Showing papers by "Karen Francis published in 2012"

The role of Government policy in supporting nurse-led care in general practice in the United Kingdom, New Zealand and Australia: an adapted realist review.

Abstract: hoare k.j., mills j. & francis k. (2011) The role of government policy in supporting nurse-led care in general practice in the United Kingdom, New Zealand and Australia: an adapted realist review. Journal of Advanced Nursing 68(5), 963–980. Abstract Aim. This article is a report on a review that examined the role of Government policy in primary care and its association with nurse-led care in the United Kingdom, New Zealand and Australia between 1998 and 2009. Background. The United Kingdom, New Zealand and Australia share a similar model of first point access to the healthcare system via general practitioners. General practice is synonymous with the term primary care. Data sources. Medline, CINAHL, EMBASE, Scopus, PsychInfo, Google, Department of Health, England (United Kingdom), Ministry of Health, New Zealand, Department of Health and Ageing, Australia. Searches of electronic databases from 1998 to December 2009 and hand searches of identified leads and key journals. Historical papers accessed to describe the genesis of practice nursing and historical Government policy documents prior to 1998, were examined. Review methods. A modified realist review was used to synthesize research and policy documents relating to government policies pertaining to nurse-led care. In addition, a systematic review was used to identify literature that described practice nurse-led care. Results. Nurse-led primary care services are well described in the United Kingdom with a total of 45 studies meeting the inclusion criteria for the second review. There are no published studies from New Zealand, and only two from Australia describing nurse-led primary care. Conclusion. New Zealand and Australia lag behind the United Kingdom in practice nurse development. Implementation of clinical governance was fundamental to the development of nurse-led care in the UK.

Dancing with data: an example of acquiring theoretical sensitivity in a grounded theory study.

Abstract: Glaser suggested that the conceptual route from data collection to a grounded theory is a set of double back steps. The route forward inevitably results in the analyst stepping back. Additionally sidestepping through, leading participants down lines of inquiry and following data threads with other participants, is also characteristic of acquiring theoretical sensitivity, a key concept in grounded theory. Other ways of acquiring theoretical sensitivity comprise: reading the literature, open coding, category building, reflecting in memos followed by doubling back on data collection once further lines of inquiry are opened up. This paper describes how we 'danced with data' in pursuit of heightened theoretical sensitivity in a grounded theory study of information use by nurses working in general practice in New Zealand. Providing an example of how analytical tools are employed to theoretically sample emerging concepts.

The decision-making processes adopted by rurally located mandated professionals when child abuse or neglect is suspected.

Abstract: The reporting of suspected child abuse and neglect is a mandated role of medical doctors, nurses, police and teachers in Victoria, Australia. This paper reports on a research study that sought to explicate how mandated professionals working in rural Victorian contexts identify a child/ren at risk and the decisions they make subsequently.

Sifting, sorting and saturating data in a grounded theory study of information use by practice nurses: A worked example

Abstract: The terminology used to analyse data in a grounded theory study can be confusing. Different grounded theorists use a variety of terms which all have similar meanings. In the following study, we use terms adopted by Charmaz including: initial, focused and axial coding. Initial codes are used to analyse data with an emphasis on identifying gerunds, a verb acting as a noun. If initial codes are relevant to the developing theory, they are grouped with similar codes into categories. Categories become saturated when there are no new codes identified in the data. Axial codes are used to link categories together into a grounded theory process. Memo writing accompanies this data sifting and sorting. The following article explains how one initial code became a category providing a worked example of the grounded theory method of constant comparative analysis. The interplay between coding and categorization is facilitated by the constant comparative method.

Exploring social workers’ personal domains in rural practice

Abstract: • Summary: This article is grounded on Cheers, Darracott, and Lonne’s (2007) framework for conceptualizing the factors that influence rural social care practitioners in their work. Focusing on the ...

The impact of nursing leadership and management on the control of HIV/AIDS: an ethnographic study.

Abstract: This paper reports on an aspect of a larger ethnographic study that sought to investigate the impact of HIV/AIDS on the practice of primary care nurses in Jordan. Nursing leadership and the style of management adopted by senior nursing and medical administrators at the Ministry of Heath were identified as factors impacting on the practice of the nurses and their capacity to raise community awareness and contribute to the prevention and control of HIV/AIDS. The study was undertaken in three rural and three urban primary health care centres (PHCC). Data collection included participant observation, key informant interviews, and document analysis. These data informed the development of descriptive ethnographic accounts that allowed for the subsequent identification of common and divergent themes reflective of factors recognized as influencing the practice of the nurse participants.

