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Bakgrund: Pre-operativ ångest är en subjektiv upplevelse och vanligt förekommande. För patienten leder det här bland annat till ökad smärta, behov av mer narkosmedel, längre tid för återhämtning och ytterligare vårdtid. Det finns ett antal bedömningsinstrument för att mäta pre-operativ ångest, såväl som interventioner för att lindra den. Syfte: Att med en litteraturstudie beskriva vilken effekt omvårdnadsåtgärder har vid pre-operativ ångest. Metod: Uppsatsen baserades på en litteraturöversikt av studier som belyst effekten av interventioner för att lindra pre-operativ ångest. Tio artiklar valdes ut efter kvalitetsgranskning och noggrann bearbetning för att besvara syftet. Resultat: Resultatet av de tio artiklarna skapade tre övergripande rubriker som visar på effekten av de studerade interventionerna på pre-operativ ångest. Interventionerna delades sedan in efter likheter vad gällde interventionstyp. Det som i denna litteraturstudie visade sig ha bäst effekt på pre-operativ ångest var musik och beröring i olika former. Slutsats: Det finns flera omvårdnadsåtgärder som visat god effekt för att lindra pre-operativ ångest. Sjuksköterskan har en central roll i detta genom att skapa en tillitsfull relation och identifiera ångesten i ett tidigt skede. Klinisk betydelse: Om pre-operativ ångest mäts på rutin, i ett tidigt skede, med hjälp av något bedömningsinstrument har sjuksköterskan möjlighet att bemöta individens problematik. Det är därför av stor vikt att beprövade och fungerade alternativa omvårdnadsåtgärder finns att tillgå på sjukhusen, som ett komplement till farmakologisk behandling. / Background: Pre-operative anxiety is a subjective and common experience. For the patient, it leads to increased pain, the need for more anesthetic, longer recovery time and extended hospitalization. There are multiple assessment instruments to measure pre-operative anxiety, as well as interventions to alleviate it. Purpose: Review the current literature to describe the effect of nursing interventions on pre-operative anxiety. Method: This essay was based on a literature review, studies highlighted the effect of interventions to alleviate pre-operative anxiety. Ten articles were selected after quality inspection and careful processing to fulfill the purpose. Result: From the results of the ten studies, three broad headings were created that show the effect of the studied interventions on pre-operative anxiety. The interventions were then divided by commonalties related to the type of intervention. The interventions shown to have the best effect on pre-operative anxiety where music and touch in various forms. Conclusion: There are several assessment instruments and nursing interventions that have shown good efficacy in alleviating pre-operative anxiety. The nurse has a central role in this by creating a trusting relationship and identifying anxiety at an early stage to help support these individuals. Clinical significance: If pre-operative anxiety is measured on a routine basis, at an early stage, using any assessment instruments the nurse have the opportunity to respond to individual problems. Due to that, it is of utmost importance that tested and reliable interventions are available in hospitals, as a compliment to medical treatment.

