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Aim:   This study reports the use of exploratory factor analysis to determine construct validity of a modified advanced practice role delineation tool., Background:   Little research exists on specific activities and domains of practice within advanced practice nursing roles, making it difficult to define service parameters of this level of nursing practice. A valid and reliable tool would assist those responsible for employing or deploying advanced practice nurses by identifying and defining their service profile. This is the third article from a multi-phase Australian study aimed at assigning advanced practice roles., Methods:   A postal survey was conducted of a random sample of state government employed Registered Nurses and midwives, across various levels and grades of practice in the state of Queensland, Australia, using the modified Advanced Practice Role Delineation tool. Exploratory factor analysis, using principal axis factoring was undertaken to examine factors in the modified tool. Cronbach's alpha coefficient determined reliability of the overall scale and identified factors., Results:   There were 658 responses (42% response rate). The five factors found with loadings of ≥400 for 40 of the 41 APN activities were similar to the five domains in the Strong model. Cronbach's alpha coefficient was 0·94 overall and for the factors ranged from 0·83 to 0·95., Conclusion:   Exploratory factor analysis of the modified tool supports validity of the five domains of the original tool. Further investigation will identify use of the tool in a broader healthcare environment., (© 2011 Blackwell Publishing Ltd.)

Objective: During hospitalization older people often experience functional decline which impacts on their future independence. The objective of this study was to evaluate a multifaceted transitional care intervention including home-based exercise strategies for at-risk older people on functional status, independence in activities of daily living (ADLs) and walking ability., Methods: A randomized controlled trial was undertaken in a metropolitan hospital in Australia with 128 patients (64 intervention, 64 control) aged over 65 years with an acute medical admission and at least one risk factor for hospital readmission. The intervention group received an individually tailored programme for exercise and follow-up care which was commenced in hospital and included regular visits in hospital by a physiotherapist and a registered nurse, a home visit following discharge and regular telephone follow-up for 24 weeks following discharge. The programme was designed to improve health-promoting behaviours, strength, stability, endurance and mobility. Data were collected at baseline, then 4, 12 and 24 weeks following discharge using the Index of ADL, Instrumental Activities of Daily Living (IADL) and the Walking Impairment Questionnaire (WIQ; modified)., Results: Significant improvements were found in the intervention group in IADL scores (P < 0.001), ADL scores (P < 0.001) and WIQ scale scores (P < 0.001) in comparison to the control group. The greatest improvements were found in the first 4 weeks following discharge., Conclusions: Early introduction of a transitional model of care incorporating a tailored exercise programme and regular telephone follow-up for hospitalized at-risk older adults can improve independence and functional ability., (© 2011 Blackwell Publishing Ltd.)

Aim: To document the rise in prepartum and intrapartum caesarean section and the demographic and medical factors contributing to the rise., Methods: Data from 52,423 deliveries between January 1997 to May 2005 were analysed for yearly change in caesarean section rates and multiple demographic and medical factors., Results: The prepartum caesarean section rate increased by 1.6% per year and the intrapartum caesarean section rate by 0.8% per year. There was no increase in the overall prevalence of obesity, short stature, advanced maternal age, medical complications or previous caesarean section. There were significant increases in nulliparity, private care, induction of labour and the use of electronic monitoring, but these were insufficient to explain the magnitude of the rise., Conclusion: The increase in prepartum and intrapartum caesarean section displayed was not fully explained by medical and demographic changes in the population.