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Background: During the COVID-19 pandemic, telehealth emerged as a means of safely providing primary healthcare (PHC) consultations. In Australia, changes to telehealth funding led to the reconsideration of the role of telehealth in the ongoing provision of PHC services. Aim: To investigate GPs', registered nurses' (RNs), nurse practitioners' (NPs), and allied health (AH) clinicians perceptions of the sustainability of telehealth in PHC post-pandemic. Design & setting: Semi-structured interviews were undertaken with 33 purposively selected clinicians, including GPs (n = 13), RNs (n = 5), NPs (n = 9), and AH clinicians (n = 6) working in PHC settings across Australia. Participants were drawn from responders to a national survey of PHC providers (n = 217). Method: The thematic analysis approach reported by Braun and Clarke was used to analyse the interview data. Results: Data analysis revealed that the perception of providers was represented by the following two themes: lessons learnt; and the sustainability of telehealth. Lessons learnt included the need for rapid adaptation to telehealth, use of technology, and the pandemic being a catalyst for long-term change. The sustainability of telehealth in PHC comprised four subthemes around challenges: the funding model, maintaining patient and provider safety, hybrid service models, and access to support. Conclusion: Providers required resilience and flexibility to adapt to telehealth. Funding models must reward providers from an outcome focus, rather than placing limits on telehealth's use. Hybrid approaches to service delivery will best meet the needs of the community but must be accompanied by support and education for PHC professionals. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore primary health care nurses' coping strategies and evaluate the psychometric properties of the Brief Coping Orientation to Problems Experienced (COPE) scale. Background: Primary health care nurses are experiencing significant COVID‐19‐related psychological impacts. Beyond understanding the impacts, there is a need to explore coping strategies. Methods: This online cross‐sectional survey was completed by 359 Australian primary health care nurses between October and December 2020. Results: Factor analysis revealed seven factors (support, disengagement and venting, humour, positive reframing, acceptance, substance use and spiritual/religious beliefs) (Cronbach's alpha >.69). There was an association between age, years of nursing and years of primary health care nursing and the factors of 'support', 'disengagement and venting' and 'positive reframing'. Years of experience were also associated with the factor 'humour'. Urban respondents had higher scores for the 'support' factor. Conclusions: The Brief COPE scale is a valid and reliable tool for assessing primary health care nurses' coping. As demographic characteristics impact the coping strategies that nurses use, supports need to be tailored to optimize their impact. Implications for Nursing Management: Nurse managers need to consider the workforce demographics when designing and implementing support strategies. The Brief COPE can identify current coping strategies and inform interventions to build coping capacity. [ABSTRACT FROM AUTHOR]

This qualitative study describes the impact of the first wave of the COVID‐19 pandemic on the provision of care by Australian primary health care (PHC) nurses. Participants were purposefully recruited following completion of a national survey about PHC nurses' experiences during the pandemic. Twenty‐five semi‐structured interviews were conducted by two experienced researchers and professionally transcribed. The mean duration of interviews was 38.5 min. Thematic analysis revealed three themes about the impact of COVID‐19 on PHC nurses' provision of care. These were: workplace adjustments, changes in healthcare delivery and concerns about long‐term health impacts of COVID‐19. The sudden disruption and de‐stabilisation of care delivery was reported as significantly impacting on initial service provision, although participants reported adapting quickly and finding new ways to deliver care. The impact of the pandemic on high risk communities and mental health support needs of clients created additional challenges, although some participants reported positive outcomes such as increased confidence of some clients to provide self‐care. There were concerns about the potential long‐term health impact on communities due to reduced levels of cancer screening, disrupted management of chronic conditions and reduced opportunistic health assessments. Findings from this study demonstrated how PHC nurses played an important role in the continued provision of PHC by adapting quickly to changed circumstances, adjusting and modifying clinical activities, and by monitoring for future potential negative outcomes from the pandemic. These findings are important for the future management of pandemics and inform the long‐term planning of PHC services. [ABSTRACT FROM AUTHOR]

