Showing papers by "Karen Francis published in 2008"

Memoing in qualitative research: Probing data and processes

Abstract: This paper explores memoing in the context of qualitative research methodologies. The functions of memos in the research process are discussed and a number of techniques for employing memo writing to enhance the research experience and outcomes are examined. Memoing is often discussed in the literature as a technique employed in grounded theory research, yet there is limited exploration of the value of memo writing in qualitative methodologies generally. Memoing serves to assist the researcher in making conceptual leaps from raw data to those abstractions that explain research phenomena in the context in which it is examined. Memos can be effectively employed by both the novice and experienced researcher as a procedural and analytical strategy throughout the research process. Data exploration is enhanced, continuity of conception and contemplation is enabled and communication is facilitated through the use of memoing. While guidelines exist to aid in the production and use of memos, memoing remains a flex...

Where have all the young ones gone: implications for the nursing workforce.

Abstract: The global nursing shortage, coupled with an ageing nursing workforce, has placed significant pressure on the Australian Government to implement strategies to meet future nursing demands as well as develop strategies to manage the current crisis. In response, the Australian government funded additional undergraduate places at universities between 2002 and 2008 and offered financial incentives for nurses who were not currently employed to return to practice. Many undergraduate places at the university (in all disciplines) have been taken up by mature-aged students. The high percentage of graduating, mature-aged nursing students is helping to alleviate the current nursing shortage, but runs the risk of exacerbating the shortage projected to occur around the year 2020. This article postulates that graduating this high percentage of mature-aged nursing students is making a significant contribution to nursing today, helping to alleviate the current nursing shortage. However, it runs the risk of exacerbating the shortage projected to occur around the year 2020. In this article the authors explore the current nursing shortage and the changing educational opportunities that affect recruitment of mature-aged students into tertiary-based nursing programs. Recommendations are provided for appropriate succession planning for the future. Citation: Drury, V., Francis, K., Chapman, Y. "Where Have All the Young Ones Gone: Implications for the Nursing Workforce" (December 5, 2008) OJIN: The Online Journal of Issues in Nursing Vol 14 No 1. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No1Jan09/ArticlePreviousTopic/YoungOnesandNursingWorkforce.aspx Key words: mature-aged students, nursing education, nursing workforce, undergraduate education Globally the nursing workforce is ageing with fewer young people entering the profession to replace the large number of baby boomers due to retire in the coming decade (Erickson & Grove, 2007; Peterson, 2001b). Currently there is dissatisfaction amongst nurses who cite heavy workloads; shift work; minimal mentoring, supervision and support; low wages; poor working conditions; minimal professional opportunities; and limited autonomy as contributing to the number of nurses leaving the profession (Cline, Reilly, & Moore, 2003; Peterson, 2001a; Strachota, Normandin, Nancy, Clary, & Krukow, 2003). In 2004 the average age of a nurse in Australia was 43.2 years. The proportion of nurses 50 years or over increased from 24% in 2001 to 35% in 2005 (Australian Institute of Health and Welfare, 2006; Rosenthal, 2008). Currently in the United Kingdom (UK) one in five nurses is over 50 (Buchan & Seccombe, 2003; Watson, Manthorpe, & Andrews, 2003). This pattern is the same globally with the United States (US), New Zealand, Canada, and European countries all reporting an ageing nursing workforce (International Council of Nurses, 2008; National Centre for Health Workforce Analysis, 2000; O'Malley & Annals, 2004a; United States Department of Health and Human Services, 2000). Buerhaus et al. (2000) asserted that by 2020 the largest cohort of nurses will be between 50 and 69 years, and that the retirement of these nurse will exacerbate the shortage of nurses at that time. If the present trajectory continues, it could be postulated that over the next two decades 75% of nurses working in these countries today are likely to retire. Compounding the problem of an ageing workforce is the age at which undergraduate (pre-licensure / pre-registration) nursing students commence and complete their courses. There is evidence to suggest that globally fewer school leavers (people who have completed their high school education and are generally 17 or 18 years of age), who traditionally were the core of pre-registration nursing programs, are choosing nursing as a career (Aiken et al., 2001; Buerhaus & Staiger, 1999; Hopkins, 2001; O'Malley & Annals, 2004b; United States Department of Health and Human Services, 2000). …

The crusade--a metaphorical explication of the journey made by mature female undergraduate nursing students.

