Core components of the rural nurse specialist role in New Zealand
Introduction: New Zealand has a rural population with unique healthcare needs. Traditionally, rural health care has been provided by medical general practitioners (GPs); however, as the number of GPs declines, the rural nurse specialist (RNS) role has emerged. The RNS is a registered nurse with adva...
Gespeichert in:
| Veröffentlicht in: | Rural and remote health 2018-01, Vol.18 (2), p.1-8 |
|---|---|
| Hauptverfasser: | , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 8 |
|---|---|
| container_issue | 2 |
| container_start_page | 1 |
| container_title | Rural and remote health |
| container_volume | 18 |
| creator | Bell, Jennie Crawford, Ruth Holloway, Kathy |
| description | Introduction: New Zealand has a rural population with unique healthcare needs. Traditionally, rural health care has been provided by medical general practitioners (GPs); however, as the number of GPs declines, the rural nurse specialist (RNS) role has emerged. The RNS is a registered nurse with advanced nursing skills that enable independent, autonomous practice within rural areas. The health needs of each rural community are specific to that area and the RNS role has been developed according to local healthcare needs. The purpose of this research was to provide a description of the RNS role in New Zealand. Methods: A descriptive exploratory approach was used in this qualitative study. The study was conducted in two parts. Phase 1 consisted of document content analysis of RNS position descriptions and phase 2 comprised four semi-structured interviews with RNSs. Data were analysed using thematic analysis. The Modified Strong Model of Advanced Practice was utilised as a framework for thematic analysis during both phases. Results: Rural nurse specialists demonstrated a wide variance in the understanding of the term 'RNS'. The RNS role was found to include provision of care across a wide range of settings according to local needs. Advanced assessment skills were expected by employers and considered a major component of the role by RNSs. Advanced assessments skills were utilised to enhance communication and thus increase collaboration with other health professionals. The ability to effectively communicate and collaborate with other health professionals was found to be a high priority. However, RNSs perceived that collaboration and thus patient care was affected by a lack of role clarity. The nurse practitioner (NP) role in New Zealand was considered more effective, with greater role recognition for the NP. Education was considered essential to maintain advanced assessment skills. RNSs identified providing education in the form of health promotion relevant to local needs as important. There was a lack of information regarding publication and professional leadership, highlighting this as an area for development. Another issue was the importance of stress management in an isolated area. Conclusion: The RNS role requires advanced knowledge to provide independent patient care. Advanced skills utilised include assessment, diagnosis and treatment of patients. RNSs must have postgraduate education to develop the advanced skills required in this role. RNSs perceive the |
| doi_str_mv | 10.22605/RRH4260 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2051074054</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><informt_id>10.3316/informit.151001617702905</informt_id><sourcerecordid>2675437426</sourcerecordid><originalsourceid>FETCH-LOGICAL-c422t-c37d25cd50e38372370c182f36832100dab465e13fde00bbbbfbf01098bcda603</originalsourceid><addsrcrecordid>eNpdkFtLxDAQhYMo3sFfIAFffFmd3JruoyzqCqIg-uJLSNOpZmmbNWkR_71R1wvOywzMx5kzh5ADBiecF6BO7-7mMg9rZJtJqSaFUHL9z7xFdlJaAHANJd8kW3xaaianbJuczUJE6kK3DD32Q6KhocMz0jhG29J-jAlpWqLztvVpoDG0SH1Pb_CVPqJtbV_vkY3Gtgn3V32XPFyc38_mk-vby6vZ2fXESc6HiRO65srVClCUQnOhwbGSN6IoBWcAta1koZCJpkaAKldTNcBgWlautgWIXXL8pbuM4WXENJjOJ4dt9oBhTIaDYqAlKJnRo3_oIoyxz-4ML3QGdA7rV9DFkFLExiyj72x8MwzMZ6xmFWtGD1eCY9Vh_QN-55iB-y8gdn4wLrQtusGHPi3skExCG92z8X0TPvchPpk6-I87QrDid8HyC8AKpjXwKSjxDqwbjYg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2675437426</pqid></control><display><type>article</type><title>Core components of the rural nurse specialist role in New Zealand</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Bell, Jennie ; Crawford, Ruth ; Holloway, Kathy</creator><creatorcontrib>Bell, Jennie ; Crawford, Ruth ; Holloway, Kathy</creatorcontrib><description>Introduction: New Zealand has a rural population with unique healthcare needs. Traditionally, rural health care has been provided by medical general practitioners (GPs); however, as the number of GPs declines, the rural nurse specialist (RNS) role has emerged. The RNS is a registered nurse with advanced nursing skills that enable independent, autonomous practice within rural areas. The health needs of each rural community are specific to that area and the RNS role has been developed according to local healthcare needs. The purpose of this research was to provide a description of the RNS role in New Zealand. Methods: A descriptive exploratory approach was used in this qualitative study. The study was conducted in two parts. Phase 1 consisted of document content analysis of RNS position descriptions and phase 2 comprised four semi-structured interviews with RNSs. Data were analysed using thematic analysis. The Modified Strong Model of Advanced Practice was utilised as a framework for thematic analysis during both phases. Results: Rural nurse specialists demonstrated a wide variance in the understanding of the term 'RNS'. The RNS role was found to include provision of care across a wide range of settings according to local needs. Advanced assessment skills were expected by employers and considered a major component of the role by RNSs. Advanced assessments skills were utilised to enhance communication and thus increase collaboration with other health professionals. The ability to effectively communicate and collaborate with other health professionals was found to be a high priority. However, RNSs perceived that collaboration and thus patient care was affected by a lack of role clarity. The nurse practitioner (NP) role in New Zealand was considered more effective, with greater role recognition for the NP. Education was considered essential to maintain advanced assessment skills. RNSs identified providing education in the form of health promotion relevant to local needs as important. There was a lack of information regarding publication and professional leadership, highlighting this as an area for development. Another issue was the importance of stress management in an isolated area. Conclusion: The RNS role requires advanced knowledge to provide independent patient care. Advanced skills utilised include assessment, diagnosis and treatment of patients. RNSs must have postgraduate education to develop the advanced skills required in this role. RNSs perceive the NP role as having better role clarity; therefore, all participants were considering becoming an NP. There are barriers to becoming an NP, thus an expansion of the current RNS role is recommended. Further recommendations from this study include increased professional leadership to improve RNS visibility and further continued interprofessional education to enhance collaboration.</description><identifier>ISSN: 1445-6354</identifier><identifier>EISSN: 1445-6354</identifier><identifier>DOI: 10.22605/RRH4260</identifier><identifier>PMID: 29871491</identifier><language>eng</language><publisher>Townsville QLD: James Cook University</publisher><subject>Attitudes ; Care ; Clinical Competence ; Collaboration ; Communication ; Community ; Content analysis ; Cooperative Behavior ; Data analysis ; Education ; Emergency medical care ; Evaluation ; Health care ; Health Education - organization & administration ; Health promotion ; Health Promotion - organization & administration ; Health services ; Humans ; Infections ; Interprofessional Relations ; Interviews ; Interviews as Topic ; Medical diagnosis ; New Zealand ; Nurse practitioners ; Nurse Practitioners - organization & administration ; Nurse specialists ; Nurse Specialists - organization & administration ; Nurse Specialists - standards ; Nurse's Role ; Nursing ; Nursing care ; Nursing skills ; Patients ; Practice ; Qualitative Research ; Role playing ; Rural areas ; Rural Health Services - organization & administration ; Rural Health Services - standards ; Rural nursing ; Rural populations ; Social aspects ; Stress, Psychological - therapy ; Supervisors</subject><ispartof>Rural and remote health, 2018-01, Vol.18 (2), p.1-8</ispartof><rights>2018. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c422t-c37d25cd50e38372370c182f36832100dab465e13fde00bbbbfbf01098bcda603</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,864,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29871491$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bell, Jennie</creatorcontrib><creatorcontrib>Crawford, Ruth</creatorcontrib><creatorcontrib>Holloway, Kathy</creatorcontrib><title>Core components of the rural nurse specialist role in New Zealand</title><title>Rural and remote health</title><addtitle>Rural Remote Health</addtitle><description>Introduction: New Zealand has a rural population with unique healthcare needs. Traditionally, rural health care has been provided by medical general practitioners (GPs); however, as the number of GPs declines, the rural nurse specialist (RNS) role has emerged. The RNS is a registered nurse with advanced nursing skills that enable independent, autonomous practice within rural areas. The health needs of each rural community are specific to that area and the RNS role has been developed according to local healthcare needs. The purpose of this research was to provide a description of the RNS role in New Zealand. Methods: A descriptive exploratory approach was used in this qualitative study. The study was conducted in two parts. Phase 1 consisted of document content analysis of RNS position descriptions and phase 2 comprised four semi-structured interviews with RNSs. Data were analysed using thematic analysis. The Modified Strong Model of Advanced Practice was utilised as a framework for thematic analysis during both phases. Results: Rural nurse specialists demonstrated a wide variance in the understanding of the term 'RNS'. The RNS role was found to include provision of care across a wide range of settings according to local needs. Advanced assessment skills were expected by employers and considered a major component of the role by RNSs. Advanced assessments skills were utilised to enhance communication and thus increase collaboration with other health professionals. The ability to effectively communicate and collaborate with other health professionals was found to be a high priority. However, RNSs perceived that collaboration and thus patient care was affected by a lack of role clarity. The nurse practitioner (NP) role in New Zealand was considered more effective, with greater role recognition for the NP. Education was considered essential to maintain advanced assessment skills. RNSs identified providing education in the form of health promotion relevant to local needs as important. There was a lack of information regarding publication and professional leadership, highlighting this as an area for development. Another issue was the importance of stress management in an isolated area. Conclusion: The RNS role requires advanced knowledge to provide independent patient care. Advanced skills utilised include assessment, diagnosis and treatment of patients. RNSs must have postgraduate education to develop the advanced skills required in this role. RNSs perceive the NP role as having better role clarity; therefore, all participants were considering becoming an NP. There are barriers to becoming an NP, thus an expansion of the current RNS role is recommended. Further recommendations from this study include increased professional leadership to improve RNS visibility and further continued interprofessional education to enhance collaboration.</description><subject>Attitudes</subject><subject>Care</subject><subject>Clinical Competence</subject><subject>Collaboration</subject><subject>Communication</subject><subject>Community</subject><subject>Content analysis</subject><subject>Cooperative Behavior</subject><subject>Data analysis</subject><subject>Education</subject><subject>Emergency medical care</subject><subject>Evaluation</subject><subject>Health care</subject><subject>Health Education - organization & administration</subject><subject>Health promotion</subject><subject>Health Promotion - organization & administration</subject><subject>Health services</subject><subject>Humans</subject><subject>Infections</subject><subject>Interprofessional Relations</subject><subject>Interviews</subject><subject>Interviews as Topic</subject><subject>Medical diagnosis</subject><subject>New Zealand</subject><subject>Nurse practitioners</subject><subject>Nurse Practitioners - organization & administration</subject><subject>Nurse specialists</subject><subject>Nurse Specialists - organization & administration</subject><subject>Nurse Specialists - standards</subject><subject>Nurse's