Aims: To validate the 'safe and effective staffing tool' and explore the impact of COVID‐19 on the quality of Australian primary health care (PHC). Design: A national survey was conducted from October to December 2020. Methods: The online survey was distributed via social media and professional organisations to PHC nurses. Results: Three‐hundred fifty‐nine PHC nurses participated. A two‐factor solution was found with factors named; 'Perception of quality of care provided' and 'Personal satisfaction with care delivered'. Cronbach's alpha demonstrated good internal consistency for the total scale (α =.915) and each subscale (α =.879/α =.864). Nearly three‐quarters of participants (71.3%) were satisfied with the quality of care they delivered. Participants working in general practice, and those with more nursing experience had significantly higher scores in the factor 'perceptions of quality of care provided' and the total 'quality and satisfaction with care'. A lack of time, inadequate supervision and support, and performing non‐nursing duties were reported to be impacting care quality. Most participants (80.5%) reported that COVID‐19 had impacted negatively on the detection and management of non‐COVID related health conditions. Conclusion: The 'safe and effective staffing tool' is a valid and reliable measure of perceived quality of care and satisfaction with care delivered. Many PHC nurses perceive that there has been an overall reduction in the quality of care delivered due to COVID‐19 and feel that there is a lack of adequate supervision and workplace support. Given the limited baseline data, further research is required to understand the extent that COVID‐19 impacts these findings. However, this study demonstrates that strategies need to be implemented to support PHC nurses to provide high‐quality care to optimise health outcomes and maintain nurse satisfaction. Impact: This is the first attempt to evaluate care quality in Australian PHC. Policymaking requires this evidence to drive changes to better support PHC nurses. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to explore primary health care nurses' mental health, concerns and perceived safety and supports during COVID‐19. Background: Respiratory pandemics have negative impacts on nurses' wellbeing. While literature is replete with hospital nurses' experiences, there is less exploration of COVID‐19 impacts on primary health care nurses. Given the importance of primary health care nurses in the health system, understanding their experiences is vital. Methods: Three hundred and fifty nine primary health care nurses responded to an online cross‐sectional survey. The Depression Anxiety Stress Scales (DASS‐21) was used to measure emotional state. Data were analysed using descriptive and inferential statistics. Results: DASS‐21 scores indicated that 39.6% of participants were experiencing symptoms of depression, anxiety or stress. Of those, 41.8% were experiencing symptoms on one scale, 26.9% were experiencing symptoms on two scales and 31.2% were experiencing symptoms across all three scales. Most participants identified that their feelings were related to COVID‐19. Conclusions: COVID‐19 is having a significant impact on primary health care nurses' mental health. Nurse managers need to develop strategies to effectively address nurses' concerns and effectively support them to sustain the workforce during and after the pandemic. Implications for Nursing Management: Findings from this study can inform the design of effective nurse support programmes to reduce mental health impacts and promote staff wellbeing during the pandemic. [ABSTRACT FROM AUTHOR]

Purpose: COVID‐19 has presented health care professionals with unprecedented challenges. Significant risks have emerged as nurses have continued to work in delivering frontline health care during the pandemic. Feeling "at risk" has significant deleterious effects on nurses. The study sought to explore the perceptions of risk by Australian primary health care nurses (PHC) during COVID‐19. Methods: Twenty‐five Australian PHC nurses were purposively recruited from survey respondents who indicated a willingness to be interviewed. Phone interviews were undertaken between June and August 2020. Audio‐recordings were transcribed and analyzed thematically. Findings: Participants shared concerns about risks in the workplace that emerged during COVID‐19 and described the strategies used to mitigate these identified risks. Three themes were identified: (a) Professional concerns, (b) Personal/family concerns, and (c) Patient needs. Conclusions: Understanding PHC nurses' perceptions of risk during COVID‐19 provides an important insight into how they can be better supported to manage the risks that they face and feel safer in their workplace. Ensuring that PHC nurses are well‐supported is important to optimize job satisfaction, reduce burnout and improve patient care. Clinical Relevance: There is a need to ensure that nurses feel safe during crises such as pandemics to protect both individual nurses and the broader workforce. Protecting the health workforce is essential to optimizing service delivery and promoting health outcomes. [ABSTRACT FROM AUTHOR]