Abstract: A B S T R A C T Introduction: Mature students now account for a significant percentage of undergraduate nursing students. For most mature students, application for access to a university course and subsequent enrolment will generate changes that can have long-term effects on their and their family's lives. Commencing university study is a major transition in the mature student's life, producing increased stress and lifestyle adjustment and changes. The mature age student participating in tertiary study has undergone, and continues to experience, transition, resulting in new social networks, new behaviours and a new sense of self. Little has been written about this rite of passage and the journey these students take as they negotiate learning to nurse. Methods: The constructivist grounded theory utilised is an interpretive research method that uses the constant comparative method to reduce data and develop categories and codes. Data collection and data analysis occurs concurrently but also cyclically. Ten participants were interviewed from two rural Australian universities for this study. Results: The mature students in this study identified five discrete yet overlapping stages in their university journey, expressed as: (1) initiating the crusade; (2) engaging the force; (3) retreating and regrouping; (4) soldiering on; and (5) the victory march. Initiating the crusade involves mature students preparing for university, while engaging the force examines the beginning of the university journey whereby participants identify new skills needed to learn to navigate their student role. Retreating and regrouping occurs when students' emotional integrity is threatened and involves students harnessing emotional strength through support from peers that allows them to soldier on or to keep going despite crisis and conflicting role demands. Finally, students spoke of a

Australia and New Zealand Community as partner: Theory and practice in nursing

Abstract: Community as Partner is an invaluable resource for students, practicing community nurses and other health professionals. Up-to-date and rich in detail, this new textbook explores the World Health Organization's policies and goals for health for all, and discusses and demonstrates how these policies are being implemented at a national and local level in Australia and New Zealand. The partnership approach taken in Community as Partner provides a framework for planning health promotion programs with local communities. A wide range of community groups are introduced and analysed. A variety of examples of actual health promotion programs and activities are provided to show how effective partnerships can be forged to promote the health and wellbeing of local communities.

Walking With another: rural nurses' experiences of mentoring:

Abstract: The aim of this constructivist grounded theory study was to explore rural nurses' experiences of mentoring. Mentoring is often proposed as a solution to the problem of nursing workforce shortages. The global problem of workforce for nurses can be defined using the parameters of recruitment and retention rates, `problems' with which result in staff shortages, particularly of experienced nurses. Constructivist grounded theory has its foundations in relativism and an appreciation of the multiple truths and realities of subjectivism. Seven Australian rural nurses were interviewed. To ensure data saturation of particular categories and the fit of tentative theoretical conceptualisations, two participants were interviewed twice with no new codes identified from the subsequent interviews. Cultivating and growing new or novice rural nurses was the core category which conceptualised a two-part process consisting of getting to know a stranger and walking with another. Supportive relationships such as mentoring were found to be an existing, integral part of experienced rural nurses' practice — initiated by living and working in the same community. In this grounded theory, cultivating and growing is conceptualised as the core category. A two-part process was identified — getting to know a stranger and walking with another. This paper examines one of these subcategories, walking with another, relating the ways in which experienced rural nurses walk with another by firstly keeping things in perspective for new or novice rural nurses, and secondly using a particular form of language called nurse chat. For experienced rural nurses, mentoring in this way delivers a number of different outcomes with various nurses. Because it is a part of the experienced rural nurse's practice on an ongoing basis, individual mentoring relationships do not provide an end in relation to this nurse's experiences of mentoring, rather they are part of an ongoing experience. Creating supportive environments that include developing relationships such as mentoring is a potential solution to local staffing needs that does not require intensive resources. Experienced nurses engaged in clinical practice have the potential to cultivate and grow new or novice nurses — many already do so. Recognising their role and providing support as well as development opportunities will bring about a cycle of mentoring within the workplace.

Review of small rural health services in Victoria: how does the nursing‐medical division of labour affect access to emergency care?

Abstract: Aims This paper is based on a review of the Australian and International literature relating to the nursing-medical division of labour. It also explores how the division of labour affects patient access to emergency care in small rural health services in Victoria, Australia. Background The paper describes the future Australian health workforce and the implications for rural Victoria. The concept of division of labour and how it relates to nursing and medicine is critically reviewed. Two forms of division of labour emerge – traditional and negotiated division of labour. Key themes are drawn from the literature that describes the impact of a traditional form of division of labour in a rural context. Methods This paper is based on a review of the Australian and international literature, including grey literature, on the subject of rural emergency services, professional boundaries and roles, division of labour, professional relationships and power and the Australian health workforce. Results In Australia, the contracting workforce means that traditional divisions of labour between health professionals cannot be sustained without reducing access to emergency care in rural Victoria. A traditional division of labour results in rural health services that are vulnerable to slight shifts in the medical workforce, unsafe services and recruitment and retention problems. A negotiated form of division of labour provides a practical alternative. Conclusion A division of labour that is negotiated between doctors and nurses and supported by a legal and clinical governance framework, is needed to support rural emergency services. The published evidence suggests that this situation currently does not exist in Victoria. Strategies are offered for creating and supporting a negotiated division of labour.