Background: Patients who are going through a surgical intervention, almost always have some form of anxiety related to this. Pharmacological interventions are routinely used for treatment of preoperative anxiety. Although there are different forms of strategies and nursing interventions that can be used by the nurse anaesthesia to meet patients with preoperative anxiety. Purpose: To describe non-pharmacological nursing interventions utilized by nurse anesthetist to alleviate patients’ pre-operative anxiety. Design/Method: A literature review was performed. 23 studies with quantative method met the inclusion criteria and was included in the review. Result: A number of non-pharmacological nursing interventions reduces the preoperative anxiety in patients undergoing surgical intervention. The findings display interventions that all have a significant effect on preoperative anxiety: acupuncture, massage, aromatherapy, relaxation exercises, music therapy, supporting conversation, pre-recorded information, oral information and written information and education. Common for all these interventions is that they are all performed when the care-relationship according to Fundamentals of Care is established.  No research was found to illustrate any difference between men and women in how the preoperative anxiety is affected by these nursing interventions. Conclusion: Non-pharmacological nursing interventions prior to surgery alleviate the pre-operative anxiety in patients. By using relatively simple and inexpensive measures, individually adapted to the patient’s requirements, the preoperative anxiety can be relieved. There is a lack in knowledge regarding differences between how nursing interventions affects the pre-operative anxiety in men versus in women. / Bakgrund: Patienter som ska genomgå ett kirurgiskt ingrepp känner nästan alltid oro inför detta. Rutinmässigt används oftast farmakologisk behandling för att dämpa preoperativ oro. Det finns olika strategier och omvårdnadsåtgärder som anestesisjuksköterskan kan använda för att bemöta patienter med preoperativ oro.  Syfte: Syftet är att beskriva vilka icke-farmakologiska omvårdnadsåtgärder som används av anestesisjuksköterskor för att lindra patienters preoperativa oro.  Metod: En litteraturstudie med systematisk ansats användes. 23 studier med kvantitativ metod mötte urvalskriterierna och inkluderades i studien. Huvudresultat: Ett flertal icke-farmakologiska omvårdnadsåtgärder minskar den preoperativa oron hos patienter som ska genomgå kirurgi. Resultatet visar interventioner som alla har signifikant effekt på den preoperativa oron; akupunktur, massage, aromterapi, avslappningsövningar, musikterapi, stödjande samtal, inspelad information, muntlig respektive skriftlig information och undervisning. Gemensamt för dessa interventioner är att de alla utförs när vårdrelationen enligt Fundamentals of Care är etablerad. Ingen forskning hittades som belyser eventuella skillnader mellan kvinnor respektive män i hur den preoperativa oron påverkas av omvårdnadsåtgärder. Slutsats: Icke-farmakologiska omvårdnadsåtgärder i anslutning till operation lindrar patienters preoperativa oro. Genom relativt enkla och billiga åtgärder anpassade efter individens önskemål kan den preoperativa oron minskas. Det saknas aktuell kunskap om skillnader i hur omvårdnadsåtgärder påverkar kvinnor respektive mäns preoperativa oro.

During later years, the primary care services are experiencing a heavier strain in terms of increasing expenses and higher demand for medical services. An increased awareness about pharmaceutical adverse effects and the global concern of antibiotic resistance has given self-care and active surveillance a stronger position within the primary care services. The management strategy for minor illnesses is important because care-seekers tend to repeat successful strategies from past events, and past experience with self-care drives future self-care practices. The overall aim of this thesis was to explore people’s experiences and needs when practicing self-care and receiving self-care advice for minor illnesses. This was achieved by studying people’s experiences with and knowledge of minor illnesses, self-care interventions and channels of information used when providing self-care for minor illness. Needs for confidence in self-care were studied, as well as supporting and obstructing factors in the practice of self-care. Satisfaction with telephone nursing and people’s experiences of reassurance in relation to the decision-making process in self-care for minor illness was explored. The results showed that experience correlated with self-rated knowledge of the condition, and the least common conditions most often generated a health care services consultation. To confidently practice self-care people needed good knowledge and understanding about obtaining symptom relief. Younger persons more often reported the need of having family or friends to talk to. Easy access to care was most often reported as a support in self-care, and a lack of knowledge about illnesses was most often reported as obstructing self-care. Care-seekers receiving self-care advice were less satisfied with the telephone nursing than care-seekers referred to medical care, and feeling reassured after the call was the most important factor influencing satisfaction. Self-care advice had a constricting influence on healthcare utilization, with 66.1% of the cases resulting in a lower level of care than first intended. The course of action that persons in self-care decided on was found to relate to uncertainty and perception of risk. Reassurance had the potential to allay doubts and fears to confidence, thereby influencing self-care and consultation behavior. In conclusion, symptoms of minor illness can cause uncertainty and concern, and reassurance is an important factor influencing people’s course of action when afflicted with minor illness. The nurse constitutes a calming force, and the encounter between the nurse and the care-seeker holds a unique possibility of reassurance and confidence that minor illness is self-limiting to its nature and that effective interventions can provide relief and comfort. Just as health is more than the absence of disease, self-care is more than the absence of medical care.