Critical discourse analysis: understanding change in maternity services.

Abstract: This paper provides an example of the use of critical discourse analysis (CDA) in the area of maternity care policy and describes the process of CDA as an effective research method for understanding the influences of change in the context of Australian maternity services. CDA is a methodological approach that examines how discourse is formed and given power, as a result of how power is used, who uses it and the context within which this usage takes place. The application of CDA is described in this study for the purpose of examining key-stakeholder use of knowledge and power for the purpose of influencing the direction of the maternity services reform. The CDA theoretical framework guided discourse identification and analysis of the purpose behind the discourse through examination of power relationships between key stakeholders. The use of a theoretical lens in the form of neoliberalism to supplement the theoretical framework facilitated the exposure of forces intrinsic to the maternity care context driving change.

Reflective thought in memos to demonstrate advanced nursing practice in New Zealand

Abstract: Dewey first described reflective thought as a way to solve issues of perplexity in his seminal work How We Think. Dewey's work underpinned Strauss' contribution to The Discovery of Grounded Theory. Grounded theory methods are characterised by memo writing. This paper will describe how memos, in the form of slides, were employed to demonstrate advanced skill acquisition in practice by an immigrant nurse and health visitor to a panel convened by the New Zealand Nursing Council. Globalisation and migration of the nursing workforce contributes to advancement of the nursing profession in some countries. New Zealand, whose critical mass of primary health care nursing leaders is small, with no specific postgraduate primary health care qualification, benefit from the transferable skills of migrant nurse and community practitioners. Finding easier ways to demonstrate advanced practice to New Zealand’s Nursing Council would maximise the potential contribution of immigrant nurses.

Australian rural maternity services: Creating a future or putting the last nail in the coffin

Abstract: [Extract] Nurses and midwives are the largest group of health providers in Australia (60%), and with increasing remoteness, this proportion increases substantially. The recruitment and retention of nurses, and more specifically midwives in rural health services, is at crisis point. Sustainable birthing services will be reliant on a stable, regenerative workforce. Key to this goal is the education of nurses, midwives and doctors, all of whom have stringent pre-service professional placement quotas in order to meet required competencies to practice.

Victorian rural emergency care--a case for advancing nursing practice.

Abstract: The aim of this paper is to profile the emergency care patients seen by a selection of rural health services in Victoria, and show how advancing nursing practice could contribute to a more sustainable model of care. Quantitative patient data extracted from five rural health services across Victoria ranging in size, were analysed using descriptive statistic techniques. Most patients who attended for emergency care did not require urgent or immediate medical attention (70%), many had minor injuries (over 30%) and did not need medicines (57%) but were attended by a doctor either directly or via telephone (over 74%). If emergency care services in rural Victoria are to be sustained in the face of severe medical workforce shortages, registered nurses will need to be enabled through professional development, legislation and organisation policy to manage autonomously a larger proportion of the non-urgent, less complex patients who present to these emergency services.

Making a difference: the experiences of midwives working with women who use illicit drugs

Abstract: Aim: This article describes the experiences of midwives who choose to work with pregnant women who use illicit drugs. Background: Pregnant women who use illicit drugs present complex challenges for those whochoose to work with them. Society's views on illicit drug use fluctuate from acceptance and harm minimizationto reprimand and retribution. Method: Qualitative interviews were conducted between June and August 2009 with 12 Australianmidwives. A thematic analysis method informed by hermeneutic phenomenology was applied to interpretthis data to explicate lived experiences and gain deeper understanding and meanings of this phenomenon. Findings: Three major themes encapsulated the experience: making a difference, making partnerships, and learning to let go. The focus of this article, "making a difference," included two subthemes of "working on the margins" and "transition and transformation." The midwives were both rewarded andchallenged by the needs of women who use illicit drugs and by the systems in which they worked. Conclusions: The midwives acknowledged that their aspirations "to make a difference" was notalways sufficient when working with women who use illicit drugs. They also require the establishmentof maternity services that are compassionate and accessible, including woman–care provider partnershipsand continuity of the care environments.

Australian college of nursing rural nursing and midwifery faculty: Advocating for greater equity in rural health

Abstract: [Extract] Working in rural Australia is a privilege and challenge that all rural nurses and midwives understand. Knowing the community, being known by the community, doing without, yet understanding much, can be achieved through innovative thinking and practice.