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Identifying the factors that increase the likelihood of medical graduates choosing rural medical careers is key to addressing the global shortage of rural doctors. Using linked graduate-workforce outcomes data, this study aimed to identify predictors of rural medical practice in Aotearoa New Zealand (NZ).
A national prospective cohort study linking data from the longitudinal Medical School Outcomes Database to workforce location data. Univariate and multivariate analyses were conducted to generate ORs for putative predictors of rural medical career.
All NZ medical graduates from 2011 to 2019 were followed for a minimum of 3 years.
During the study period, there were a total of 4152 medical graduates nationally. Included in the analysis were 3291 graduates who had linked longitudinal medical school and workforce data, of whom 133 (4%) doctors were classified as having decided on a career in rural medicine. Independent predictors of rural practice included being of rural origin (OR 2.13, 95% CI 1.19 to 3.81, p=0.011), age older than 25 years at entry to medical school (OR 2.88, 95% CI 1.54 to 5.36, p
This is the first national study linking medical school data to rural medical workforce outcomes. It demonstrates that previously known predictors of rural practice intention are borne out with actual career outcomes, and these also hold true at a national level. However, this research highlights that diverse pathways into rural practice are vital, given that urban-origin students and those with no early rural career intention make up a substantial number of the early-career rural medical workforce.
Assess US registered nurse genomic competency.
Administered the Genetics and Genomics Nursing Practice Survey (GGNPS).
GGNPS assesses genomic knowledge, skills, attitudes, confidence, and utilization in nursing practice. Distributed by the American Nurses Association via email and online to US registered nurses. Results are analyzed using descriptive statistics and compared to 2010 data.
1065 registered nurses responded. Most (41%) were Master's prepared, actively seeing patients (51%) and 66% considered it very important to learn more about genomics. Most (55%) reported their genomic knowledge was poor yet 51% reported a patient initiated a genetic discussion with them in the past 3 months. 66% completed all knowledge score items with a median score of 9/12, no change from 2010. Only 26% had heard of the Essential Competencies. Most reported no genomic curricular content (64%); had not attended a genomic course since licensure (64%); intended to learn more about genomics (70%); and would attend a course on their own time (79%).
Nurses felt genomics was important but have capacity deficits. Despite genomic discoveries and evidence-based practice guidelines that impact healthcare quality and safety, 20 years after the Genomic Competencies were established (2005) nursing genomic practice capacity remains low.
Genomics is critical to the safe, quality nursing practice regardless of the level of academic training, clinical role, or specialty.
Inequities in health status exist in New Zealand across the rural–urban spectrum. In parallel, rural–urban differences in health service utilisation vary by service type. Despite the New Zealand public health system being based on principles of universal access, equity and fairness, levels of health expenditure on rural and urban populations are not well understood. The purpose of the study is to undertake a rural–urban analysis of public health system expenditure, based on individual-level service utilisation and national pricing of health service events.
Individual-level service utilisation and pricing will be collated from national collection databases for all eligible users of publicly funded services. The analysis will include calendar years 2017–2024. Descriptive analysis and a two-part generalised linear regression model will be used to identify if rural–urban differences in expenditure exist, and what the association of rurality is with expenditure (if any). The model will also be used to identify geographic regions with expenditure levels that vary from those predicted using regression model weights. As the specific statistical approach will be determined by data attributes, this protocol outlines the intended approach to construct the analytical model.
Ethics approval was obtained from the University of Otago Human Research Ethics Committee (HD23/052). Māori consultation has been undertaken with the Ngāi Tahu Research Consultation Committee and will continue throughout the research process.
This scoping review aims to explore the existing research on the impact of authentic leadership on nurses' innovative behaviours.
The following databases were searched (from 2013 to 2023): PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, Scopus, APA Psych Info, Educational Resources Information Centre, and ABI Inform.
Search results were exported into Covidence software to assist with the selection and assessment of retrieved studies. Studies were included that specifically examined the relationship between authentic leadership and innovative behaviour among nurses working in healthcare settings.
12 papers remained for full-text review after title and abstract screening. Four studies that met the inclusion criteria were included in the final analysis. Using the Crowe Critical Appraisal Tool two reviewers independently evaluated these four studies. Findings revealed that authentic leadership affects nurses' innovation and creativity in various healthcare settings and cultural contexts. It also highlighted mediating factors such as increased engagement and knowledge sharing. Resilience and technological infrastructure were identified as additional factors that affect and support this relationship and influence the development and enaction of innovative behaviours.
