Showing papers in "Australian Journal of Advanced Nursing in 2009"

Spirituality and spiritual engagement as perceived by palliative care clients and caregivers

Abstract: Objective The purpose of this study was to examine the lived experience of spirituality and spiritual engagement as perceived by palliative care clients and their caregivers. Design A qualitative hermeneutic phenomenological approach was used based on van Manen’s methodological structure of human science research to answer the research questions. Following ethics approval, fourteen home‐based in‐depth interviews were conducted with four palliative care clients and ten palliative care caregivers. Van Manen’s ‘holistic’ and ‘selective’ approaches were used to identify the main themes in this study. Setting The participants of this study were recruited from people across rural communities of South Australia who had received or were receiving palliative care and their caregivers. Findings Seven main themes emerged from the data. These were categorised under two headings: spirituality and spiritual engagement. Spirituality was associated with ‘God’, ‘coping’, ‘religion’ and ‘relationships with others’, while spiritual engagement was associated with ‘maintaining relationships’, ‘love’ and ‘participating in religious practices’. Conclusion This phenomenological inquiry set out to understand the lived experience of spirituality and engaging in spiritual matters for clients living with life‐limiting conditions and their caregivers. In the process, the study identified the many benefits that may be derived from engaging in spirituality. The findings have relevance to clients and caregivers because they may wish to seek opportunities to discuss spiritual matters with health professionals and for health professionals, who will be better prepared for such conversations.

The psychosocial needs of families during critical illness: comparison of nurses' and family members' perspectives

Abstract: Objective To explore the needs of relatives whose family member is unexpectedly admitted to an Intensive Care Unit and compare ranked need statements between family members and nurses. Design This is a descriptive study using the Critical Care Family Needs Inventory (CCFNI) to measure, rank and compare a series of need statements. Setting An Intensive Care Unit (ICU) in regional Victoria, Australia. Subjects A convenience sampling strategy was used to acquire a total of 58 participants; 25 family members of patients unexpectedly admitted to the ICU and 33 nurses. Results Comparative analysis of the data revealed that there were minor differences identified in the rank order of the need statements listed in the CCFNI amongst nurses and family members. A comparison with previous studies also identified minor differences in both the rank order of individual need statements and the five factor analysis categories previously established. Conclusion The CCFNI continues to be a good diagnostic tool in family needs assessment.

Development of a questionnaire to assess health care students’ hand hygiene knowledge, beliefs and practices

Abstract: Objective: To determine the reliability and validity of a hand hygiene questionnaire (HHQ) developed to examine health care students’ hand hygiene knowledge, beliefs and practices. Design: Pilot testing of the HHQ Setting: Undergraduate students of nursing undergoing university education Subjects: The HHQ was administered to 14 student nurse volunteers in the final year of their undergraduate degree and to another 45 volunteers following revision. Main outcome measures: Main outcomes measures were test-retest coefficients, Cronbach’s alpha values and mean inter-item correlations of the scale items. Results: The face validity of the HHQ was high. Cronbach’s alpha values of 0.80, 0.74 and 0.77 were obtained for the Hand Hygiene Beliefs scale (HBS), the Hand Hygiene Practices Inventory (HHPI), and the Hand Hygiene Importance Scale (HIS) following removal of items with low item-to-total correlations or zero variance. The mean item-to-total correlations of the HBS, HHPI and IS were 0.37, 0.33, and 0.61 respectively. The two-week test-retest coefficients for each scale were 0.85, 0.79 and 0.89 respectively. Socially desirable responding was identified in participants’ responses to the HBS using the 11-item short form of the Marlowe-Crowne Social Desirability scale. Conclusions: The HHQ demonstrated adequate reliability and validity and should be further tested on a wider sample of health care students.

Acute care and older people : Challenges and ways forward.

Abstract: Objective: This article aims to (a) suggest ways in which acute hospital environments might be modified to better meet the needs of the older person and (b) question whether options other than ac ...