Treatment content in child and adolescent mental health services: development of the treatment recording sheet.

Abstract: This paper presents a clinician self-report measure developed to record the specific components of treatment used with adolescents attending a Child and Adolescent Mental Health Service (CAMHS). Using action research methodology, 18 clinicians attended up to five facilitated discussion groups during 2006 to discuss the planned implementation of a clinical trial. The clinicians helped adapt a checklist for recording treatment strategies applied in CAMHS with adolescents. The sessions were audio-taped and transcribed for thematic analysis. The final treatment recording checklist is presented. The clinicians reported the instrument was helpful for recording the content of their interventions and understanding their colleagues practice.

Using overseas registered nurses to fill employment gaps in rural health services: Quick fix or sustainable strategy?

Abstract: Objective: This study sought to identify and evaluate approaches used to attract internationally trained nurses from traditional and non-traditional countries and incentives employed to retain them in small rural hospitals in Gippsland, Victoria. Design: An exploratory descriptive design. Setting: Small rural hospitals in Gippsland, Victoria. Participants: Hospital staff responsible for recruitment of nurses and overseas trained nurses from traditional and non-traditional sources (e.g. England, Scotland, India, Zimbabwe, Holland, Singapore, Malaysia). Results and Conclusion: Recruitment of married overseas trained nurses is more sustainable than that of single registered nurses, however, the process of recruitment for the hospital and potential employees is costly. Rural hospitality diffuses some of these expenses by the employing hospitals providing emergency accommodation and necessary furnishings. Cultural differences and dissonance regarding practice create barriers for some of the overseas trained nurses to move towards a more sanguine position. On the positive side, single overseas registered nurses use the opportunity to work in rural Australian hospitals as an effective working holiday that promotes employment in larger, more specialized hospitals. Overall both the registered nurses and the employees believe the experience to be beneficial rather than detrimental.

Examining the methods used for a critical ethnographic enquiry

Abstract: INTRODUCTIONEthnography, as an interpretive paradigm came to prominence in the 1900s through anthropological and sociological inquiry; however, in the 1960s, ethnography became emergent with health care studies especially in the medical and nursing arena. This re-emergence of ethnography as a suitable methodology for the health sciences provided humanism to describe and explain culturally specific phenomenon. Ethnography in this context was unable to determine political influences imputing, directing or preventing the phenomena under investigation. It was through the discourse of the Manchester (English) and Chicago (American) schools of eminent scholars debating this dilemma that Critical Ethnography was promoted, accepted and adopted by the emerging health research community.Critical Ethnography delves beneath the surface to examine the power relations and influences affecting the phenomenon by using field methods to identify the culture, the 'consciousness' or the 'lived experiences' of others, exposing the political, social and material disempowerment of individuals and disadvantaged groups in order to elicit change (Street 1992: 12). It is the method which articulates the substance and credence of an inquiry through its procedural rules, though according to Brewer (2000) method and methodology are inextricably linked especially when adopting a qualitative ethnographic approach. The method articulated in this paper is based on a critical ethnographic inquiry conducted by the researcher titled 'Endof-life care and palliative care for aged persons within a residential multi-purpose service: A critical ethnographic study'.PROGRESSING THE INQUIRYResearch extends, validates or provides new knowledge about a phenomenon, demonstrating its significance and scholarly value to peers and other interested parties. Scholarly inquiry first establishes the extent of the knowledge of the phenomenon under investigation prior to the commencement of the inquiry. Preliminary discussions and planning of where, when and how the study is to be conducted has to be determined preceding contact being made with the potential organisation, or holders of the subject material. Ethics approval was gained from the host university and the organisations ethics committee.JUSTIFICATION FOR CONDUCTING THE INQUIRYThe justification for conducting an inquiry in a multi-purpose service (MPS) was that little is known about the provision or delivery of end-of-life and palliative care within these facilities. The researcher consulted the literature and found it devoid of research studies conducted in MPSs, or by clinicians providing services to/ for or on behalf of an MPS. The area of interest for the researchers is the delivery of end-of-life and palliative care, as recently the government through the national palliative care program introduced the publication Guidelines JOT a Palliative Approach in Residential Aged Care ('the Guidelines') (Australian Government Department of Health & Ageing 2004) with an expectation that all residential aged care units would adopt and implement these guidelines. The study will provide new knowledge relating to the structure of MPSs, their provision of nursing care delivered to residents of a cohort deemed disadvantaged (institutionalised) and vulnerable (aged persons), living in such a location.METHODOLOGY AND METHODIt is the research question, which dictates the methodology; the theoretical and philosophical framework and therefore the method adopted for any inquiry (Denzin & Lincoln 2000; Minichiello et al. 2004; Polit & Beck 2004). The method is the structure and the process by which the inquiry is conducted; it provides the rigour and authenticity to the research findings allowing replication, scrutiny and validity. In more recent times nursing and medical research has been conducted to develop 'best practice' guidelines, informed by research inquiry (Taylor et al. …

