Showing papers by "Karen Francis published in 2013"

The response of the maize nitrate transport system to nitrogen demand and supply across the lifecycle.

Abstract: An understanding of nitrate (NO3-) uptake throughout the lifecycle of plants, and how this process responds to nitrogen (N) availability, is an important step towards the development of plants with improved nitrogen use efficiency (NUE). NO3- uptake capacity and transcript levels of putative high- and low-affinity NO3- transporters (NRTs) were profiled across the lifecycle of dwarf maize (Zea mays) plants grown at reduced and adequate NO3-. Plants showed major changes in high-affinity NO3- uptake capacity across the lifecycle, which varied with changing relative growth rates of roots and shoots. Transcript abundances of putative high-affinity NRTs (predominantly ZmNRT2.1 and ZmNRT2.2) were correlated with two distinct peaks in high-affinity root NO3- uptake capacity and also N availability. The reduction in NO3- supply during the lifecycle led to a dramatic increase in NO3- uptake capacity, which preceded changes in transcript levels of NRTs, suggesting a model with short-term post-translational regulation and longer term transcriptional regulation of NO3- uptake capacity. These observations offer new insight into the control of NO3- uptake by both plant developmental processes and N availability, and identify key control points that may be targeted by future plant improvement programmes to enhance N uptake relative to availability and/or demand.

Qualitative Research in the Health Sciences: Methodologies, Methods and Processes

Abstract: Part 1: Methodologies 1. Introduction Beverley Taylor 2. Grounded Theory Beverley Taylor 3. Historical Research Karen Francis 4. Ethnography Karen Francis 5. Phenomenology Beverley Taylor 6. Narrative Inquiry Beverley Taylor 7. Case Study Research Beverley Taylor 8. Feminisms Beverley Taylor 9. Action Research Karen Francis 10. Mixed Methods Research Beverley Taylor Part 2: Methods and Processes 11. Introduction Beverley Taylor 12. Interviewing And Analysis Beverley Taylor 13. Group Work and Analysis Beverley Taylor 14. Narrative Analysis Beverley Taylor 15. Discourse Analysis Karen Francis 16. Creative Forms Of Qualitative Data Collection & Analysis Beverley Taylor 17. Uptake of Qualitative Research in Health Sciences Karen Francis

Self-management activities in diabetes care: a systematic review

Abstract: Objective. To identify the range of self-management activities people diagnosed with diabetes engage in to manage their disease, the frequency of use, and whether self-management practices change over time. Methods. A systematic review of the literature was undertaken. Thirty-two studies identified through electronic databases met the inclusion criteria and were included in the review. Results. The study found that people living with diabetes undertake regular self-management activities and that compliance with medication regimes is high. Adherence, however, varied with respect to blood glucose testing, diet, physical activity and foot care. Levels of physical activity were not found to change over time. Evidence suggests that some people with diabetes modify their self-management practices in response to factors such as holidays. Conclusions. The review suggests that the majority of people with diabetes self-manage, although there is variation in adherence to key self-management activities. How self-management practices change over time and whether this impacts on health outcomes is an area for future research.

New graduate nurses as knowledge brokers in general practice in New Zealand: a constructivist grounded theory.

Abstract: Practice nursing in New Zealand is not well described in the literature. One survey illustrated that most of the New Zealand practice nurses sampled did not know of the country's two premier evidence-based health websites. A recent review compared general practice in the UK, New Zealand and Australia and found that whereas there had been significant developments in empowering the practice nurse workforce to run nurse-led clinics in the UK, New Zealand and Australia lagged behind. The aim of this reported constructivist grounded theory study was to investigate practice nurses' use of information. Conducted in Auckland, New Zealand, data were collected through ethnographic techniques in one general practice between September 2009 and January 2010 to enhance theoretical sensitivity to the area of information use. Subsequently, six experienced practice nurses (one twice after moving jobs) and five new graduate nurses from five different general practices were interviewed, using open-ended questions, between January 2010 and August 2011. Concurrent data collection and analysis occurred throughout the study period. The use of memos, the constant comparative method, data categorisation and finally, data abstraction resulted in the final theory of reciprocal role modelling. Experienced practice nurses role modelled clinical skills to new graduate nurses. Unexpectedly, new graduate nurses were unconscious experts at sourcing information and role modelled this skill to experienced practice nurses. Once this attribute was acknowledged by the experienced practice nurse, mutual learning occurred that enabled both groups of nurses to become better practitioners. Graduate nurses of the millennial generation were identified as a resource for experienced practice nurses who belong to the baby boomer generation and generation X.