The relationship between clinical outcomes and quality of life for residents of aged care facilities

Abstract: Objectives It is widely assumed improving care in residential facilities will improve quality of life (QoL), but little research has explored this relationship. The Clinical Care Indicators (CCI) Tool was developed to fill an existing gap in quality assessment within Australian residential aged care facilities and it was used to explore potential links between clinical outcomes and QoL. Design and Setting Clinical outcome and QoL data were collected within four residential facilities from the same aged care provider. Subjects Subjects were 82 residents of four facilities. Outcome Measures Clinical outcomes were measured using the CCI Tool and QoL data was obtained using the Australian WHOQOL‑100. Results Independent t‑test analyses were calculated to compare individual CCIs with each domain of the WHOQOL‑100, while Pearson’s product moment coefficients (r) were calculated between the total number of problem indicators and QoL scores. Significant results suggested poorer clinical outcomes adversely affected QoL. Social and spiritual QoL were particularly affected by clinical outcomes and poorer status in hydration, falls and depression were most strongly associated with lower QoL scores. Poorer clinical status as a whole was also significantly correlated with poorer QoL. Conclusions Hydration, falls and depression were most often associated with poorer resident QoL and as such appear to be key areas for clinical management in residential aged care. However, poor clinical outcomes overall also adversely affected QoL, which suggests maintaining optimum clinical status through high quality nursing care, would not only be important for resident health but also for enhancing general life quality.

Living the experience of breast cancer treatment: The younger women's perspective

Abstract: Objective To explore the experience of breast cancer for young women under fifty years of age and describe their personal experience of coping with breast cancer treatment. Design An interpretive qualitative design was used to explore the experience of breast cancer in a young women's life. A purposive sample of six women completed in-depth interviews. A thematic analysis of the transcripts generated several themes relating to their personal journey through breast cancer treatment. Setting The setting for this study was an oncology outpatient's setting in a large private hospital in Queensland, Australia. Subjects Six women aged between 28 and 45 years of age with a diagnosis of breast cancer in the last 12 months. Results Treatment for breast cancer began so quickly following diagnosis leaving little time to adjust to the concept of a life threatening disease. The severity of the effects from treatment influenced the women's sense of person and ability to care for family. Fatigue, nausea and early onset menopausal changes were particularly troubling. Women described a positive resolve to survive. Conclusions Treatment concerns for younger women are qualitatively different from those of older women. They consider they are too young to assume 'the sick role' and are not prepared for its sudden onset, neither are their support networks. The right kind of support can assist younger women and their families to cope during the early stages of diagnosis and intervention.

E-portfolios: Developing Nurse Practitioner Competence and Capability

Abstract: Objective: This paper aims to integrate nurse practitioner literature on competence and capability with post graduate and nursing literature on e‑portfolios in order to demonstrate the potential merits of e‑portfolios in nurse practitioner education for competence and capability development. Primary Argument In the Nurse Practitioner Standards Project, competence and capability were proposed as key criteria to assess candidates in nurse practitioner educational courses. Portfolios have traditionally been used to demonstrate competence in nursing and are integral to nursing education as well. An examination of the portfolio and electronic portfolio literature in postgraduate nursing education and professional practice indicates that these portfolios fall under two main structures, each with different purposes: 1) A spinal column structure, with evidence and reflective pieces aligned to competency standards or course objectives, for the purposes of meeting prescribed competencies, professional development planning and showcasing evidence for authorisation or potential employers; and 2) A cake mix structure, which consists of a reflective narrative tying evidence together, which enables a greater focus on personal learning journeys, reflection and the development of personal qualities. Finally, evidence from the general nursing literature suggests the complexity of e‑portfolios in assessment and evaluation can be overcome by using qualitative research methods. Conclusion: To meet the competence and capability needs of nurse practitioners, portfolios could be used, for competence and showcasing and for learning and capability. Further research would be useful to refine and explore the use of e‑portfolios to meet the needs of NP candidates and their educators, clinical mentors, authorisation personal and employers. The current evidence on nurse practitioner education, competence, capability and e‑portfolios points to the integration of the use of an e‑portfolio into current nurse practitioner curriculum models to meet the unique needs of nurse practitioner candidates.

Mature learners becoming registered nurses: a grounded theory model

Abstract: Objective: This study describes how mature aged people reconstruct themselves as nursing students. Design: This is a constructivist grounded theory study that used grounded theory methods of concurrent data generation and analysis, coding, developing categories and memoing. Setting: The study was undertaken at the rural campuses of two major Australian universities. The universities were in two different states of Australia. Subjects: Data were gathered through semi-structured interviews and focus groups over an eighteen month period between January 2006 and June 2007 with fourteen mature aged undergraduate nursing students. These students were in the second or third year of three year baccalaureate degrees that led to registration as registered nurses (titled Registered Nurse Division 1 in the state of Victoria, Australia). Participants' backgrounds were all slightly different. Two participants were currently employed as enrolled nurses (titled Registered Nurse Division 2 in the state of Victoria, Australia). Three participants were married, two were supporting parents and one participant was in a committed defacto relationship. Only one participant had no children with other participants having between one and seven children aged between one week old and twenty years. Results: This study found that mature aged students experienced three stages in their trajectory of 'Becoming a registered nurse'. These phases were called: Taking the first step; Keeping going; and finally, Letting go and moving forward. Conclusion: Mature aged undergraduate students have different needs to younger students including academic and pastoral support, on campus subsidised childcare and creative timetabling. During each phase of their university journey mature aged undergraduate nursing students developed different skills and knowledge and identified different needs that resulted in both professional and personal growth.

