Professor Debra Jackson works at the University of Technology, Sydney (UTS), Australia. Debra contributes to international nursing scholarship through her work as an Editor of the Journal of Clinical Nursing; Managing Editor for the Advances in Contemporary Nursing series, and as an active peer reviewer for Australian and international journals and funding bodies. She has published extensively, and has over 250 publications including journal articles, books and book chapters.
Abstract: A wide range of statutory and non-statutory child protection and family support services exist to prevent the occurrence or re-occurrence of maltreatment. They may be oriented towards primary, secondary or tertiary levels of prevention, employ various types of professional and/or paraprofessional workers, and target a diverse range of groups. The purpose of this study was to examine the experiences of parents who were directed by child protection authorities to attend a tertiary level child protection and family enhancement program. In depth unstructured interviews were used to gather data about these parents' experience. Thematic content analysis of these transcripts identified four major themes as follows: 1) It's a good place to be: Participation as an affordable social outlet; 2) Learning about kids: Participation as a source of learning; 3) They are there for me: Participation as a source of practical help and support; and, 4) I am a good mother: Participation as a source of tension and conflict. Participants' perceptions of friendship with workers emerged as the most significant and valued aspect of their experience. These feelings of friendship were tested when staff undertook their mandatory reporting role. Feelings of betrayal arose that challenged the women's previous unconditional feelings of trust, and jeopardized the therapeutic relationships that had been established.
Abstract: To identify the challenges associated with using journaling as a method of data collection and to offer strategies for effectively managing those challenges.
Abstract: Settling in a new country exposes immigrants to various health risk factors, and the existing literature alludes to immigrant women being more vulnerable than men. This article highlights some of the difficulties faced by West African women while settling into life in Australia. A qualitative DESIGN: beginning again and experiencing loneliness and isolation. Participants encountered difficulties in developing social networks and obtaining employment, and as a result, they felt lonely and isolated. Therefore, nurses and health care professionals need to incorporate screening for precursors of emotional and social well-being issues when caring for this population.
Abstract: Sexually transmitted infections have long been associated with stigma and stereotypes due to their very nature. Throughout history sexually transmitted infections have been associated with female prostitution and deviant immoral behaviour making women who contract these infections particularly vulnerable to being stigmatised and stereotyped. Although the stigma attached to such infections has previously been documented in the literature, the aim of this research was to gain in depth insight into young Australian women's experiences of having a sexually transmitted infection from a feminist perspective. Findings from this study provide insight into the onerous effects stigma can have on women with these infections and sheds light on how these effects can influence self-perceptions, fear of rejection and feelings of unworthiness. These findings can provide nurses with greater understanding and insight into the effects of stigma on women's experiences of having a sexually transmitted infection. Having this understanding and insight has the potential to promote therapeutic care and minimise the stigma that may be felt among women who have contracted this type of infection.
Abstract: Aims and objectives.  The aim of this study is to explore neonatal nurses' perspectives of their role in facilitating family centred care in the neonatal intensive care unit. Background.  The philosophy of family centred care focuses on the health and wellbeing of the newborn and their family, through the development of a respectful partnership between the health care professional and the infant's parents. Many studies report family centred care in the context of paediatric care; however, few studies explore neonatal nurses' perspective of family centred care in the context of neonatal care. Design.  Qualitative interpretative approach. Methods.  Four focus groups and five individual face-to-face interviews were conducted with neonatal intensive care nurses (total n = 33) currently practicing in a tertiary Neonatal Intensive Care Unit in Australia. Each focus group and face to face interview was audio-taped and transcribed. Data was analysed using thematic analysis. Results.  Four dominant themes emerged from the data: (1) Getting to know parents and their wishes (2) Involving family in the day to day care (3) Finding a 'happy' medium (4) Transitioning support across the continuum. Conclusion.  These findings revealed a general understanding of family centred care principles. Nurses reported the potential benefits and challenges of adopting a family centred care approach to deliver optimal care for neonates and their families. The study highlighted that nurses need ongoing organisation support, guidance and further education to assist them in delivering family centred care effectively. Relevance to clinical practice.  Family centred care is a central tenet underpinning neonatal care. Understanding neonatal nurses' perspectives will be useful when developing strategies to strengthen family centred care in the neonatal intensive care unit, and potentially improve neonatal care and family outcomes.