Advanced roles for nurses working in general practice: A study of barriers and enablers for nurses in rural Australia

Abstract: Rural Australians have poorer access to health services than Australians living in metropolitan areas primarily because of shortages in the health professional workforce. Nurses taking on advanced skills could help this situation by relieving doctors but our understanding of the factors that enhance or inhibit uptake is poorly understood in rural areas of Australia. The aim of this study is to identify the barriers and enablers associated with the implementation of advanced nursing roles in rural general practice specifically although an urban general practice was included to ensure that the diversity of practices were represented. The selection of general practices was based on ( 1 ) . a standardised classification system that uses geographic location and population base as the key criterion and ( 2 ) . ease of access for the research team. The general practices were all located within 3 hours drive of the researchers’ home base. Using case study design four rural and one metropolitan located general practices were included. The researchers compared recorded nursing activities with job descriptions, educational opportunities and advanced competency standards. Interviews with practice principals, practice managers and nurses were undertaken. Findings are categorised as: personal which includes motivation, knowledge and time; workplace which includes status, guidelines and practice conventions and routines; and policy which includes national payment systems, and scope of practice. The potential for nurses to advance their practice and meet the needs of patients, particularly in the specialist areas of chronic care and health promotion, is still under developed in the rural practices. The findings have led to the development of a framework for the introduction of advancing practice roles for nurses that will meet the needs of a currently, under-served community.

Hermeneutic phenomenology: a methodology of choice for midwives

Abstract: Hermeneutic phenomenology has been used widely by researchers to understand lived experiences. This methodology asserts that individual people are as unique as their life stories. The practice of midwifery is underpinned by a philosophy that values women and the uniqueness of their child-bearing journey. The tenets of hermeneutics phenomenology align with those of contemporary midwifery practice, making it a useful research methodology for providing insights into issues relevant to the profession. The purpose of this paper is to unravel some foundational concepts of hermeneutic phenomenology and recommend it as a methodology of choice for midwives to apply to their application to midwifery-in-action.

Using an emic and etic ethnographic technique in a grounded theory study of information use by practice nurses in New Zealand

Abstract: This paper draws lessons from the use of an emic–etic ethnographical technique in a grounded theory study of how New Zealand practice nurses use information. The technique was used to heighten theoretical sensitivity in this study. As a nurse practitioner, I (the lead author) could not step out of my emic perspective to provide an etic perspective of my own general practice. From my emic embodied subjectivity I constructed my work environment to fit with best practice. Conversely, in four other general practices, my lack of personal connection protected an etic sense of disembodiment. New insights into mental models guiding the emic and etic roles of ethnography are suggested. Emic and etic perspectives, along with embodied and disembodied feelings, are not binary opposites but rather sit along a philosophical continuum. Their position on this continuum depends on the role and relationships of the researcher(s) in the social and cultural context of the area of inquiry.

Ageing in Indonesia – Health Status and Challenges for the Future

Abstract: Ageing and problems concerning the aged were until recently the domain of developed countries, but they are now becoming an increasing and alarming reality in developing and underdeveloped countries such as Indonesia. Families and even the nation are facing many challenges relating to support for the elderly. This is because in the past developing policies, and caring for, the elderly were not major priorities of Government as the elderly represented a small percentage of Indonesia’s population. One of the challenges impacting on the provision of care for the elderly is the lack of health service programs for the elderly who are living in their own homes. Health personnel shortages including community health nurses have been identified as a significant contributor to this health service problem. This paper will initially consider Indonesia’s geography as a nation comprising many islands. It will then discuss the impact of a changing population profile and present an overview and critique of the current level of health services provided to promote wellbeing for the elderly.

Career progression - The views of Queensland's nurses

Abstract: Objectives: To inform policy through determination of the views of Queensland nurses on career progression. Design: A quantitative cross-sectional cohort design with mailed survey. Setting: Financial members of the Queensland Nurses' Union. Main outcome measures: Extent of the relationship between opportunity for career progression in nursing with turnover and retention. Results: A majority (54.4%) of the 1365 respondents were satisfied with their career progression. Only 11.6% were dissatisfied. Satisfaction was not related to length of time in nursing, but did increase among nurses enrolled in further education programs. Dissatisfaction was related to four themes: lack of support to advance knowledge; lack of opportunities for promotion; number of career options; and costs associated with advancement. A quarter of the nurses were contemplating a move within nursing in the next year and most of these nurses (62%) indicated that the move was for the purpose of career advancement. One in six nurses were contemplating leaving nursing altogether; however only 12.8% of those cited lack of career as the factor for intended departure. Results continued the trend seen in previous surveys over the last decade of a small but significant reduction in the perception that career prospects in nursing were limited. Conclusion: Although the perception that there are limitations to career advancement in nursing has reduced in the last decade, there is still room for improvement. Lack of career progression remains a concern of nurses; however this is not generally manifested in an intention to leave nursing. Rather, nurses are prepared to consider moves within nursing to further their careers.