Aim: To explore primary healthcare nurses' psychological well‐being related to the COVID‐19 pandemic. Design: Qualitative descriptive study. Methods: Semi‐structured interviews were conducted with 25 participants between June and August 2020 who indicated their willingness to participate in an interview following a national survey. Interviews were audio‐recorded and transcribed verbatim by professional transcribers. Data were analysed using thematic analysis. Results: The importance of professional and public support and acknowledgement of the nurses' role during the pandemic positively influenced feelings of being valued. The psychological impact of negative experiences increased anxiety and stress levels. Participants reported a range of self‐care strategies, including increased vigilance with infection control at home and work and attention to physical exercise and diet. Most participants remained positive about their roles and career decisions, although some indicated that the negative psychological impacts prompted re‐evaluation of their career. Conclusions: Primary healthcare nurses have been exposed to a range of personal and professional stressors during the pandemic that have impacted their psychological well‐being. Awareness of stressors and an understanding of what has helped and what has impacted well‐being are important in guiding future workplace support systems. Further work to explore the long‐term impact of these stressors and the effectiveness of coping strategies employed by primary healthcare nurses is warranted. Impact: Managers and professional organisations need to consider the personal and professional stressors that have impacted on primary healthcare nurses' psychological well‐being to promote health and well‐being among nurses following COVID‐19. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to explore the perceptions, attitudes and beliefs of middle‐aged Australians around their health, lifestyle risks and chronic disease. Background: Health promotion and risk reduction are important to stem the rising prevalence of chronic disease. While there has been much emphasis on supporting these strategies in older Australians, there has been less attention on those in middle age. However, as this group age, their health will inevitably be impacted by lifestyle risk. Design: A qualitative descriptive study using semi‐structured interviews. Reporting was guided by the COREQ checklist. Methods: Thirty‐four participants aged 40–65 years were recruited across South Eastern New South Wales, Australia, using convenience sampling. Semi‐structured interviews were conducted by four registered nurses with qualitative research experience. Verbatim transcripts were analysed using thematic analysis. Results: Sixteen women and 18 men participated in the interviews. Four themes emerged, namely: adopting healthy lifestyles; denial; an impetus for change; and sustaining change. Perceptions about what constituted good health varied, with male participants being more ambivalent about their health. Impetus for change was mostly influenced by family history, awareness of health risks and identification of risks by health professionals. Participants found sustaining change challenging, particularly with regard to smoking cessation and dietary modifications. Conclusions: Understanding the perceptions of health of middle‐aged people is important and enables health professionals to engage in early behavioural change conversations that consider perceived barriers to lifestyle modification. Findings from this study emphasise the importance of discussions about lifestyle risk to reduce the future burden of chronic disease. Relevance to Clinical Practice: These findings illustrate the importance of understanding perceptions of health to guide primary health care nurses to develop person‐centred health promotion and chronic disease prevention strategies in this age group. [ABSTRACT FROM AUTHOR]