Abstract: This paper is concerned with the use of published literary autobiographies that contain first-hand accounts of illness narratives, to explore their usefulness as a form of qualitative data to generate knowledge that can inform nursing practice. There is increasing realisation that the experiences of patients and families should be used to guide health care service delivery, and autobiographical accounts are a valuable resource, providing first-hand accounts of the ways illness, disability, and health care, are experienced by patients and their families.
Abstract: Abstract A wide range of statutory and non- statutory child protection and family support services exist to prevent the occurrence or re-occurrence of maltreatment. They may be oriented towards primary, secondary or tertiary levels of prevention, employ various types of professional and/or paraprofessional workers, and target a diverse range of groups. The purpose of this study was to examine the experiences of parents who were directed by child protection authorities to attend a tertiary level child protection and family enhancement program. In depth unstructured interviews were used to gather data about these parents experience. Thematic content analysis of these transcripts identified four major themes as follows: 1) It's a good place to be: Participation as an affordable social outlet; 2) Learning about kids: Participation as a source of learning; 3) They are there for me: Participation as a source of practical help and support; and, 4) I am a good mother: Participation as a source of tension and conflict. Participants' perceptions of friendship with workers emerged as the most significant and valued aspect of their experience. These feelings of friendship were tested when staff undertook their mandatory reporting role. Feelings of betrayal arose that challenged the women's previous unconditional feelings of trust, and jeopardized the therapeutic relationships that had been established.
Abstract: There is an abundance of literature documenting the shortage of nurse faculty, both in Australia and internationally. This shortage has repercussions for the next generation of nurses, contributes to the overall nursing workforce shortage, and holds implications for the development of nursing research and continued practice development. The literature suggests a multitude of factors contributing to the shortage, including the ageing of current nurse faculty, and an undersupply of doctorally prepared nurses to take their place. To date, most nurse academics come from a clinical background with little preparation for the complex faculty role; despite this there is little exploration of their experiences transitioning to academia. The limited available evidence suggests that this new role may be accompanied by feelings of uncertainty, anxiety and isolation associated with changed responsibilities, an emphasis on scholarly activities and teaching, and the unique culture of the academic environment. The aim of this paper is to provide a critical review of the literature, identify issues relevant to the nurse faculty shortage and provide direction for further research.
Abstract: Frequently, research and conference papers explore difficult or problematic areas of practice that can inadvertently render daily nursing accomplishments invisible and create the perception of a discipline in crisis. In this qualitative study, we explore the views of registered nurses about achievements in the workplace and good nursing work in an acute inpatient mental health setting in Sydney, Australia. Mental health nurses were asked a series of questions about their experiences and understanding of what constitutes good nursing work as well as their sense of optimism about their work. A total of 40 structured face-to-face interviews were completed. Among the responses to questions about achievements and good nursing practice, five broad themes were identified: i) teamwork; (ii) interpersonal interactions with patients; (iii) providing practical and holistic support to patients; (iv) patients' mental health improvements; and (v) optimism-pessimism continuum. Findings contribute to a discussion of good nursing work in acute mental health settings, as well as self-perceptions of optimism and hopefulness, which are important contributors to positive, supportive health-care settings and patient recovery.
Abstract: In the present study, we interviewed 40 patients in acute inpatient mental health settings regarding their experience of, and views about, receiving pro re nata (PRN) medication. Patient requests for PRN were primarily to relieve anxiety or to aid sleep, and the majority of the participants (80%) could describe a situation where this medication was very helpful. From the perspective of patients, interactions surrounding the immediate administration of PRN medication were inadequate, in that half of the interviewees were simply told to take the medication, and three-quarters said that, in their experience, formal consent was not commonly sought. Three-quarters of respondents came up with alternatives to PRN, and half wanted more information about the medication itself. These findings could contribute to improved nursing assessment for PRN medication need, administration, and monitoring.