Researching with young people as participants: Issues in recruitment

Abstract: An essential element of human research is the successful recruitment of participants. Many researchers appear to be able to recruit participants quickly and without significant issues, while other researchers have more challenges. This paper presents some issues encountered when recruiting participants for a phenomenological research project on the lived experiences of young people aged 16–24 years, with type 1 diabetes living in a rural setting. Insights and strategies are presented to assist researchers when recruiting young people to their research.

An action research approach to practice, service and legislative change

Abstract: Aims: To describe the action research approach taken to engage a multidisciplinary group of health professionals and managers from five rural health services with government officers in redesigning their emergency care services and informing legislative change. Background: The diminishing size of the medical workforce across rural Victoria in Australia captured the Victorian state government's attention when this threatened the sustainability of emergency care services in rural and remote hospitals in 2006. The government funded the collaborative practice model pilot between 2006 and 2008 to develop and test an alternative model of emergency care service in which nurses practised at a more advanced and autonomous level. Data sources: Data were sourced from a combination of interviews, focus groups and patient records. Review methods: Qualitative data were analysed using convergent interview and thematic analysis. Quantitative data were analysed using frequencies and cross tabulations. Discussion: The three critical success factors owing to action research are presented. It provided a politically safe approach to service, policy and legislative change, ensured collaboration permeated the endeavour and helped to shift the focus from a technical to an emancipatory approach to action research. Conclusion: Action research was key to the success achieved by the participants in changing clinical practice, service delivery and the Victorian Drugs Poisons and Controlled Substances Act (1981) to authorise registered nurses to supply medicines. Implications for practice: This paper offers an approach that nurses in practice, management and government can take to drive changes at practice, service and legislative levels in advanced nursing practice.

A Changing Australian Population Demographic: The Role of Rural Nurses

Abstract: The Australian population is ageing, a trend occurring globally in developed world nations [1]. This change in the population demographic has led to policy reform as a mechanism to stem the predicted increased demand on the health care system particularly for chronic disease management and palliative care [2-4]. Australia’s population is approximately 23 million and is concentrated in the major cities on the coastal fringe in each state and territory. Those who do not live in these cities reside in rural areas. Research demonstrates that rural Australians are disadvantaged and have inequitable access to a range of services including health care compared to city counterparts [1]. Ageing rural people are at increased risk of being further disadvantaged as the demand for available health care intensifies.

An Ethnography of Thai Folk Healing in Patients Suffering from Lomammapart, a Stroke-like Condition

Abstract: This paper reports on an ethnographic study using Spradley’s method, that explored the treatment and outcomes of treatment for patients with lomammapart who were cared for by traditional folk healers in Southern Thailand. Lomammapart is the Thai Folk Medicine term for stroke. Many patients with lomammapart in Thailand choose treatment by traditional folk healers. Data generation involved participant observation and in-depth interviews with key informants, ten folk healers who had experience in treating patients with lomammapart as well as general informants, eight patients with the condition. Treatment outcomes for patients with lomammapart were measured using the Barthel Index to assess activities of daily living at baseline and after three months. The findings revealed that the healing methods of lomammapart, based on folk medicine, consisted of Jubsen massage, herbal medicine, ritual, and advice. Jubsen massage was performed to expel the wind in the bodylines from the upper to the lower parts of body. Herbs that were prepared as hot beverages were used to expel wind in the bodylines and intestinal system and to eliminate the toxicity from the body to the excretory system. Rituals were performed to heal the spiritual self. In addition, the perceptions of success or otherwise of the efficacy of the treatments provided and the associated treatment outcomes were reported by folk healers and patients. Measurement of activities of daily living indicated that treatment resulted in the patients having better movement, and in sleeping, feeding, excretion, functioning of the body organs, living in society, and normal sensations. The findings of this study will help nurses’ to understand the health practices of folk healers based on beliefs and culture regarding care of such patients, so that they can try to integrate this knowledge with modern health care services to support patient needs. The rich findings also contribute to understandings of cultural knowledge of care and treatment in Thailand.