Nurse practitioner provision of patient education related to medicine

Abstract: Objective: To describe the perceptions of Australian NPs and NP candidates (student NP and NPs in transitional roles but not yet authorised) in regards to their confidence and practice in providing medicine information to patients / clients. Design: An electronic survey related to prescribing practices. Setting: The survey was open to all Australian NPs (n=250 at time of survey) and NP candidates. Subjects: The survey was completed by 68 NPs and 64 NP candidates (student NP and NPs in transitional roles but not yet authorised) across Australia. Main outcome measures: Survey findings. Results: Sixty seven percent of NPs and 54% of NP candidates identified feeling very confident in providing their clients with education about medicines. Of the NP respondents 78% identified they generally do inform patients of the active ingredient of medications and 60% of NP respondents indicated they provide or discuss CMI leaflets with their patients. Conclusion: The results suggested that NPs and NP candidates are providing some of their clients with medicine information and using CMI leaflets in some prescribing consultations. Although confidence in the area of provision of education to patients related to medicines is high this may be incongruent with actual concordance supporting nursing behavior. Person centered patient education is central to the principles of building concordance. The incongruities between confidence in the provision of medication education to patients and self reported concordance building NP prescribing behavior needs to be a focus of critical reflection on NP prescribing practice.

Cancer patients’ sensemaking of conversations with cancer nurses in outpatient clinics

Abstract: ObjectiveCommunication is of significant importance to cancer patients however little is known about how they experience and make sense of their interactions with cancer nurses. This study was designed to investigate how and in what ways patients interpret initial consultations with cancer nurses in terms of how they perceive the role of the nurse.DesignThis qualitative study involved ‘sensemaking’ interviews with patients following their firstconsultation with nurses.SettingThe study was carried out in two outpatient cancer clinics in hospitals in Norway.SubjectsThe sample consisted of nine cancer outpatients experiencing a range of cancer situations.Main outcome measuresThe main outcomes measure was an understanding of the way in which cancer patients make sense of the role of nurses following initial consultation.ResultsPreconceptions of the role of the nurse were limited, with the nurse perceived as playing a mainly functional, task‑centred, role. Patients’ actual experience broadened their sense of the role of the cancer nurse to encompass a psychosocial supportive role.ConclusionsThe sensemaking approach used in this study offered a depth of insight into core factors that shaped the patients’ understanding. It is argued this approach has benefits for nursing research. Possible advantages for nursing practice and further research are suggested.

Practice Nurses Best Protect the Vaccine Cold Chain in General Practice

Abstract: Objective: Maintenance of the vaccine cold chain is integral to administering potent vaccines thereby protecting individuals and communities against vaccine preventable diseases. Previous studies have highlighted threats to vaccine cold chain integrity. The aim of this study was to assess vaccine cold chain integrity and to identify local factors affecting vaccine cold chain integrity in Hunter general practices, where approximately 85% of vaccines are administered. Design: A quasi experimental research design was used to conduct a site audit of general practice vaccine storage facilities in both urban and rural areas of the Hunter region of New South Wales. Practice staff who handled vaccines completed a practices and knowledge questionnaire during the audit visit. Setting: General Practice. Subjects: This study was an area wide survey of all Hunter general practice immunisation service provider sites (n=256) where an audit was conducted of all vaccine refrigerators in use at the time of the audit, and one questionnaire per site was completed with respect to the cold chain management of all vaccine consignments delivered within the previous three months (n=924). Main Outcome Measures: Main outcome measures were adherence to acceptable vaccine cold chain management practices as identified by National Health and Medical Research Council guidelines and maintenance of vaccine refrigerator temperatures within the World Health Organization's (WHO) recommended range of 2 C and 8 C. Results: A key finding from this study was the positive influence of general practice nurses on general practices achieving vaccine cold chain integrity as defined by WHO. Ninety eight percent (98%) of general practices where a general practice nurse was employed maintained vaccine cold chain integrity whereas only 42% of general practices where no general practice nurse was employed (95% CI: 10, 58) achieved the same result. Two types of vaccine refrigerators were identified in Hunter general practices; these were non bar type and bar type. Of 150 non bar type refrigerators in Hunter general practices 97% operated within the safe temperature range for the storage of vaccines, while only 58% of the bar type fridges maintained acceptable temperatures for vaccine storage (95% CI: 8 69). Conclusions: Study findings highlighted the value of employing general practice nurses in general practice in relation to maintaining vaccine cold chain integrity, and encouraging such nurses to become authorised immunisers so they can participate in ongoing immunisation education. The study findings supported the argument to outlaw bar type refrigerators for storing vaccines as these posed an unacceptable threat to vaccine cold chain integrity.