Abstract: Commonly, the expression 'PhD' evokes a level of trepidation amongst potential candidates from both the clinical and academic spheres. In contemporary settings, a Doctor of Philosophy is highly regarded and increasingly necessary for a successful academic nursing career. The aim of this paper is to explore the options for doctoral education for nurses, and consider the role of the doctorate in career planning for nursing, and in the attainment of career goals. Here we discuss some key issues and practicalities including career planning, selecting a doctoral program, choosing a university, supervision, committees and panels, achieving a work-life balance and dealing with conflict. The PhD process should be an enriching and satisfying experience which may lead to enhanced professional and personal growth; however, there are potential pitfalls that nurses should be aware of before embarking on doctoral training. Future studies are needed to assess the impact of the different doctorates offered to see if, in fact, they are advancing nursing practice and research endeavours.
Abstract: Many women privilege the mothering role over other areas of their lives, and for ill women, it can be difficult to relinquish maternal responsibility. Not being able to mother in their usual way can have consequences for women's wellbeing and view of themselves as 'good' mothers.
Abstract: This paper is a report of a study of sexually active young women's experiences of negotiating condom use both before and after diagnosis of a sexually transmitted infection.
Abstract: Undergraduate nurses are employed as assistants in nursing (AIN) in inpatient mental health settings; however, there is a paucity of published research exploring registered nurses' (RN) views about the AIN role in these settings. This qualitative study documents the views and experiences of RN working with undergraduate AIN. Fifty structured face-to-face interviews were analysed, and the results are discussed in three sections. The first section outlines RN perceptions of qualities and skills required of AIN in mental health, and the responses primarily focus on communication skills, initiative, and willingness to learn. The second section targets factors in the workplace that might enhance the interest of AIN in a mental health nursing career; the responses emphasize their need to work with experienced staff. The last section outlines RN expectations of AIN, most of which are met and involve physical observations and technical tasks; less fulfilled activities primarily cluster around interactions with patients. Findings highlight the advantages and disadvantages of drawing on undergraduate nursing students as AIN in mental health settings. Communication skills, personal initiative, safety training to prevent violence, and education to increase knowledge and awareness about mental illness, diagnosis, and mental status-related skills were all important concerns articulated by RN.
Abstract: In contemporary Western society, infertility has the capacity to impact greatly on couples, emotionally and socially. In the face of such infertility, couples are able to seek assisted reproductive technologies to assist in the pursuit of biological parenthood. These technologies are not infallible though, and the likelihood of success remains small. Therefore it is inevitable that some couples will remain childless, and this has been associated with grief and adversity. Findings present the narratives of participant couples' through and beyond the many adversities encountered due to remaining childless despite infertility treatment. Regardless of theories that seek to pathologise couples experiencing this type of adversity, participant couples demonstrated resilience in redirecting their energies into areas of their lives where they could achieve positive outcomes. This research highlights the importance of caring for couples rather than individuals undergoing infertility treatment. It provides support for approaches that foster couples' relationships with the aim of promoting individuals' resilience.
Abstract: This article describes the development and tests the reliability and validity of a new survey instrument, the Child-to-Mother Violence Scale (CMVS). This instrument was devised specifically to measure data regarding the incidence, perpetrators, targets, experiences and influences on child-to-mother violence as the first phase of a larger study that investigated child-to-mother violence in the western suburbs of Sydney, Australia.
Abstract: Attrition from undergraduate nursing programs continues to warrant investigation particularly in the climate of nursing shortages and fiscal reflection on academic institutional programs. This three-year study used a prospective longitudinal survey design to determine entry characteristics of students, attrition, progression and completion in an undergraduate program. Students were surveyed in the first three weeks of commencing their program and gave permission for academic grades to be collected during their six session, three year Bachelor of Nursing program. Of the 740 students enrolled 48% (357 students) were surveyed and 352 students (99%) gave consent for their grades to be collected. One-third of the student cohort graduated in the expected three-year timeframe, one-third had dropped out and one-third was still completing their studies. A higher Grade Point Average and being a native English speaker were most predictive of students completing their course in the minimum expected timeframe.