Children have the right to participate in matters concerning them. The Swedish Child Welfare Services constitute an arena in which a significant portion of open care interventions for children and their families take place, and thus a context in which children’s participation should be realized. The overall aim of this licentiate thesis is to explore how child participation is constructed in interventions provided by Swedish Child Welfare Services. The study is based on social constructionist theory and includes semi structured interviews with 11 children aged 7-16, whom had experience of receiving open care interventions provided by Swedish Child Welfare Services over a period of time and focus group discussions with 14 family social workers who provide suchlike interventions. The data were analysed using Thematic Analysis.     The first article, which has been published in a peer-review journal, is based on semi structured interviews with the children and focus group discussions with the family social workers. The article explores how child participation is constructed in interventions provided by Swedish Child Welfare Services and which elements are of importance to this process. The results suggest that child participation is a collaborative process in which both the child and the family social worker have an active role to play. Participation is done through a series of seemingly small, everyday actions by the child and the family social worker. By actively asking questions and allowing the child to practice participation and influence the process, the family social workers can, together with the child, work toward increased child participation in interventions.     The second article explores children's actions of participation and how these can be understood in relation to situational constraints using the concept of agency. The article is based on the interviews with the children. The findings suggests that children's actions, as described by the children, are formed in relation to the context. Some actions of participation can be described as permissible and some, when children behave in a way that exceeds the boundaries permitted by their position as children, disturb the existing order. The results suggest there are situational constraints, such as limited range of options available to influence the intervention, limited access to apply for support and limited ways to find new solutions when the children are not satisfied with an intervention.     The overall contribution of the study lies in the enhanced understanding of the collaborative process through which participation is done, as well as the increased knowledge of children’s actions of participation in a social work context. / <p>Paper II in dissertation as manuscript</p><p>Paper II is not included in the fulltext online</p>

<p>Care and treatment of women with inflammatory symptoms of the breast during lactation</p><p>Inflammation of the breast during lactation causes considerable discomfort to mothers and carries a risk of early abandonment of breastfeeding. Little is known about the effects of care interventions, including acupuncture, used for these mothers or about mothers’ experiences of the complaint. Aim: to study care and treatment given at a midwife-led breastfeeding clinic to mothers with inflammatory symptoms of the breast during lactation, to gain knowledge of mothers’ experiences of being afflicted by breast inflammation and to investigate factors which may be associated with the development of breast abscess. Methods: method triangulation was used to study different aspects of the phenomenon of inflammatory symptoms of the breast during lactation; two randomised controlled trials I (n = 88) and II (n = 210), a descriptive study III (n = 210), an interview study with a Grounded Theory approach IV (n = 14), and a population-based register study V (n = 1,454,068 singleton deliveries). Results: mothers’ symptoms were more effectively relieved when acupuncture was used but acupuncture treatment did not shorten contact with health services. Nine percent (I) and 15 % (II) respectively, of mothers were prescribed antibiotics. Twelve percent experienced renewed symptoms requiring health care contact within 6 weeks (III). Seven mothers (0.1% of breastfeeding mothers) developed breast abscess, which was comparable to the figure in the population-based study (V). The presence of Group B streptococci in the breast milk was related to longer contact with health care (II). Mothers’ “will to breastfeed” may make it possible for them to withstand physical and emotional difficulties caused by the illness. Mothers considered access to clinical expertise to be an important factor in their care (IV). Primiparous mothers, those over the age of 30 years and those who give birth after 41 weeks gestation appear to be at a significantly increased risk for the development of breast abscess (V).