Showing papers by "Karen Francis published in 2011"

Member checking and Heideggerian phenomenology: a redundant component

Abstract: Although member-checking has long been accepted as the gold standard in quantitative research, it is not the pinnacle for expressing rigour in Heideggerian phenomenology because it contradicts many o the underpinning philosophies. Similarly, employing 'experts' to confirm findings conflicts with the values of interpretivism. In this paper, th authors argue that member-checking is frequently used to cover poor interview technique or a lack of understanding of the methodology chosen to underpin the study. They debate why member-checking is incongruent with Heideggerian philosophy and suggest strategies that enhance the generation of data and render the follow-u interview redundant.

Hidden costs associated with the universal application of risk management in maternity care.

Abstract: This paper presents a critical analysis of risk management in maternity care and the hidden costs associated with the practice in healthy women. Issues of quality and safety are driving an increased emphasis by health services on risk management in maternity care. Medical risk in pregnancy is known to benefit 15% or less of all pregnancies. Risk management applied to the remaining 85% of healthy women results in the management of risk in the absence of risk. The health cost to mothers and babies and the economic burden on the overall health system of serious morbidity has been omitted from calculations comparing costs of uncomplicated caesarean birth and uncomplicated vaginal birth. The understanding that elective caesarean birth is cost-neutral when compared to a normal vaginal birth has misled practitioners and contributed to over use of the practice. For the purpose of informing the direction of maternity service policy it is necessary to expose the effect the overuse of medical intervention has on the overall capacity of the healthcare system to absorb the increasing demand for operating theatre resources in the absence of clinical need.

Shaping public opinion on the issue of childbirth; a critical analysis of articles published in an Australian newspaper

Abstract: The Australian government has announced a major program of reform with the move to primary maternity care, a program of change that appears to be at odds with current general public perceptions regarding how maternity care is delivered. A critical discourse analysis of articles published in 'The Age', a newspaper with national distribution, subsequent to the release of the discussion paper by the Australian Government in 2008 was undertaken. The purpose was to identify how Australian maternity services are portrayed and what purpose is served by this representation to the general public. Findings from this critical discourse analysis revealed that Australian maternity services are being portrayed to the general public as an inflexible outdated service struggling to meets the needs of pregnant women and in desperate need of reform. The style of reporting employed in this newspaper involved presenting to the reader the range of expert opinion relevant to each topic, frequently involving polarised positions of the experts on the issue. The general public are presented with a conflict, caught between the need for changes that come with the primary maternity model of care and fear that these change will undermine safe standards. The discourse; 'Australia is one of the safest countries in which to give birth or be born, what is must be best', represents the situation where despite major deficiencies in the system the general public may be too fearful of the consequences to consider a move away from reliance on traditional medical-led maternity care.

National review of maternity services 2008: women influencing change

Abstract: Background In 2009 the Australian government announced a major program of reform with the move to primary maternity care. The reform agenda represents a dramatic change to maternity care provision in a society that has embraced technology across all aspects of life including childbirth.

Rural Nursing in the Australian Context

Abstract: The Australian rural environment is unique, diverse and challenging for nurses who are the most significant providers of health care in this context. Rural Nursing: the Australian Context provides readers with an understanding of the knowledge and skills required to practise in rural locations and communities. This book includes chapters on pregnancy, parenting, childhood, adolescence, adulthood, ageing and mental health. It examines rurality, population and health demographics, and the different practice opportunities available in rural settings. The authors outline the importance of having well-established professional networks and encourage readers to develop practice skills in response to a particular community. Each chapter features a vignette, reflective questions and a list of websites for further reading. Written by a team of academics and practising rural nurses, Rural Nursing will equip nursing students with the confidence to provide high-quality health care in a range of practice settings.

Understanding the context of providing HIV prevention and treatment in Papua New Guinea.

Abstract: The HIV epidemic in Papua New Guinea is now described as a generalized epidemic; that is, more than 1% of people aged 15 to 49 years are infected with HIV. The individual behavior of people is not the single most important factor that places them at risk of infection and drives the spread of the epidemic. Rather, a diverse range of factors—biological, sociocultural, and political—makes people vulnerable to infection and dictates their access to care and treatment services. This article examines these biological, sociocultural, and political influences on the HIV epidemic and on prevention and treatment strategies in Papua New Guinea.

Person-centered maternity services in New Zealand: a practice development initiative to improve the health of pregnant women and infants

Abstract: Rationale, aims and objectives: Primary health care and maternity services in New Zealand are delivered via independent self-employed practitioners and separate organisations with no requirement to co-ordinate care. There are disparate immunisation timeliness and rates between ethnic groups. The aim of this practice development initiative is to improve the health of pregnant women and infants. The objectives are to link the general practice enrolled pregnant women with a midwife on confirmation of their pregnancy, record the date of delivery in the general practice notes, enrol the infant with the general practice shortly after birth and so increase the timeliness and rates of immunisations. Methods: Following an initial audit, information is now recorded on the engagement of pregnant women with a midwife in early pregnancy. Contact is made with the midwife and recorded in the general practice notes around the expected delivery date. An invitation to enrol the infant with the general practice is sent to the family four weeks post natal. Immunisation timeliness and rates of infants are audited monthly. Results: Details of the midwife were recorded in the notes of 59 out of a total of 63 pregnant women during 2010, illustrating that the new model of care had been adhered to for the majority of pregnant women. Monthly immunisation timeliness and rates of 94 – 100% were achieved January 2010 – December 2010 in infants six weeks – 6 months old. Conclusion: Primary care can be re-shaped in South Auckland by following international models to facilitate engagement of pregnant women with a midwife and increase immunisation timeliness and rates of infants.

Educational Leadership in Nursing: Supporting cultural change to develop research capacity in novice nurse academics

Abstract: The question of leadership in nursing education is one that has been examined extensively in the literature. In this paper, the authors will initially provide a vignette written in the first person aimed at illustrating the ethos of the university in which they work. This vignette will then be followed by an analysis of actions and strategies used in a capacity building project aimed at developing novice nurse academics' research skills. Theories of transformational leadership, and contingency theory of leadership are discussed in relation to the processes used, thus illustrating the application of theory to the practice of nursing leadership in the academy.

Nursing in remote or isolated areas of Queensland: role, resources and readiness for practice

Abstract: Introduction: Examining the role of the nurses working in remote and isolated areas of Queensland and identifying the necessary competencies, training and resources required by registered nurses to work in these practice contexts was the aim of this commissioned research study. Methods: A multiple case study research design was utilised to investigate nursing in remote and isolated areas of Queensland. The data generation methods included an integrative review of the published and grey literature, an analysis of workforce data, and a mini environmental scan to determine the parameters and characteristics of the three cases. These data provided background for interpreting additional data generated from semi-structured interviews and focus groups with nurses employed in each case. Results: 13.11% of the nursing workforce in Queensland work in non-metropolitan areas as classified using the ARIA classification index with 4.34% of this number employed in remote or very remote areas. For most of these nurses their role is generalist and acute care interventionist focussed, although there was an acceptance that health outcomes would improve if primary prevention activities were prioritised. Conclusion: The role of nurses working in remote and isolated practice settings in Queensland is complex. A refocussing of the role of these nurses with an emphasis on primary health care is recommended. Nurses must be adequately resourced in these positions and prepared for their unique role both clinically and culturally. Access to pre-deployment professionals to engage with communities and promote wellbeing.