Abstract: Sessional teachers are taking an increasing role in classroom teaching in Schools of Nursing. However, there is a paucity of literature reporting the experiences of, and impact on, career academics working with or alongside the burgeoning numbers of sessional teachers. Therefore, the purpose of this paper is to explore the experiences of continuing academics working with sessional teachers. This qualitative study used purposive sampling to recruit nurse academics and collect narrative data related to their experiences of working with sessional teachers. Four major themes emerged from the data, namely: They have got real credibility - perceptions of clinical currency, We've got people who are very good clinically, but don't know how to teach - lacking skills and confidence, No allegiance to the school or the students - perceived lack of commitment and accountability, and A terrible burden - workload implications for continuing academics. The development and implementation of standards for the recruitment and employment of sessional teachers would benefit both continuing academics and sessional teachers, and assist in the delivery of quality teaching and learning to nursing students.
Abstract: Academic writing skills are essential to the successful completion of preregistration nursing programs, yet the development of such skills is a challenge for many nursing students, particularly those who speak English as a second language (ESL). It is vital to develop and evaluate strategies that can support academic writing skills for ESL nursing students. This qualitative study evaluated a four-day academic writing intervention strategy designed to support ESL first-year nursing students. Data from the program showed two major areas of difficulty for participants relating to academic writing: problems understanding course content in English, and problems expressing their understanding of that content in English. The participants noted a key benefit of this program was the provision of individual feedback. Programs such as this intervention successfully meet the demands of ESL nursing students, although ongoing support is also needed.
Abstract: Mid-career students who undertake doctoral studies have often achieved standing and success in their careers and may already hold quite senior leadership positions in the profession. In view of this, mid-career students may struggle with the transition to student, particularly if they have not studied for a number of years and have multiple pressures on their time. Supervisors on the other hand, operate within cultures of performance based indicators, and are under pressure to facilitate timely student completions. While students must take ultimate responsibility for their doctoral work, it is possible for supervisors to identify problems early, and offer practical solutions to assist mid-career students overcome their problems, and facilitate optimal engagement. In this paper we highlight some of the challenges this vulnerable student group can present, and identify some practical strategies supervisors can suggest to assist in the timely and successful completion of doctorate degrees.
Abstract: This paper explores the challenges of interviewing people about sensitive topics. It uses existing literature and the first author's experience of interviewing women traumatised by having an emergency hysterectomy following a severe postpartum haemorrhage. It also highlights the strategies that can assist interviews.
Abstract: Nurses involved in whistleblowing often face economic and emotional retaliation, victimization and abuse. Yet for many nurses, one major part of their whistleblowing experience is the negative impact it has on their families. This paper reports findings from a qualitative study pertaining to the effects of whistleblowing on family life from the perspective of the nurses. Using a narrative inquiry approach, fourteen nurses were interviewed who were directly involved in whistleblowing complaints. Data analysis drew out three themes: strained relationships with family members, dislocation of family life, and exposing family to public scrutiny. The harm caused to the nurses involved in a whistleblowing event is not restricted to one party but to all those involved, as the harrowing experience and its consequences are echoed in the family life as well. It is important for organizations to seek strategies that will minimize the harmful effects on nurses' families during whistleblowing events.
Abstract: This discussion paper argues for the critical importance of successful leadership for effective mental health nursing, observing that nursing leadership has long been regarded problematically by the profession. Using empirical and theoretical evidence we debate what leadership styles and strategies are most likely to result in effective, recovery-orientated mental health nursing. Models of transformational and distributed leadership are found to be highly congruent with mental health nursing values, yet the literature suggests it is a type of leadership more often desired than experienced. We note how the scholarly literature tends to ignore the "elephant in the room" that is organizational power, and we question whether transformational leadership pursued within a specific clinical context can influence beyond those confines. Nevertheless it is within these contexts that consumers experience nursing, effective or otherwise, thus we should advocate what is known about effective leadership wherever it is required.
Abstract: Analysis of Australian nursing research output is becoming more important as academic institutions move into implementing quality programs of research output. Notable in determining research quality is the publication of research papers in journals with a high ranking within the Institute for Scientific Information (ISI) or Excellence in Research for Australia (ERA). This paper reports an analysis of Australian nurse researcher output in journals highly ranked by the ISI and ERA. Research abstracts were analysed for topic, sources of data, location of research and methodological paradigm. A total of 530 articles from five Australian and from five USA and UK journals were analysed. There was an increase in output from the period of prior analyses in 2000. Practice issues are the most common topic followed closely by nurse education. While most studies used nurses as sources of data there were more studies in which consumers of nursing care were the point of inquiry. Both qualitative and quantitative methods were utilised. Given the importance of rationalising nursing practice and adding new knowledge to evidence based care, it is imperative for the nursing profession to disseminate research findings. Failure to do this may result in poor return in investment outcomes for the future of nursing in Australia and internationally.