Basic life support knowledge of undergraduate nursing and chiropractic students

Abstract: Objective: The aim of this study was to examine retention of CPR/BLS knowledge of third year nursing and fourth year chiropractic students following instruction and assessment of CPR/BLS skills and knowledge as part of their undergraduate degree program. Design: Non-experimental exploratory survey to determine perceived ability and knowledge of CPR/BLS following completion of CPR/BLS instruction. Setting: University Health Sciences School. Subjects: 87 third year undergraduate nursing and 43 fourth year undergraduate chiropractic students at Royal Melbourne Institute of Technology (RMIT). Main outcome measure: The level of knowledge of CPR/BLS was assessed via the number of correct responses to questions regarding CPR/BLS. A visual analogue scale was used for the students to score their self rated perceived knowledge and skill. Results: The majority of students (78%) felt they were well prepared to perform CPR/BLS, however there were deficiencies in both groups with regards to knowledge of current guidelines. Chiropractic students were less likely to identify the correct compression rate compared to the nursing group (Spearman's rho 0.669, p-.001) with 95% of the chiropractic students not able to identify the correct rate. Thirty four percent of the students were unable to identify the correct ventilation compression ratio with nursing students again more likely to respond correctly (Spearman's rho 0.508, p-.001). Nursing students scored themselves highly for self rated knowledge and ability to perform CPR. Chiropractic students tended to score themselves at a lower rating in these areas than the nursing students; however the differences were not statistically significant. Conclusions: Although students from both disciplines had significant gaps in knowledge of CPR/BLS nursing students outperformed chiropractic students in all aspects of CPR/BLS knowledge. Despite the knowledge gap students from both disciplines were confident in their self assessed ability to perform and assess the need for CPL/BLS.

Implementing clinical guidelines for acute stroke management: Do nurses have a lead role?

Abstract: Objective: Health professionals should be aware of, and implement, best practice clinical guidelines for stroke care. Using the latest National Stroke Foundation Clinical Guidelines for Acute Stroke Management this study aimed to determine which member of the multidisciplinary team would most likely be responsible for taking the lead role for implementing each recommendation. Methods: Three nurses and one allied health professional independently classified each of the 148 recommendations according to whom they thought most likely to take the lead role in implementing each recommendation. A teleconference was held to discuss any differences of opinion and gain consensus. Results: The multidisciplinary team was identified as responsible for taking the lead role most often (n=54, 36%), followed by medical practitioners (n=52, 35%) and nurses (n=13, 8%). Nurses were identified as being involved either as the lead initiator or as part of the multidisciplinary team in implementing 79 (53%) of recommendations. A significantly higher percentage of recommendations where implementation was determined to be led by medical practitioners were attributed a Grade A or B strength of evidence (ie higher strength) (49%) when compared with those recommendations determined to be led by nurses (6%) (p=0.04). There was no significant difference between the number of Level I or II based recommendations determined to be led by medical practitioners compared to those led by nurses (59%; 11% respectively; p=0.26). Conclusions: Neuroscience nurses have a key role in the multidisciplinary stroke team and should contribute to the implementation of many of the evidence based guideline recommendations for acute stroke.