The implications of policy on delivering a palliative approach in residential aged care: Rhetoric or reality?

Abstract: This critical ethnographic study aimed to understand policy and documentation in relationship to guiding nursing practice in delivering a palliative approach to residents of an aged care unit of a Multi-purpose Service (MPS). A thematic analysis was undertaken that searched the text for cultural determinants of practice, and similarities and differences between the data sets. Where discrepancies occurred, key informants were revisited and questioned regarding anomalies. Using a critical lens this interpreted data formed the substantive findings of this research. The Guidelines for a Palliative Approach in Residential Aged Care (RAC) were not known or understood by management or nurses employed in this MPS. This paper supports the need for research to be conducted into evaluating the Guidelines as the current premise of this research is that policy is rhetoric not reality in providing a planned trajectory of care for residents and their family members.

Funding regimes and the implications for delivering quality palliative care nursing within residential aged care units in Australia.

Abstract: INTRODUCTION: BACKGROUND: Funding to Australian residential aged care units has undergone recent reforms. Parallel with these fiscal developments, the Australian Government commissioned the Guidelines for a Palliative Approach in Residential Aged Care that addressed the inequities of service associated with dying in residential aged care. AIMS: This literature review describes the variances in funding between Australian residential aged care facilities (RACFs), and multi-purpose services (MPSs) and, in doing so, exposes the impact that funding variances have on the delivery of end-of-life and palliative care to residents in aged care units. FINDINGS: Government funding policy allowed RACFs an opportunity to adopt and implement the guidelines and standards, through funding individual resident identified healthcare needs. By comparison, MPSs are funded through an agreed (government and organisation) number of beds to provide nursing care to residents. This funding allocation forms MPSs' general consolidated revenue for service delivery. KEY ISSUES: RACFs identify nursing care needs of residents through a residential classification scale, while management of MPSs allocates funding to service provision. CONCLUSIONS: The significant factor of funding beds (MPS) not the delivery of nursing care required by residents (RACFs) does impact on the implementation of a palliative approach for residents and, hence, the delivery of quality nursing care. Nursing management should consider funding implications when allocating resources to services in MPSs.

Discourses associated with nursing aged people who are dying in the Australian context: a review of the literature.

Abstract: Aim: To examine the discourses associated with nursing care of aged people who are dying in the Australian context Background: The discourses associated with nursing aged people who are dying are not universally understood, and there is confusion regarding the meaning of terminology used to describe specific nursing practices in the aged care setting in Australia Methods: A literature search was undertaken to identify nursing practices and the discourses associated with nursing aged people who are dying in the Australian context Words used in the literature to describe practices related to nursing care of the dying were distilled, and a search of the Cummulative Index to Nursing and Allied Health Literature (CINAHL) database using this vocabulary was undertaken to explicate the meanings associated with specific terminology Findings: The review of literature highlighted a plethora of nursing practices related to caring for people who are aged and dying Hospice care, palliative care, terminal care, end-of-life care and a palliative approach are terms used to describe specific practices associated with nursing people who are dying These terms have distinct meanings; however, they are often used interchangeably in aged care settings adding to confusion and the potential for compromised nursing practice standards Implications for practice: Understanding the terminology associated with nursing practice provided to people who are aged and dying allows the profession to engage in dialogue that is universally understood Dialogue allows for rigorous debate, research and ultimately the evolution of nursing practice, improved outcomes for this group and the avoidance of unnecessary legal challenge to individual and institutional practice standards Conclusion: The terminology associated with the provision of care to the aged who are dying is reflective of the broader healthcare discourse focused on dying and death Shared agreement about this terminology will avoid unnecessary litigation resulting from misunderstanding of the discourses that describe and define practice and enhance health outcomes for the aged dying and their families and/or significant others

From traditional healers to telemedicine: a history of nursing in Malaysia.