Abstract: Stigma is a powerful social phenomenon with insidious health implications. Understanding stigma as it applies to various populations is imperative for nurses as it enables nurses to enhance individual patient care and nurses are well positioned to influence both social and health care policies which may exacerbate the experience of stigma. This article is a report of a study to explore the experiences of women who provide long-term foster care. Interviews were conducted with 20 women who provided long-term foster care in Australia. Data were coded according to the components of stigma described by Link and Phelan (2001). Findings reveal participants rejected the label of foster carer to avoid the negative stereotype. When unable to conceal their foster carer label, participants experienced social isolation and status loss. Moreover, participants felt marginalized and disempowered within the governing systems.
Abstract: salamonson y., bourgeois s., everett b., weaver r., peters k. & jackson d. (2011) Psychometric testing of the abbreviated Clinical Learning Environment Inventory (CLEI-19). Journal of Advanced Nursing. ABSTRACT: Aim.  This paper is a report of a test of the psychometric properties of a 19-item version of the Clinical Learning Environment Inventory. Background.  Although the clinical learning environment provides the 'real-life' context essential for preparing nursing students for their professional role, the quality of student learning is influenced by the quality of the clinical placement. Methods.  Nursing students completed an abbreviated (19-item) form of the Clinical Learning Environment Inventory to rate their perception of the clinical learning environment. Descriptive statistics, principal component analysis, discriminant validity and Cronbach's alpha reliabilities were computed. Results.  Between March and December 2009, 231 online surveys were submitted. The mean age of participants was 30·3 years (sd: 10·4) and 87% were female. All 19 items loaded on two factors, 'Clinical Facilitator Support of Learning' and 'Satisfaction with Clinical Placement', with factor loadings above the 0·4 threshold. Cronbach's alpha coefficient was 0·93 for the total Clinical Learning Environment Inventory-19, with subscales ranging from 0·92 to 0·94. Multiple regression uncovered that participants who engaged in health-related paid work were independently and significantly more positive on the 'Clinical Facilitator Support of Learning' subscale, whereas those who worked >16 hours a week, or allocated the afternoon shift were independently and significantly more negative on the 'Satisfaction with Clinical Placement' subscale. Conclusion.  Providing an effective and productive clinical experience is vital in preparing nursing students to become competent clinicians. The Clinical Learning Environment Inventory-19 offers a useful measure to explore nursing students' satisfaction with two aspects of this clinical experience - clinical facilitator support of learning and the clinical learning environment.
Abstract: Aims and objectives.  To determine clinical mental health nurses' views and preferences about continuing professional development. Background.  Participation in continuing professional development is now expected for nurse and midwifery registration. However, it is unclear how clinically based mental health nurses view continuing professional development and its relevance to career intentions. Design.  Qualitative. Method.  Semi-structured face-to-face interviews with mental health nurses (n = 50) drawn from inpatient mental health units. Results.  The most prominent factor identified through this research is that the majority of the fifty participants valued continuing professional development and sought more opportunities to participate. They particularly favoured in-house locally based sessions targeting patient-related clinical skills enhancement. Importantly, this interest in continuing professional development was not confined to new graduates needing to consolidate their skills. Work-based flexibility, the types of courses available and opportunities for study leave were also identified as important factors. Of the 50 nurses interviewed, 40% expressed a desire for continuing professional development vis-à -vis remaining in the service; 30% of nurses responded to the same question with an emphasis on the importance of collegial support amongst peers and management; and 30% of the nurses indicated their primary focus for continuing professional development was to further their tertiary studies. Conclusions.  These results are not only timely given the requirements around continuing professional development, but are also important to drive improvements in quality continuing professional development where needs are prioritised, discussed and agreed on. Relevance to clinical practice.  Findings from this study highlight the value clinical nurses place on having access to work-based and clinically focussed education and development. Relevant on-the-job professional education has the potential to improve job satisfaction and retention of clinical nurses, thus ultimately directly and positively influence patient care.