Farewell to the handmaiden? Profile of nurses in Australian general practice in 2007

Abstract: Objective To describe the characteristics of nurses working in Australian general practice, including their backgrounds, working environments, tasks and duties. Design National cross‐sectional survey. Setting General practices in all regions of Australia. Subjects 104 registered and enrolled nurses working as practice nurses (PNs). Results Participants were predominantly registered nurses (93%); all female; and had been in general practice for an average of 6.2 years. They were generally working part time (average 26.2 hours per week), with pay ranging from $18 to $45 per hour. Registered nurses had higher rates of pay but there was no clear relationship between rate of pay and years in general practice. The majority (86%) had completed one or more short courses, and one in six (16%) held or were undertaking postgraduate studies in practice nursing. PNs in the sample worked in practices where there was an average of one PN for every 2.43 GPs. Almost half (47%) worked in practices which employed allied health professionals, and 90% employed practice managers. All undertook duties relating to direct patient care, coordination of care, and management of the clinical environment. 90% undertook practice management and administration tasks, including 57% who provided some reception or secretarial support. Conclusions Although some differentiation of roles within the PN workforce was apparent, there were few discernable differences in nurse or practice characteristics associated with these different profiles, and they were unrelated to experience and remuneration. Findings highlight the need for development of career pathways and better monitoring of the PN workforce.

Effectiveness of an advanced practice emergency nurse role in a minor injuries unit

Abstract: Objective: To evaluate the effect of an emergency department discharge initiative (EDDI) nurse on discharge processes and patient transition outcomes. Design: Prospective comparative study of two groups of patients, aged 18-70 years discharged from a minor injuries unit. Setting: Emergency Department Minor Injuries Unit at a large tertiary hospital in South East Queensland, Australia. Subjects: In total 337 patients were eligible and 231 were included in the study. Participants were recruited into two groups one before the introduction of the intervention (n= 103) and one after the introduction of the intervention (n=128). Intervention: Introduction of an EDDI nurse (an advanced practice role) focusing on improving patient pre-discharge care and transition home. Main outcome measures: Data were collected pre-discharge and one week post discharge, using self reports of discharge planning processes and the Care Transitions Measure (CTM) Questionnaire. Results: Patients seen by the EDDI nurse were significantly more likely to receive written discharge information, a discharge letter, information on equipment, information on medication side effects and have follow-up arranged, than those not seen. The intervention group also had a better understanding of post discharge healthcare management with a mean CTM score of 83.3 out of a possible 100 compared with the pre-intervention mean of 64.4. (p<0.001). Conclusions: The introduction of an EDDI nurse in the minor injuries unit improves discharge information provision and follow-up and leads to an improvement in post-hospital care transition from the patient's perspective.

Developing the Nurse Practitioner Role in a Rural Australian Hospital: A Delphi Study of Practice Opportunities, Barriers and Enablers

Abstract: Objectives To gain a consensus view of potential roles for Nurse Practitioners (NPs) in a rural Australian hospital and identify the barriers and enablers in their development and implementation. Developing the Nurse Practitioner role in a rural Australian hospital ‐ a Delphi study of practice opportunities, barriers and enablers Design A three round Delphi study. Setting A rural hospital. Participants Twenty eight nurses, five doctors, four consumers, two health service managers, two allied health practitioners, one midwife, three community workers, two administrators and three others with hospital affiliation. Main Outcome Measures Consensus at 75% level of agreement or greater, identifying service gaps which might benefit from NPs and the barriers and enablers impacting on the success of developing and implementing the role. Results Introduce mental health, aged and critical care NPs initially. Barriers and enablers identified as impacting on the development and implementation of the role were: Educational access for isolated rural nurses ‐ local cohort learning with employment contracts encompassing fee assistance and designated study time. Acceptance from doctors ‐ supported role provided the proposed service is sustainable. Small teams of NPs would achieve this. Inappropriate Recruitment ‐ NP role matching service need, not individual. Policy and Funding Constraints ‐ clients are best served by NPs working across the care continuum. Co funding by acute and community providers could overcome the current constraints of commonwealth/state payment. Conclusion In developing and implementing NP roles at a rural health service the issues of access to tertiary education, creating a sustainable number of NP positions and financial cooperation from community and acute providers must be taken into account. Only then can nurses who wish to take on this NP role in a rural health service have the possibility of success.

The experience of socially isolated older people in accessing and navigating the health care system

Abstract: Objective: This article reports findings from a study exploring the challenges experienced by socially isolated and unwell older people as they attempted to access the health care system. Understanding the specific issues confronting these individuals would inform the development of more appropriate models of community based aged care. Design: A longitudinal qualitative, interpretive study using a case study approach with indepth interviewing. Setting: This study was conducted in metropolitan Brisbane, with frail older people who were accessed via their GP service. Participants: Six participants who met pre-determined selection criteria were recruited to this longitudinal study, and interviewed twice over a six month period. Findings: Fear emerged as a common experience embracing aspects of daily life such as depletion of social networks, being dependent on others, loss of mobility and diminishing ability to drive. Inadequate or unreliable public transport resulted in extended waiting times to attend medical appointments. Conclusions: Despite efforts to address the specific issues of frail older people living independently, this study highlights the suffering experienced by those who are socially isolated and lack the knowledge, skills, physical wellbeing and support to locate and access relevant health services.

