Margaret University, Musselburgh, UK
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Hui A, Latif A, Hinsliff-Smith K, Chen T. Exploring the impacts of organisational structure, policy and practice on the health inequalities of marginalised communities: Illustrative cases from the UK healthcare system. Health Policy 2020; 124:298-302. [DOI: 10.1016/j.healthpol.2020.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/12/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE To systematically map and synthesise the literature on older adults' perceptions and experiences of integrated care. SETTING Various healthcare settings, including primary care, hospitals, allied health practices and emergency departments. PARTICIPANTS Adults aged ≥60 years. INTERVENTIONS Integrated (or similarly coordinated) healthcare. PRIMARY AND SECONDARY OUTCOME MEASURES Using scoping review methodology, four electronic databases (EMBASE, CINAHL, PubMed and ProQuest Dissertation and Theses) and the grey literature (Open Grey and Google Scholar) were searched to identify studies reporting on older adults' experiences of integrated care. Studies reporting on empirical, interpretive and critical research using any type of methodology were included. Four independent reviewers performed study selection, data extraction and analysis. RESULTS The initial search retrieved 436 articles, of which 30 were included in this review. Patients expressed a desire for continuity, both in terms of care relationships and management, seamless transitions between care services and/or settings, and coordinated care that delivers quick access, effective treatment, self-care support, respect for patient preferences, and involves carers and families. CONCLUSIONS Participants across the studies desired accessible, efficient and coordinated care that caters to their needs and preferences, while keeping in mind their rights and safety. This review highlights the salience of the relational, informational and organisational aspects of care from an older person's perspective. Findings are transferable and could be applied in various healthcare settings to derive patient-centred success measures that reflect the aspects of integrated care that are deemed important to older adults and their supporters.
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Affiliation(s)
- Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Amy Marshall
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Manasi Murthy Mittinty
- Pain Management Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Gillian Harvey
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
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Öberg U, Orre CJ, Hörnsten Å, Jutterström L, Isaksson U. Using the Self-Management Assessment Scale for Screening Support Needs in Type 2 Diabetes: Qualitative Study. JMIR Nurs 2020; 3:e16318. [PMID: 34345780 PMCID: PMC8279441 DOI: 10.2196/16318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 05/10/2020] [Accepted: 08/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Globally, most countries face a common challenge by moving toward a population-based structure with an increasing number of older people living with chronic conditions such as type 2 diabetes. This creates a considerable burden on health care services. The use of digital tools to tackle health care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as management of the day-to-day impact of a condition, something that is often a lifelong task. The use of a screening instrument, such as the Self-Management Assessment Scale (SMASc), offers the potential to guide primary health care nurses into person-centered self-management support, which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses' experiences using a digitalized scale for measuring patients' needs for self-management support in primary health care settings has been found. OBJECTIVE This paper describes diabetes specialist nurses' (DSNs) experiences of a pilot implementation of the SMASc instrument as the basis for person-centered digital self-management support. METHODS This qualitative study is based on observations and interviews analyzed using qualitative content analysis. RESULTS From the perspectives of DSNs, the SMASc instrument offers insights that contribute to strengthened self-management support for people with type 2 diabetes by providing a new way of thinking and acting on the patient's term. Furthermore, the SMASc was seen as a screening instrument with good potential that embraces more than medical issues; it contributed to strengthening person-centered self-management support, and the instrument was considered to lead both parts, that is, DSNs and patients, to develop together through collaboration. CONCLUSIONS Person-centered care is advocated as a model for good clinical practice; however, this is not always complied with. Screening instruments, such as the SMASc, may empower both nurses and patients with type 2 diabetes with more personalized care. Using a screening instrument in a patient meeting may also contribute to a role change in the work and practice of DSNs.
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Affiliation(s)
- Ulrika Öberg
- Department of Nursing Umeå University Umeå Sweden
| | - Carl Johan Orre
- Department of Computer Science and Media Technology DVMT, Malmö University Malmö Sweden
| | - Åsa Hörnsten
- Department of Nursing Umeå University Umeå Sweden
| | | | - Ulf Isaksson
- Department of Nursing Umeå University Umeå Sweden
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Harvey G, Dollard J, Marshall A, Mittinty MM. Creating the Right Sort of Ship to Achieve Integrated Care: A Response to Recent Commentaries. Int J Health Policy Manag 2019; 8:317-318. [PMID: 31204449 PMCID: PMC6571490 DOI: 10.15171/ijhpm.2019.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Joanne Dollard
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Amy Marshall
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
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