Abstract: This article synthesises principles and ideas from relevant literature on professional boundaries and applies them to higher education settings with the intention of contributing to contemporary debates on appropriate, respectful, and ethical conduct in academia. This is against a background of structural changes and growing complexity of academic institutions in concert with decreasing adherence to rules of conduct and established privileges historically handed down from traditional universities. The professional and personal conduct of nurse academics is increasingly unfettered in association with 'market' forces and simultaneously more available for scrutiny in association with a greater awareness of and institutionalisation of human rights and protections across all sectors of society.
Abstract: PURPOSE:  This paper provides an overview of some challenges facing mental health practice nurses transitioning to academic life, and suggests possible strategies to prevent foreseeable difficulties. FINDINGS:  New and existing mental health faculty will benefit from a greater awareness of barriers and developing entry protocols to enhance the transition experience and reduce early workplace stressors. PRACTICE IMPLICATIONS:  Preparation and support for mental health staff transitioning from practice to the academe are essential to enhance the transition experience and reduce early workplace stressors.
Abstract: Aim.  This paper reports the healthcare experiences of women who have been diagnosed with a sexually transmitted infection. Background.  The incidence of sexually transmitted infections is increasing throughout the globe on an annual basis. To effectively curb this trend and reduce the spread of these infections, effective education and treatment is essential. Design.  This study used a feminist approach. Methods.  Ten women participated in this study. Interviews were conducted online and transcripts were thematically analysed. Results.  Findings from this study revealed that the women generally characterised their healthcare experiences as negative. Some women perceived being negatively judged by healthcare professionals and felt they were not provided with sufficient information or support when diagnosed with a sexually transmitted infection. Conclusion.  This paper reveals how healthcare professionals have the ability to exacerbate the adversity felt by women diagnosed with a sexually transmitted infection and how providing appropriate therapeutic care can assist young women who have been diagnosed with these types of infections. Relevance to clinical practice.  Nurses and other healthcare professionals can better serve patients by providing emotional and therapeutic support and information about the possible effects and long-term sequelae of sexually transmitted infections. Further, by providing sufficient information and support, the negative effects of having a sexually transmitted infection can be reduced and women's ability to cope with a sexually transmitted infection can be enhanced.
Abstract: To develop an interpretation of Australian nurse leaders' understandings and experiences of mentorship for nurse leadership. The study aimed to explore experiential meanings and understandings that Australian nurse leaders apply to their mentoring relationships; determine whether mentoring relationships contribute to nurse leader development in Australia; and identify how Australian nurse leaders conceptualize mentorship.
Abstract: Aims and objectives.  This study reports the intimate partner violence experiences of West African women living in Australia. Background.  Increasing diversity in Australia's population presents new and complex challenges to nurses and other health care providers, particularly in relation to the health needs of immigrant women. Design.  A qualitative naturalistic inquiry design was used. Method.  A convenience sample of 21 West African immigrant women in Australia who were 18 years and over were engaged in face-to-face, in-depth interviews and asked to talk about their health experiences. The interviews were transcribed verbatim and analysed thematically. Intimate partner violence was revealed as a major theme in this analysis. Results.  Data revealed that eighteen of the women had experienced intimate partner violence. The women's accounts of intimate partner violence were dominated by two subthemes 'suffering in silence' and 'reluctance to seek help.' Conclusion.  Findings revealed intimate partner violence as a significant issue for the newly migrated African women who participated in this study. Relevance to clinical practice.  Intimate partner violence is associated with significant adverse physical and psychological health outcomes. It is important that nurses understand the cultural barriers that can impede immigrant women's ability to seek out and receive appropriate support and intervention and provide opportunities for women to disclose experiences of intimate partner violence.
Abstract: Students who transition from high school to college are often excited by the new phase of their lives. However, they are exposed to circumstances and expectations which place them at risk for psychiatric disorders or that may exacerbate pre-existing problems. In this paper, we discuss risk factors and other issues associated with students transitioning to college or university life, identify challenges for health professionals, and suggest possible strategies to improve the mental health of young adults on college campuses. Academic staff and health care providers need to be aware of how best to engage and assist students during an important phase of their life. Processes and care pathways also need to be easily understood, user friendly, and appropriately resourced. It is anticipated that staff, students, and industry health care providers will benefit from a greater awareness of some of the mental health issues that may occur in higher education.