</p><p>Conclusions: mothers’ symptoms were more effectively dissipated when acupuncture treatment was used. However, acupuncture treatment did not shorten mothers’ contact with health care services. Interventions, including acupuncture treatment for relief of symptoms may help mothers to withstand their discomfort and await the body’s own anti-inflammatory response and therefore make it possible to substantially reduce the use of antibiotic therapy for this group. The results indicate a need for a better understanding of the influence on breastfeeding of hormones administered to birthing and breastfeeding women. The availability of immediate clinical expertise is an important factor for these mothers, which health care planners should be aware of. Information on potential breastfeeding problems should be improved.</p><p>Key words: acupuncture, antibiotics, breast abscess, breastfeeding, care interventions, inflammatory symptoms, lactation mastitis</p> / <p>Vård och behandling av kvinnor med inflammation i brösten under amningsperioden</p><p>Bröstinflammation orsakar stort obehag för ammande mödrar och innebär en risk för att amning avslutas i förtid. Det finns ringa kunskap om effekterna av interventioner, inkluderande akupunktur, som används vid vård av dessa kvinnor. Det saknas även kunskap om mödrarnas upplevelser av bröstinflammation. Syfte: att studera vård och behandling av kvinnor med bröstinflammation vid en amningsmottagning ledd av barnmorskor, att utveckla kunskap om mödrars upplevelser av att vara drabbad av bröst inflammation samt att undersöka faktorer som kan ha betydelse för utvecklandet av bröstabscess. Metoder: metodtriangulering användes för att studera olika aspekter av fenomenet bröstinflammation under amningsperioden; två randomiserade kontrollerade studier I (n = 88) and II (n = 210), en deskriptiv studie III (n = 210), en intervjustudie med en grounded theory ansats IV (n = 14) och en populationsbaserat registerstudie V (n = 1 454 068 enkelbörds förlossningar). Resultat: mödrarnas symptom lindrades mer effektivt med akupunktur akupunkturbehandling men förkortade inte deras kontakt med vården. Nio procent (I) respektive 15 % (II) av mödrarna fick antibiotika. Tolv procent fick recidiv vilket föranledde kontakt med vården inom 6 veckor (III). Sju mödrar (0,1 % av ammande mödrar) utvecklade bröstabscess (II), vilket överensstämde med resultat i den populationsbaserade studien (V). Förekomsten av Grupp B streptococcer i bröstmjölken var relaterad till längre vårdkontakt (II). Mödrarnas viljan att amma kan göra det möjligt för dem att uthärda fysiska och emotionella svårigheter som sjukdomen innebär (IV). Tillgång till klinisk expertis var en viktig del av vården för dessa kvinnor. Att vara förstföderska kan innebära en något större risk för utveckling av bröstabscess. Mödrar över 30 år samt de som föder efter graviditetsvecka 41 har också en ökad risk för abscess (V).</p><p>Slutsatser: mödrarnas symptom lindrades mer effektivt när akupunktur användes. Kontakten med vården blev dock inte förkortad av akupunkturbehandling. Interventioner som inkluderar akupunkturbehandling kan tillåta mödrar att invänta kroppens anti-inflammatoriska respons och kan därför möjliggöra en avsevärd minskning av antibiotika terapi för dessa mödrar. Resultaten visar behov av att bättre förstå hur amning påverkas av hormoner administrerade till kvinnor under förlossningsarbete och amningen. Tillgång till omedelbar klinisk expertis är en viktig faktor för dessa mödrar vilket hälso- och sjukvårdsplanerare bör vara medvetna om. Förbättrad information angående potentiella amningsproblem bör eftersträvas.</p><p>Nyckelord: akupunktur, amning, antibiotika, bröstabscess, bröstinflammation, interventioner, mastit, mjölkstockning</p>