Aim: To explore the job satisfaction and turnover intentions of general practice nurses and examine factors that influence job satisfaction and turnover intention. Background: Workforce issues such as satisfaction, retention and turnover intention have been explored in acute care. However, increasingly nurses are being employed outside hospitals. General practice is a significantly different work environment to acute care. Understanding workforce issues in community settings is important for employers, managers and policymakers to sustain and grow this workforce to meet consumer demands. Method: A descriptive survey was conducted within a single Primary Health Network in Australia. Results: Having an identified practice nurse leader/manager, feeling that their training and qualifications are used to the full and not feeling isolated, alone or lacking opportunities for mentoring were all significantly correlated with higher job satisfaction. The lowest average satisfaction scores related to pay. 44.9% of participants were unsure whether they would remain working in general practice. The relationship between total job satisfaction and intention to leave was significant. Conclusion: These findings guide managers in developing strategies to recruit and retain nurses in general practice employment. Implications for Nursing Management: Managers must consider factors influencing job satisfaction and turnover intention to maximize recruitment and retention of nurses. [ABSTRACT FROM AUTHOR]

General practice data provide important opportunities for both population health and within-practice initiatives to improve health. Despite its promise, a lack of accuracy affects the use of such data. The Sentinel Practices Data Sourcing (SPDS) project is a structured chronic disease surveillance and data quality improvement strategy in general practice. A mixed-methods approach was used to evaluate data quality improvement in 99 participating practices over 12 months. Quantitative data were obtained by measuring performance against 10 defined indicators, whereas 48 semi-structured interviews provided qualitative data. Aggregated scores demonstrated improvements in all indicators, ranging from minor to substantially significant improvements. Participants reported positively on levels of support provided, and acquisition of new knowledge and skills relating to data entry and cleansing. This evaluation provides evidence of the effectiveness of a structured approach to improve the quality of primary care data. Investing in this targeted intervention has the potential to create sustained improvements in data quality, which can drive clinical practice improvement. Accurate data collection and reporting are vital to guide policy and health service planning. A mixed-methods evaluation of a chronic disease surveillance and data quality improvement strategy in general practices in a regional Australian Primary Health Network demonstrated the effectiveness of a structured approach to improve the quality of primary care data. Investing in this intervention has the potential to create sustained improvements in data quality, which can drive clinical practice improvement. [ABSTRACT FROM AUTHOR]

Aim: To identify Australian primary health care nurses' immediate support needs during the COVID‐19 pandemic. Background: COVID‐19 has had widespread implications for primary health care nurses. Supporting these nurses' capacity to deliver quality care ensures that ongoing health needs can be met. Methods: Primary health care nurses were recruited to an online survey via social media and professional organisations in April 2020. Results: Six‐hundred and thirty‐seven responses were included in the analysis. Participants provided 1,213 statements about perceived supports required to provide quality clinical care. From these, seven key categories emerged, namely personal protective equipment, communication, funding, industrial issues, self‐care, workplace factors and valuing nurses. Conclusion: A number of key issues relating to personal health and safety, care quality and job security need to be addressed to support primary health care nurses during the COVID‐19 pandemic. Addressing these support issues can assist in retaining nurses and optimizing the role of primary health care nurses during a pandemic. Implications for Nursing Management: Responding to the needs of primary health care nurses has the potential to facilitate their role in providing community‐based health care. This knowledge can guide the provision of support for primary health care nurses during the current pandemic, as well as informing planning for future health crises across the health service. [ABSTRACT FROM AUTHOR]