Abstract: Malaysia is a country currently striving for developed nation status. Its history is both colourful and fascinating, from its pre-colonial times, through over a century of British rule, to its growth in the post-war period. Geographically and culturally this country is diverse and charming. Nursing in Malaysia shares a similarly interesting past. This article explores the history of nursing in Malaysia through pre-colonial, colonial, independent and global phases. With the bulk of progress occurring during the period of colonisation, nursing in Malaysia was influenced considerably by the profession as it was concurrently developing in Britain. Nonetheless, the uniqueness of the Malaysian environment has ensured that nursing has been shaped and strengthened by the challenges that have been confronted along this tortuous path. As a result, nursing in Malaysia is in a position to continue to rise above known and unknown obstacles facing contemporary health care in an increasingly complex global environment.

The Australian health care system

Abstract: [Extract] Australia has one of the world's most efficient, accessible, equitable and cost-effective health care systems through the provision of a universal health insurance scheme called Medicare. A variable taxation (1.5-2.5% of income) ensures an adequate GDP (over 8%) is expended annually. The Australian Health Care System has a complex mix of government and private health care services with all three levels of government (federal, state and local) taking various responsibilities. Doctors, both general practitioners and specialists, practice under fee-for-service with a Medicare rebate for patients/clients. Overall Medicare aims to provide all Australians, regardless of their personal circumstances, with access to health care at an affordable cost or no cost at all, while allowing for individual choice through substantial private sector involvement in delivery and financing. In this chapter, the history of the Australian health and social care system is outlined, followed by a discussion of the national health priorities. Service providers and health care facilities are also described. The health status of Australians is outlined and a critique of the health care system is provided.

Community as partner theory and practice in nursing

Abstract: Community as Partner is an invaluable resource for students, practicing community nurses and other health professionals. Up-to-date and rich in detail, this new textbook explores the World Health Organization's policies and goals for health for all, and discusses and demonstrates how these policies are being implemented at a national and local level in Australia and New Zealand. The partnership approach taken in Community as Partner provides a framework for planning health promotion programs with local communities. A wide range of community groups are introduced and analysed. A variety of examples of actual health promotion programs and activities are provided to show how effective partnerships can be forged to promote the health and wellbeing of local communities.

Gaining human ethics approval: a strategy for refining research studies.

Abstract: We argue that developing a human ethics application is an effective method for refining the intent and design of research studies. Our study aimed to investigate the delivery of end-of-life and palliative care nursing to residents of an aged care unit in a Multi-purpose Service/Centre in rural Victoria. We used the ethics application process as a strategy to focus the study, and to refine the data collection and analysis techniques. It is our contention that the process of completing the application and gaining ethics approval is laborious; however, the intellectualising that occurs provides researchers with an opportunity to reflect upon and refine their studies, thus ensuring the ultimate success and timely completion of research investigations.

Measuring nursing work: evaluation of the pilot of a patient dependency system in hospitals in Victoria, Australia

Abstract: Aim: TrendCare, a computerised patient dependency system, was first implemented in a number of hospitals in Victoria, Australia, in 2003. The patient dependency system pilot study involved 20 hospitals and 80 wards and departments, representing 96 patient-care areas between 2003 and 2004. The aim of this evaluation was to explore whether clinical nurses involved in the pilot study thought that the data produced by the patient dependency system was useful and could assist them in the allocation of resources for managing workloads efficiently. Methods: A population approach was adopted for the survey component of the evaluation, with 4128 questionnaires distributed to all nurses using the patient dependency system at the pilot sites. 1478 questionnaires were returned, giving a response rate of 35.8%. Results: The respondents rated the user friendliness and their understanding of the components of the piloted patient dependency system quite highly. According to 86.6% of respondents, access to computers in their workplace was reasonable or better However, the perceived ability of the piloted patient dependency system to adequately capture the acuity of particular patient groups was more variable, with respondents indicating less confidence in the system to accurately capture patient acuity in more specialist clinical areas. Conclusions: While the study revealed potential applications for the TrendCare patient dependency system, it also uncovered areas that needed to be addressed for the further development and implementation of the system in the hospital environment. A longer and more comprehensive pilot study is required to fully explore the full potential of the TrendCare patient dependency system in the clinical environment. © 2008 Scientific Communications International Limited.