Using the 'Six Thinking Hats' Model of Learning in a Surgical Nursing Class: Sharing the Experience and Student Opinions

Abstract: Objective: The purpose of the study was to test the use of a creative teaching method in developing nursing students' critical thinking skills The 'six thinking hats' model, which was developed by ...

Fear of falling

Abstract: Objective: The purpose of the paper is to describe the 'fear of falling' phenomenon; to raise clinicians awareness; to consider the associated risk factors; Setting: Fear of falling can be experienced in any clinical setting or within people own homes. Primary argument: Individual clinicians and the treatment and care teams should consider fear of falling in people with a disordered gait or balance, or in the months following a fall, particularly where there is a recognised decline in 'recent' activity or obvious activity avoidance and changes in patterns of activity Conclusions: Fear of falling is an under-recognised phenomenon. This paper suggests a range of assessment tools; and outlines some management options that are available to clinicians in order to address the problem of fear of falling.

Predictors of Nurses' Commitment to Health Care Organisations

Abstract: Background: Nurses' commitment in the workplace is a psychological state linking them to their organisations. It has been viewed as a dimension of organisational effectiveness. Objectives: The purp...

Supporting the evolution of a research culture among nurses in Malaysia

Abstract: Objective: This paper describes a project to promote a research culture amongst nurses in Malaysia The project, funded by the Australian Government's Australia Malaysia Institute, and implemented by a group of Australian nurse academics, provided a rare professional development opportunity to nurses in urban and remote areas of Malaysia Setting: The Malaysian capital of Kuala Lumpur and the remote town of Sibu, on the Island of Borneo, were the setting for this project The diversity of Malaysia was epitomized in the locations chosen for the implementation of tailored professional development seminars Conclusions: Evidence based practice in nursing is a global phenomenon The importance of basing nursing care on scientifically derived, current evidence is a critical element of contemporary nursing practice This notion is appreciated and accepted by nurses in Malaysia who, despite being impacted upon by barriers to the conduct and implementation of research in the clinical area, seek opportunities to enhance patient outcomes through evidence based practice Projects such as the one described in this paper provide a means for nurses to undertake professional development through collaborative activities that are not limited by geographic, socioeconomic or cultural boundaries

Population ageing and the politics of demographic alarmism : implications for the nursing profession

Abstract: Objectives This article provides a brief examination of the prejudices and politics framing current public debate on population ageing in Australia and the possible implications of this for the allocation of required health and social sector resources. The role and responsibility of nurses and professional nursing organisations to engage in and influence public policy debate concerning the health and social care of older people is highlighted. Setting Australia Subjects Australia's ageing population and succeeding generations over the next 40 years Primary argument According to the Australian government, population ageing in Australia is poised to cause unmanageable chaos for the nation's public services. The cost of meeting the future health and social care needs of older Australians is predicted to be unsustainable. Officials argue that government has a stringent responsibility to ration current and future resources in the health and social care sector, cautioning that if this is not done, the nation's public services will ultimately collapse under the strain of the ever increasing demands placed on these services by older people. This characterisation of population ageing and its consequences to the nation's social wellbeing may however be false and misleading and needs to be questioned. Conclusion The nursing profession has a fundamental role to play in ensuring responsible debate about population ageing and contributing to public policy agenda setting for the effective health and social care of Australia's ageing population.

Rethinking Student Night Duty Placements

Abstract: Objective: Student clinical placements principally occur over morning and afternoon shifts. This paper reports findings from a qualitative study that investigated experiences and value of night duty placements for undergraduate nursing students. Design: Final year students from one university were invited to participate in a two week night shift placement. A qualitative approach involving focus groups with students and ward nurses, prior to, and following the clinical placements was used. In addition, individual interviews were conducted with other key stakeholders from the university and health care service. Setting: The study was conducted in one metropolitan public hospital in Victoria, Australia. A clinical teacher was employed by the university to provide student support during the placement. Subjects: Fourteen final year nursing students, five permanent night staff from the hospital and four key personnel representing university and hospital perspectives consented to participate. Main outcome measures: All transcripts were thematically analysed together within the context of placement value and experience. Results: Three themes emerged from pre-placement interviews: nature of night shift, preparing to be a graduate, and change and adjustment. Post-placement interviews revealed the themes: time to learn and time to teach, adjusting, continuity and preparing to be a graduate. Conclusions: Night duty placements offered a range of possibilities and challenges. They provided opportunities for skills consolidation, enhanced understanding of nursing work and were perceived to contribute to readiness for graduate practice. Further research is needed to explore such placements on a larger scale.