Care and treatment of women with inflammatory symptoms of the breast during lactation Inflammation of the breast during lactation causes considerable discomfort to mothers and carries a risk of early abandonment of breastfeeding. Little is known about the effects of care interventions, including acupuncture, used for these mothers or about mothers’ experiences of the complaint. Aim: to study care and treatment given at a midwife-led breastfeeding clinic to mothers with inflammatory symptoms of the breast during lactation, to gain knowledge of mothers’ experiences of being afflicted by breast inflammation and to investigate factors which may be associated with the development of breast abscess. Methods: method triangulation was used to study different aspects of the phenomenon of inflammatory symptoms of the breast during lactation; two randomised controlled trials I (n = 88) and II (n = 210), a descriptive study III (n = 210), an interview study with a Grounded Theory approach IV (n = 14), and a population-based register study V (n = 1,454,068 singleton deliveries). Results: mothers’ symptoms were more effectively relieved when acupuncture was used but acupuncture treatment did not shorten contact with health services. Nine percent (I) and 15 % (II) respectively, of mothers were prescribed antibiotics. Twelve percent experienced renewed symptoms requiring health care contact within 6 weeks (III). Seven mothers (0.1% of breastfeeding mothers) developed breast abscess, which was comparable to the figure in the population-based study (V). The presence of Group B streptococci in the breast milk was related to longer contact with health care (II). Mothers’ “will to breastfeed” may make it possible for them to withstand physical and emotional difficulties caused by the illness. Mothers considered access to clinical expertise to be an important factor in their care (IV). Primiparous mothers, those over the age of 30 years and those who give birth after 41 weeks gestation appear to be at a significantly increased risk for the development of breast abscess (V). Conclusions: mothers’ symptoms were more effectively dissipated when acupuncture treatment was used. However, acupuncture treatment did not shorten mothers’ contact with health care services. Interventions, including acupuncture treatment for relief of symptoms may help mothers to withstand their discomfort and await the body’s own anti-inflammatory response and therefore make it possible to substantially reduce the use of antibiotic therapy for this group. The results indicate a need for a better understanding of the influence on breastfeeding of hormones administered to birthing and breastfeeding women. The availability of immediate clinical expertise is an important factor for these mothers, which health care planners should be aware of. Information on potential breastfeeding problems should be improved. Key words: acupuncture, antibiotics, breast abscess, breastfeeding, care interventions, inflammatory symptoms, lactation mastitis / Vård och behandling av kvinnor med inflammation i brösten under amningsperioden Bröstinflammation orsakar stort obehag för ammande mödrar och innebär en risk för att amning avslutas i förtid. Det finns ringa kunskap om effekterna av interventioner, inkluderande akupunktur, som används vid vård av dessa kvinnor. Det saknas även kunskap om mödrarnas upplevelser av bröstinflammation. Syfte: att studera vård och behandling av kvinnor med bröstinflammation vid en amningsmottagning ledd av barnmorskor, att utveckla kunskap om mödrars upplevelser av att vara drabbad av bröst inflammation samt att undersöka faktorer som kan ha betydelse för utvecklandet av bröstabscess. Metoder: metodtriangulering användes för att studera olika aspekter av fenomenet bröstinflammation under amningsperioden; två randomiserade kontrollerade studier I (n = 88) and II (n = 210), en deskriptiv studie III (n = 210), en intervjustudie med en grounded theory ansats IV (n = 14) och en populationsbaserat registerstudie V (n = 1 454 068 enkelbörds förlossningar). Resultat: mödrarnas symptom lindrades mer effektivt med akupunktur akupunkturbehandling men förkortade inte deras kontakt med vården. Nio procent (I) respektive 15 % (II) av mödrarna fick antibiotika. Tolv procent fick recidiv vilket föranledde kontakt med vården inom 6 veckor (III). Sju mödrar (0,1 % av ammande mödrar) utvecklade bröstabscess (II), vilket överensstämde med resultat i den populationsbaserade studien (V). Förekomsten