It might be that these practices do not provide adequate care to type II diabetes patients, which may be explained by unavailability of primary care nurses.
Commonly, lack of knowledge, unavailability of resources, high costs, nursing convenience, fear of adverse events or patient discomfort, and (most importantly) disagreement on the strength of the supporting evidence [ 6] in conjunction with external barriers can affect a physician's ability to execute recommendations [ 7].
47 These findings are particularly disconcerting given the much younger age demographic of the First Nations Hamilton population and the documented barriers to receiving healthcare services including long wait lists, challenges with accessing and affording transportation and the unavailability of primary care providers including physicians, nurses and other healthcare providers in the area.
Lack of a standard tool for practice and unavailability of PC unit in the hospitals involved were challenges of this study to assess the real practice of nurses on PC.
Process indicators (existence of patient will/advance directive, substitution arrangement in case of unavailability of the treating general practitioner, cooperation with nursing services) are assessed at the beginning of the observation period and at the end if changes occur.
A range of barriers to the use of the CDSS were identified, some are easily removed, such as insufficient capture of cardiovascular risk, while others are more deeply embedded in current practice, such as unavailability of some investigations or no prescribing privileges for nurses.
In the HM group, 11 of 90 participants (12%) did not receive the allocated intervention either due to withdrawal of consent (n=5) or unavailability of a mentor (n=6) due to operational issues in the community nursing service related to an influenza epidemic.
Our study had some limitations: a) Due to the unavailability of data, the study focused on only two categories of health professionals (i.e. doctors and nurses) even though there was anecdotal evidence of brain drain among other cadres.
The unavailability of unhealthy foods and high cost of healthy foods in the hospitals' cafeterias were associated with unhealthy eating habits by the nurses in this study and may be a possible factor contributing to the problem of overweight and obesity.