Factors Affecting Sexual Satisfaction in Korean Women Who Have Undergone a Hysterectomy

Abstract: Objective: This study was undertaken to examine the factors affecting sexual satisfaction in Korean women who had undergone a hysterectomy. Design: The descriptive correlational study was conducted. The model contained three stages including antecedents (stage 1), interpersonal influence (stage 2), and outcome perception (stage 3). The antecedents included perception variables (eg negative body image and depression) and individual characteristics (eg age, education, employment and physical state before and after the hysterectomy). Stage 2 focused on social support. In stage 3, the outcome perception variable was sexual satisfaction. Setting: The setting was a gynaecology outpatient clinic in a suburban general hospital in Korea. Subjects: A total of 118 women who have had a hysterectomy participated. Main outcome measures: The instruments used for this study were the Body Image Scale, the Self Rating Depression Scale, the Spousal Support Scale, and the Korean version of the Sexual Satisfaction Subscale. Results: Results show spousal support (β=-.419, p=.00) and negative body image (β=-.301, p=.02) explained 30% of the variance in sexual satisfaction. Spousal support, as a mediating variable, was the highest factor predicting sexual satisfaction of women who have had a hysterectomy. Conclusions: Findings suggest the causal relationships of sexual satisfaction can guide researchers and gynaecology nurses to understand the relative strength of predictors for sexual satisfaction. Nurse practitioners should play a leading role in assisting women who undergo hysterectomy to ensure they have emotional support from their spouse, as this can dramatically impact their sexual satisfaction.

The Breast or Bottle? Women's infant feedings choices in a subsequent birth after a previous Caesarean Section

Abstract: Design: A qualitative methodological framework, utilizing descriptive phenomenology. Setting: A maternity hospital in Brisbane, Australia. Participants: Twenty women who had given birth at Redland Hospital after experiencing a previous CS were invited to participate. Data Collection Techniques: Tape recorded interviews were conducted six weeks postpartum. Results: The findings identify that mothers fell into three different attitudinal groups regarding their decision‑making with respect to feeding their newborn. The first perspective was based on a strong commitment to breastfeeding, which was often maintained in the face of quite significant difficulties. The second perspective was a complete refusal to breastfeed and a clear decision to bottle feed made prior to the birth and adhered to irrespective of alternative advice or persuasion. The third perspective was an initial desire to breastfeed that was easily thwarted by difficulties. The findings emphasise the importance of facilitating for CS births an environment that promotes bonding and breastfeeding by ensuring, where possible, that there is no separation of mother and baby after the birth, maximum opportunity for skin‑to‑skin contact, time for the mother to breastfeed the baby in the period immediately after the birth and no supplementation of breastfeeding with formula. Conclusions: The success of the midwife or maternity nurse in relation to supporting breastfeeding was, in part, impacted on by the mother’s pre‑determined approach to feeding the newborn. Breastfeeding support for attitudinal groups one and three were most likely to be successful, while the second group was refractory to nursing breastfeeding assistance.

Enhancing the Roles of Practice Nurses: Outcomes of Cervical Screening Education and Training in NSW

Abstract: Background: There is a dearth of information about the roles practice nurses (PN) undertake in Australian general practice and what impact these roles have on patient health outcomes following specific education and training programs. Accurate data is vital to evaluate the usefulness and cost effectiveness of item numbers for PN and funding for PN education, in addition to providing some direction for the future education and support of PN. Methods: An anonymous postal survey was sent to all PN who had completed the Family Planning NSW Well Women's Screening Course (WWSC) between 2003 and 2007. Results: Over three quarters of respondents reported their clinical role had expanded, that there was need for ongoing education on all aspects of women's health, and for some PN there are barriers to role expansion. Discussion: Role expansion has occurred for PN following education and training that contributes to patient outcomes. Existing methods for collecting specific activity of PN are incomplete. Barriers exist in the utilisation of PN which could be overcome with education of both general practitioners and the community regarding the role of PN and the valuable contributions they can make to general practice.