Purpose: The COVID‐19 pandemic has presented an international health crisis of a scope not seen in our lifetime. While much attention has been paid to health workers in critical care and acute areas, nurses working outside of hospitals are also significantly affected. This study sought to investigate the experience of nurses working in Australian primary healthcare during the COVID‐19 pandemic. In particular, it sought to understand the implications on their employment status, role, and access to personal protective equipment. Design and Methods: Nurses employed in primary healthcare across Australia were invited to participate in a cross‐sectional online survey through social media and professional organizations. The survey tool was composed of demographics, and of questions about the nurses' employment, work role, and access to personal protective equipment. Findings: Of the 637 responses received, nearly half (43.7%) reported a decrease in hours and threatened or actual loss of employment. While most respondents felt that they had sufficient knowledge about COVID‐19, they expressed concern about work‐related risks to themselves and their family. Most respondents described never or only sometimes having sufficient personal protective equipment in their workplace. Just over half of respondents (54.8%) felt well supported by their employer. A third of respondents (34%) perceived that care provided in their workplace was significantly or slightly worse than before the pandemic. Conclusions: This is the first study of primary healthcare nurses' experiences during the COVID‐19 pandemic. The study findings highlighted a concerning level of insecurity around primary healthcare nursing employment, as well as issues with the availability of personal protective equipment for these nurses. The perception that the pandemic has resulted in reduced quality of care needs further exploration to ensure that those with chronic conditions are supported to maintain and promote health. Clinical Relevance: Understanding the implications of COVID‐19 on the primary healthcare nursing workforce is vital to ensure staff retention and care quality. Ensuring that the community remains healthy and supported at home is vital to both reduce the burden on the health system and reduce secondary mortality. [ABSTRACT FROM AUTHOR]

Increasingly, middle-aged people are demonstrating lifestyle risk factors that increase their risk of developing chronic disease. Reducing lifestyle risk in middle age can significantly reduce future morbidity and mortality and improve quality of life. Understanding peoples' perceptions of health support is important to inform health professionals and policymakers regarding strategies to support lifestyle risk reduction. This paper seeks to explore middle-aged Australians' perceptions of support for lifestyle risk reduction. Thirty-four middle-aged Australians were interviewed using a semi-structured interview schedule. Interviews were audio-recorded, transcribed and analysed using thematic analysis. The overarching theme 'support for healthy lifestyles' comprised three subthemes. 'Engagement with general practice' highlighted gender differences in why people attend and what impacts their access to general practice. 'Providing information' emphasised participants' experiences of lifestyle risk communication in general practice. Finally, 'Sources of support' revealed participants' current health advice-seeking behaviours. Findings highlight a need for general practices to better engage middle-aged people in behaviour change and educate them about the role of general practice in prevention and health promotion. Consistent messaging across the community and strategies that focus on gender-specific concerns are likely to ensure that middle-aged people are able to make informed choices about seeking support for lifestyle risk reduction. Primary care practitioners play a pivotal role in identifying chronic conditions and health promotion, yet little is known about how consumers perceive their role in providing support to achieve healthy lifestyles. This study identified a lack of consumer knowledge about roles of health professionals; suggested gender differences in relation to seeking health advice; and indicated that lifestyle risk discussions were perceived as often being opportunistic rather than planned. Findings indicate that programs and information promoting healthy lifestyles need to be flexible and adaptable to maximise their effect. [ABSTRACT FROM AUTHOR]

Nurses are increasingly needed in primary healthcare settings to support community-based healthcare delivery. Programs to facilitate transition of new graduate nurses are well established in acute care; however, there are few similar programs reported in settings like general practice. This paper sought to explore the experiences of new graduate registered nurses and their registered nurse mentors in a new graduate program within Australian general practice. New graduates (n = 9) and their mentors participated in interviews before, during and at the conclusion of a 12-month new graduate program. Interviews were digitally audio-recorded and professionally transcribed verbatim before being analysed using thematic analysis. Eighteen new graduate and 10 mentor interviews were conducted, revealing four themes. Preparation and Opportunities describes the influence that pre-registration education had on preparing nurses for general practice employment. Exceeding Expectations highlights the positive experiences within the program. Program Challenges draws attention to the difficulties experienced by participants, and Future Career Intentions explores future career plans. This study highlights that a general practice new graduate nurse program has the potential to build the workforce. However, strengthening undergraduate preparation of nurses around primary health care and addressing funding issues in general practice, are important to promote the success of such programs. [ABSTRACT FROM AUTHOR]