Role</subject><subject>Nursing</subject><subject>Nursing care</subject><subject>Nursing skills</subject><subject>Patients</subject><subject>Practice</subject><subject>Qualitative Research</subject><subject>Role playing</subject><subject>Rural areas</subject><subject>Rural Health Services - organization & administration</subject><subject>Rural Health Services - standards</subject><subject>Rural nursing</subject><subject>Rural populations</subject><subject>Social aspects</subject><subject>Stress, Psychological - therapy</subject><subject>Supervisors</subject><issn>1445-6354</issn><issn>1445-6354</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkFtLxDAQhYMo3sFfIAFffFmd3JruoyzqCqIg-uJLSNOpZmmbNWkR_71R1wvOywzMx5kzh5ADBiecF6BO7-7mMg9rZJtJqSaFUHL9z7xFdlJaAHANJd8kW3xaaianbJuczUJE6kK3DD32Q6KhocMz0jhG29J-jAlpWqLztvVpoDG0SH1Pb_CVPqJtbV_vkY3Gtgn3V32XPFyc38_mk-vby6vZ2fXESc6HiRO65srVClCUQnOhwbGSN6IoBWcAta1koZCJpkaAKldTNcBgWlautgWIXXL8pbuM4WXENJjOJ4dt9oBhTIaDYqAlKJnRo3_oIoyxz-4ML3QGdA7rV9DFkFLExiyj72x8MwzMZ6xmFWtGD1eCY9Vh_QN-55iB-y8gdn4wLrQtusGHPi3skExCG92z8X0TPvchPpk6-I87QrDid8HyC8AKpjXwKSjxDqwbjYg</recordid><startdate>20180101</startdate><enddate>20180101</enddate><creator>Bell, Jennie</creator><creator>Crawford, Ruth</creator><creator>Holloway, Kathy</creator><general>James Cook University</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20180101</creationdate><title>Core components of the rural nurse specialist role in New Zealand</title><author>Bell, Jennie ; Crawford, Ruth ; Holloway, Kathy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-c37d25cd50e38372370c182f36832100dab465e13fde00bbbbfbf01098bcda603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Attitudes</topic><topic>Care</topic><topic>Clinical Competence</topic><topic>Collaboration</topic><topic>Communication</topic><topic>Community</topic><topic>Content analysis</topic><topic>Cooperative Behavior</topic><topic>Data analysis</topic><topic>Education</topic><topic>Emergency medical care</topic><topic>Evaluation</topic><topic>Health care</topic><topic>Health Education - organization & administration</topic><topic>Health promotion</topic><topic>Health Promotion - organization & administration</topic><topic>Health services</topic><topic>Humans</topic><topic>Infections</topic><topic>Interprofessional Relations</topic><topic>Interviews</topic><topic>Interviews as Topic</topic><topic>Medical diagnosis</topic><topic>New Zealand</topic><topic>Nurse practitioners</topic><topic>Nurse Practitioners - organization & administration</topic><topic>Nurse specialists</topic><topic>Nurse Specialists - organization & administration</topic><topic>Nurse Specialists - standards</topic><topic>Nurse's Role</topic><topic>Nursing</topic><topic>Nursing care</topic><topic>Nursing skills</topic><topic>Patients</topic><topic>Practice</topic><topic>Qualitative Research</topic><topic>Role playing</topic><topic>Rural areas</topic><topic>Rural Health Services - organization & administration</topic><topic>Rural Health Services - standards</topic><topic>Rural nursing</topic><topic>Rural populations</topic><topic>Social aspects</topic><topic>Stress, Psychological - therapy</topic><topic>Supervisors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bell, Jennie</creatorcontrib><creatorcontrib>Crawford, Ruth</creatorcontrib><creatorcontrib>Holloway, Kathy</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Health Management</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Rural and remote health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bell, Jennie</au><au>Crawford, Ruth</au><au>Holloway, Kathy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Core components of the rural nurse specialist role in New Zealand</atitle><jtitle>Rural and remote health</jtitle><addtitle>Rural Remote Health</addtitle><date>2018-01-01</date><risdate>2018</risdate><volume>18</volume><issue>2</issue><spage>1</spage><epage>8</epage><pages>1-8</pages><issn>1445-6354</issn><eissn>1445-6354</eissn><abstract>Introduction: New Zealand has a rural population with unique healthcare needs. Traditionally, rural health care has been provided by medical general practitioners (GPs); however, as the number of GPs declines, the rural nurse specialist (RNS) role has emerged. The RNS is a registered nurse with advanced nursing skills that enable independent, autonomous practice within rural areas. The health needs of each rural