Cardiac patients' knowledge and use of sublingual glyceryl trinitrate (SLGTN)

Abstract: Objective: This study examined cardiac patients' knowledge and use of sublingual glyceryl trinitrate. Design: A non-experimental, retrospective descriptive design with a convenience sampling strategy was used. Setting and Subjects Participants were cardiac in-patients who were prescribed sublingual glyceryl trinitrate (SLGTN) at the study hospital. Main outcome measure(s): Participants' knowledge and use of SLGTN was assessed using the Sublingual Nitroglycerin Interview Schedule (SNIS) which is a valid and reliable tool. Results: Fifty-two in-patients from a general cardiac ward or coronary care unit were approached. A total of 41 (87.2%) participants were enrolled and all completed the survey. Participants' mean Knowledge score regarding SLGTN was 3.98 (SD=1.21), and the mean Use score was 3.68 (SD=1.12). Approximately one quarter of participants (24.4%) knew using SLGTN to prevent chest pain was an appropriate use for the drug. Males were significantly more likely to incorrectly transport their SLGTN than the females in the study (t=-5.316, df = 21.8, p=<0.000). Conclusions: Findings indicate that patients' have limited knowledge of and do not always appropriately use SLGTN, particularly in terms of the way men transport the medication. Therefore there is a need to develop and implement educational strategies to facilitate greater self-management of angina.

Investigating People Management Issues in a Third Sector Health Care Organisation - an Inductive Approach

Abstract: Objective: To explain use of inductive convergent interviewing to generate the perceived critical people management issues, as perceived by staff, as a prelude to longitudinal surveys in a third sector health care organisation. Design: Convergent interviewing is a qualitative technique that addresses research topics that lack theoretical underpinning and is an inductive, flexible, evolving research approach. The key issues converged after six rounds of interviews as well as a further round to ensure that all of the common people management issues had been generated. Setting: Studies in employee behaviour in the health care industry exist, but there is little in the way of tested models of predictors of such behaviour in third sector organisations in the Australian health care industry. The context is what differentiates this study covering a range of facilities and positions in hospitals and aged care situations within one third sector health care organisation. Subjects: The study proposed twenty seven extensive interviews over a range of facilities and positions. Twenty one interviewees participated in the final convergent process. Conclusions: Critical issues included: workload across occupational groups, internal management support, adequate training, the appropriate skill mix in staff, physical risk in work, satisfaction, as well as other issues. These issues confirm the proposition of sector-ness in health organisations that are multi-dimensional rather than uni-dimensional.

Inflammatory Bowel Disease Management: A Review of Nurses' Roles in Australia and the United Kingdom

Abstract: Objective: To explore the role of Australian nurses in the provision of inflammatory bowel disease (IBD) health services. Design: A questionnaire survey. Setting: Hospitals in Australia and the South West of the United Kingdom (UK). Subjects: Inflammatory bowel disease nurses. Main outcome measure: The diversity of IBD services. Results: Twelve Australian and 19 UK nurses returned completed questionnaires (approximately 40% response rate). Most participants were registered nurses, aged between 25 and 55 years. More UK participants were IBD specialist nurses (84% vs 42%; p = 0.019) and the majority of Australian nurses being clinical trial coordinators. The UK nurses had more interest in IBD (100% vs 75%; p = 0.049) and spent more time in IBD nursing (63% vs 25%; p = 0.043). Nurses in the UK provided more IBD services and tended to perceive a higher level of support from management (52% vs 25%; p = 0.12). Fewer IBD services were provided by Australian nurses despite their equivalent educational attainments, years of IBD experience and level of autonomous practice. Australian nurses identified the lack of funding, time and management support as barrier to service development. Australian nurses were less likely to be employed as dedicated IBD nurses and were required to provide nursing services to a wider clientele. Conclusion: In this study Australian IBD nurses had less specialised roles, attracted less funding and management support. Australian nurses were more focussed on clinical trial coordination and provided for a wider clientele.

Side Effects of Treatment in Patients with Hepatitis C - Implications for Nurse Specialist Practice

Abstract: Objective To identify patientsâ?T perceptions of the side effects of Hepatitis C treatment. Design The research used a selfâ?'reporting postal survey design to identify reported side effects, related to hepatitis C treatment, suffered by patients attending a specialist nurse clinic. Setting The setting for this study was an outpatient hepatology clinic in a large general hospital in Ireland.