Aim: To explore registered nurses' reflections on transitioning from acute to primary health care employment, and future career intentions. Background: Reforms in primary health care have resulted in increasing demands for a skilled primary health care nursing workforce. To meet shortfalls, acute care nurses are being recruited to primary health care employment, yet little is known about levels of satisfaction and future career intentions. Method: A sequential mixed methods study consisting of a survey and semi‐structured interviews with nurses who transition to primary health care. Results: Most reported positive experiences, valuing work/life balance, role diversity and patient/family interactions. Limited orientation and support, loss of acute skills and inequitable remuneration were reported negatively. Many respondents indicated an intention to stay in primary health care (87.3%) and nursing (92.6%) for the foreseeable future, whilst others indicated they may leave primary health care as soon as convenient (29.6%). Conclusion: Our findings provide guidance to managers in seeking strategies to recruit and retain nurses in primary health care employment. Implications for Nursing Management: To maximize recruitment and retention, managers must consider factors influencing job satisfaction amongst transitioning nurses, and the impact that nurses' past experiences may have on future career intentions in primary health care. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for Australian general practice nurses. Background Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting. Design Concurrent mixed methods design. Methods Data collection was conducted during 2013-2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts. Findings Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard. Conclusion The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses' practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance. [ABSTRACT FROM AUTHOR]

Background Healthcare systems are faced with changing community health profiles and ageing populations. Together with economic considerations, these factors have influenced the increase in provision of care in primary rather than other healthcare settings. Many nurses are electing to move from acute care to meet demands for a skilled primary healthcare workforce. However, little is reported about these nurses' experiences of transition. Aim To describe how role theory provides a theoretical framework to inform the design of a mixed-methods study exploring the transition of acute care nurses to roles in primary health care. Discussion The paper explores the relevance of role theory and its components as a validated framework for informing the design of the quantitative and qualitative components of the study. The methodology consisted of a national survey of recently transitioned nurses, with questions that explored experiences of nurses in relation to role exit, role entry, role enactment, role ambiguity, role stress, role strain and rites of passage. The qualitative component of the study incorporated semi-structured interviews with selected participants to further explore aspects of the transition. Conclusion There are few published reports on the value of theoretical frameworks in the design of nursing research. This paper describes one example of the value of selecting an appropriate theoretical framework for a national study of experiences of transition. Implications for practice Nurses transitioning between clinical settings experience a range of personal and professional challenges. Role theory provides a valuable framework which is applicable to qualitative and quantitative research into these experiences. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper seeks to explore the transition experiences of acute care nurses entering employment in primary health care settings. Background Internationally the provision of care in primary health care settings is increasing. Nurses are moving from acute care settings to meet the growing demand for a primary health care workforce. While there is significant research relating to new graduate transition experiences, little is known about the transition experience from acute care into primary health care employment. Design An integrative review, guided by Whittemore and Knafl's (2005) approach, was undertaken. Following a systematic literature search eight studies met the inclusion criteria. Methods Papers which met the study criteria were identified and assessed against the inclusion and exclusion criteria. Papers were then subjected to methodological quality appraisal. Thematic analysis was undertaken to identify key themes within the data. Results Eight papers met the selection criteria. All described nurses transitioning to either community or home nursing settings. Three themes were identified: (1) a conceptual understanding of transition, (2) role losses and gains and (3) barriers and enablers. Conclusion There is a lack of research specifically exploring the transitioning of acute care nurses to primary health care settings. To better understand this process, and to support the growth of the primary health care workforce there is an urgent need for further well-designed research. Relevance to clinical practice There is an increasing demand for the employment of nurses in primary health care settings. To recruit experienced nurses it is logical that many nurses will transition into primary health care from employment in the acute sector. To optimise retention and enhance the transition experience of these nurses it is important to understand the transition experience. [ABSTRACT FROM AUTHOR]

The article discusses the importance of continuing education for catalogers. Particular focus is given to distant continuing education using tools such as the enhanced conference call software Integrated Conference Manager. It notes that the technology allows for a more interactive learning experience as it includes both audio and visual components.