community are specific to that area and the RNS role has been developed according to local healthcare needs. The purpose of this research was to provide a description of the RNS role in New Zealand. Methods: A descriptive exploratory approach was used in this qualitative study. The study was conducted in two parts. Phase 1 consisted of document content analysis of RNS position descriptions and phase 2 comprised four semi-structured interviews with RNSs. Data were analysed using thematic analysis. The Modified Strong Model of Advanced Practice was utilised as a framework for thematic analysis during both phases. Results: Rural nurse specialists demonstrated a wide variance in the understanding of the term 'RNS'. The RNS role was found to include provision of care across a wide range of settings according to local needs. Advanced assessment skills were expected by employers and considered a major component of the role by RNSs. Advanced assessments skills were utilised to enhance communication and thus increase collaboration with other health professionals. The ability to effectively communicate and collaborate with other health professionals was found to be a high priority. However, RNSs perceived that collaboration and thus patient care was affected by a lack of role clarity. The nurse practitioner (NP) role in New Zealand was considered more effective, with greater role recognition for the NP. Education was considered essential to maintain advanced assessment skills. RNSs identified providing education in the form of health promotion relevant to local needs as important. There was a lack of information regarding publication and professional leadership, highlighting this as an area for development. Another issue was the importance of stress management in an isolated area. Conclusion: The RNS role requires advanced knowledge to provide independent patient care. Advanced skills utilised include assessment, diagnosis and treatment of patients. RNSs must have postgraduate education to develop the advanced skills required in this role. RNSs perceive the NP role as having better role clarity; therefore, all participants were considering becoming an NP. There are barriers to becoming an NP, thus an expansion of the current RNS role is recommended. Further recommendations from this study include increased professional leadership to improve RNS visibility and further continued interprofessional education to enhance collaboration.</abstract><cop>Townsville QLD</cop><pub>James Cook University</pub><pmid>29871491</pmid><doi>10.22605/RRH4260</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1445-6354 |
| ispartof | Rural and remote health, 2018-01, Vol.18 (2), p.1-8 |
| issn | 1445-6354 1445-6354 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2051074054 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Attitudes Care Clinical Competence Collaboration Communication Community Content analysis Cooperative Behavior Data analysis Education Emergency medical care Evaluation Health care Health Education - organization & administration Health promotion Health Promotion - organization & administration Health services Humans Infections Interprofessional Relations Interviews Interviews as Topic Medical diagnosis New Zealand Nurse practitioners Nurse Practitioners - organization & administration Nurse specialists Nurse Specialists - organization & administration Nurse Specialists - standards Nurse's Role Nursing Nursing care Nursing skills Patients Practice Qualitative Research Role playing Rural areas Rural Health Services - organization & administration Rural Health Services - standards Rural nursing Rural populations Social aspects Stress, Psychological - therapy Supervisors |
| title | Core components of the rural nurse specialist role in New Zealand |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-28T16%3A22%3A21IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Core%20components%20of%20the%20rural%20nurse%20specialist%20role%20in%20New%20Zealand&rft.jtitle=Rural%20and%20remote%20health&rft.au=Bell,%20Jennie&rft.date=2018-01-01&rft.volume=18&rft.issue=2&rft.spage=1&rft.epage=8&rft.pages=1-8&rft.issn=1445-6354&rft.eissn=1445-6354&rft_id=info:doi/10.22605/RRH4260&rft_dat=%3Cproquest_cross%3E2675437426%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2675437426&rft_id=info:pmid/29871491&rft_informt_id=10.3316/informit.151001617702905&rfr_iscdi=true |