Authentic leadership was found to contribute to innovative nursing behaviours that have important implications for the best practices in healthcare and outcomes.
Innovative behaviour among nurses is essential for rising to the challenges of complex healthcare environmental challenges, and the potential for authentic leadership to act as a catalyst for this is important. Future research needs to further explore the impact of authentic leadership on innovative behaviour and the contextual and cultural influences that effect this. More research is also needed on the exact nature of nurses' innovations and their potential use in healthcare.
The EQUATOR guidelines for PRISMA have been met.
No patient or public contribution.
To map existing sexual and gender minority (SGM) health research in Ireland, identify gaps in literature and outline priorities for future research and healthcare. SGM is an umbrella term that includes people who identify as lesbian, gay, bisexual, transgender, queer or intersex and is sometimes abbreviated as LGBTQI+.
A scoping review of peer-reviewed studies published between 2014 and 2024.
The review followed Joanna Briggs Institute (JBI) guidelines and PRISMA-ScR framework for scoping reviews. Articles were identified through systematic database searches and screened independently by reviewers.
PubMed, PsycINFO, CINAHL and Embase were searched for articles published between January 2014 and April 2024. Sixty studies met inclusion criteria.
The review highlighted a disproportionate focus on gay, bisexual and other men who have sex with men (gbMSM), particularly regarding HIV and sexual health. Mental health research revealed high levels of anxiety, depression and suicidality, largely attributed to minority stress and systemic discrimination. Transgender health studies documented barriers to accessing gender-affirming care and mental health services. Few studies explored experiences of sexual minority women, older SGM individuals or intersex people. Intersectional perspectives on race, disability and socio-economic status were notably absent.
SGM health research in Ireland reflects significant progress in documenting disparities in mental and sexual health. However, there is a lack of representation for some groups. There is also limited attention to intersectionality. Systematic gaps in sexual orientation and gender identity (SOGI) data impede targeted policymaking and service delivery.
Findings underscore the need for inclusive, culturally competent healthcare services, better integration of SGM health topics into nursing education, and community-centred interventions. Addressing structural barriers and improving provider competence can enhance equitable healthcare access for SGM populations.
This review addresses the fragmented state of SGM health research in Ireland, highlighting gaps in representation and systemic issues.
Authorship includes individuals from various sexual and gender minority communities.
Signs of clinical deterioration may appear differently in children with dark-coloured skin. How to assess children in this cohort is currently poorly defined.
To explore available information on the assessment of clinical deterioration in children with dark-coloured skin and identify research deficits.
A scoping review following Arksey and O'Malley and PRISMA-ScR frameworks. Five online databases, grey literature and reference lists of eligible documents were searched. Source titles, abstracts and full texts were screened. Included documents were assessed for level of evidence according to the Joanna Briggs Institute. Data were charted on a pre-defined data collection tool and analysed through descriptive and content analysis.
Out of 2382 documents screened, 37 were included. Document types included 16 quantitative studies, 14 opinion papers, five reviews and two reports. Most sources (21) were low-level evidence. Sixty-six unique terms were used to describe dark-coloured skin. Eighteen documents reported use of a skin classification system, including race/ethnicity, established colour scales, cosmetic references and observer opinion. Twelve focused on newborn hyperbilirubinaemia. Considerations for assessing jaundice, pallor, cyanosis, pulse oximetry, petechiae and signs of shock were reported. Techniques to improve assessment included optimising the environment, identifying baseline skin colour, and involving families and patients in assessment. No documents reported on assessment of mottling or capillary refill time for children with dark-coloured skin.
Assessment of clinical deterioration for children with dark-coloured skin is highly relevant to health professional practice. There is an overall deficit in high-quality research. Specific information gaps in assessment are considerations for mottling, capillary refill time, APGAR scoring, and clinical implications of device overestimation of bilirubin and oxygen saturations in children with dark-coloured skin. Health professionals are encouraged to use devices cautiously. Greater accuracy and objectivity are necessary to fill these gaps and support effective detection of signs of clinical deterioration.
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