av Grupp B streptococcer i bröstmjölken var relaterad till längre vårdkontakt (II). Mödrarnas viljan att amma kan göra det möjligt för dem att uthärda fysiska och emotionella svårigheter som sjukdomen innebär (IV). Tillgång till klinisk expertis var en viktig del av vården för dessa kvinnor. Att vara förstföderska kan innebära en något större risk för utveckling av bröstabscess. Mödrar över 30 år samt de som föder efter graviditetsvecka 41 har också en ökad risk för abscess (V). Slutsatser: mödrarnas symptom lindrades mer effektivt när akupunktur användes. Kontakten med vården blev dock inte förkortad av akupunkturbehandling. Interventioner som inkluderar akupunkturbehandling kan tillåta mödrar att invänta kroppens anti-inflammatoriska respons och kan därför möjliggöra en avsevärd minskning av antibiotika terapi för dessa mödrar. Resultaten visar behov av att bättre förstå hur amning påverkas av hormoner administrerade till kvinnor under förlossningsarbete och amningen. Tillgång till omedelbar klinisk expertis är en viktig faktor för dessa mödrar vilket hälso- och sjukvårdsplanerare bör vara medvetna om. Förbättrad information angående potentiella amningsproblem bör eftersträvas. Nyckelord: akupunktur, amning, antibiotika, bröstabscess, bröstinflammation, interventioner, mastit, mjölkstockning

Prieš priimant sprendimą ar verta medicininę naujovę taikyti klinikinėje praktikoje tiek medicinine, tiek ekonomine prasme, atliekama gydymo metodų efektyvumo ekonominė analizė. Kaštų efektyvumo analizė – sudėtinė sveikatos ekonomikos dalis. Ji nustato ryšį tarp taikomo gydymo metodo naudojamų išteklių (kaštų) ir teikiamo naudingumo sveikatai (poveikio sveikatai). Šio darbo tikslas: išnagrinėjus ekonominės analizės metodus, pateikti kaštų efektyvumo analizės modelį bei patikrinti jį „N“ sveikatos priežiūros įstaigoje taikomiems gydymo metodams. Suformuluotam tikslui pasiekti keliami uždaviniai: 1. Remiantis mokslinės literatūros analize, pateikti kaštų efektyvumo analizės kaip sudėtinės sveikatos ekonomikos dalies charakteristiką; 2. Išnagrinėti kaštų efektyvumo analizės taikymą šiandieninėse Lietuvos sveikatos priežiūros įstaigose; 3. Pasiūlyti kaštų efektyvumo analizės modelį; 4. Atlikti „N“ sveikatos priežiūros įstaigoje taikomų gydymo metodų kaštų efektyvumo analizę. Tyrimo objektas: sveikatos priežiūros įstaigos kaštai. Išanalizavus ekonominės analizės taikymo galimybes, atlikta kaštų efektyvumo analizė „N“ sveikatos priežiūros įstaigoje. Taikyti du ekonominės analizės metodai: kaštų naudingumo ir kaštų efektyvumo analizės metodai. Analizės metu įvertinti gydymo metodų kaštai ir klinikinis poveikis sveikatai. Tyrime analizuojami trys gydymo metodai: standartinis gydymo metodas – judesio terapija salėje bei du alternatyvūs gydymo metodai – judesio terapija vandenyje ir... [toliau žr. visą tekstą] / Before making a decision to employ an innovation in medicine on both medical and economical dimensions, performed economic analysis of effectiveness of health interventions. Cost effectiveness analysis is constituent of health economic. It estimates the relation between cost ant effectiveness of health interventions. The aim of this research: after study of methods of economic evaluation, to supply the model of cost effectiveness analysis and to test it for health interventions of “N” health care institution. The tasks to reach the established aim of this study are: 1. By analysis of literature, to supply the reference of cost effectiveness analysis as constituent of health economic; 2. To study the use of cost effectiveness analysis in nowadays Lithuanian’s health care institutions; 3. To offer the model of cost effectiveness analysis; 4. To perform the cost effectiveness analysis of health interventions of “N” health care institution. The object of research is: cost of health care institution. Having studied the opportunities of economic analysis, performed the cost effectiveness analysis in “N” health care institution. There were used two methods of economic analysis: cost-effectiveness and cost-utility methods. On the analysis estimated cost and effectiveness of health interventions. In the research analyzed three health interventions: standard health intervention – physiotherapy in exercises room and two alternatives health interventions – physiotherapy in the water and... [to full text]

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.