Abstract: Aims and objectives.  This article presents a qualitative meta-synthesis that explores the experiences of adult children of parents with a mental illness. Background.  There has been growing interest in the experiences of children whose parents have mental illness. However, little literature explores the experiences of adult children. Design.  Qualitative meta-synthesis. Method.  A review of English language literature search engines was undertaken and identified 905 relevant articles. Articles were excluded if they used quantitative methodology, had other methodological issues or had a focus on parental drug/alcohol issues. Twelve articles were identified as using qualitative or mixed methods studies, which were reviewed using the Critical Appraisal Skills Programme (Public Health Resource Unit, 2006). Following this, seven studies were included in the meta-synthesis. The main findings and themes identified by the original study authors were extracted from the results and discussions sections and further categorised into four main themes using content analysis methods. Results.  There were 26 themes identified by the meta-synthesis, which were collated into four wider categories and concepts. Issues related to family relationships, external familial relationship changes, the adult child's emotional reflections and illness-related concepts were identified. Conclusions.  There is a paucity of qualitative research that considers adult children's experiences of parental mental illness. In the available studies, issues related to family relationships, external familial wider relationship changes, the adult child's emotional reflections and illness-related concepts were identified as being of concern to adults who experienced parental mental illness during childhood. Relevance to clinical practice.  There is a need for all health and social care services to be aware of the experiences/needs of adult children who have experienced parental mental illness. Adult children of parents with mental illnesses should be provided with opportunities to discuss their stories to validate their experiences.
Abstract: Aims and objectives.  To highlight and illuminate the emotional sequelae of whistleblowing from whistleblowers and subjects of whistleblowing complaints. Background.  Whistleblowing has the potential to have a negative impact on individuals' physical and emotional well-being. However, few empirical studies have been conducted using qualitative methods to provide an in-depth exploration of the emotional consequences for those involved in whistleblowing incidents. Design.  Qualitative narrative inquiry design. Method.  Purposive sampling was used to recruit participants who had been involved in whistleblowing incidents. During interviews participants' accounts were digitally recorded and then transcribed verbatim. Data were then analysed by two researchers until consensus was reached. Results.  Findings revealed that participants' emotional health was considerably compromised as a result of the whistleblowing incident. Analysis of the data revealed the following dominant themes: 'I felt sad and depressed': overwhelming and persistent distress; 'I was having panic attacks and hyperventilating': acute anxiety; and, 'I had all this playing on my mind': nightmares, flashbacks and intrusive thoughts. Conclusions.  While it has been previously acknowledged that whistleblowing has the potential to have a negative impact on all aspects of an individual's life, this study notably highlights the intensity of emotional symptoms suffered by participants as well as the extended duration of time these symptoms were apparent. Relevance to clinical practice.  As professionals, nurses, as well as organisations, have a responsibility to identify those who may be suffering the emotional trauma of whistleblowing and ensure they have access to appropriate resources.
Abstract: A work-based educational programme was the intervention used in a collective case study aiming to develop, strengthen and maintain personal resilience amongst fourteen nurses and midwives. The participants attended six, monthly workshops and formed a participatory learning group. Post-intervention, participants reported positive personal and professional outcomes, including enhanced self-confidence, self-awareness, communication and conflict resolution skills. They strengthened relationships with their colleagues, enabling them to build helpful support networks in the workplace. The intervention used new and innovative ways of engaging nurses and midwives exhibiting the effects of workplace adversity - fatigue, pressure, stress and emotional labour. Participants were removed from their usual workplace environment and brought together to engage in critical reflection, experiential learning and creativity whilst also learning about the key characteristics and strategies of personal resilience. Participants' experiences and skills were valued and respected; honest airing of the differences within the group regarding common workplace issues and concerns was encouraged. The new contribution of this intervention for nursing and midwifery education was supporting the learning experience with complementary therapies to improve participants' wellbeing and reduce stress.
Abstract: Aim.  To explore the experiences of prospective adolescent fathers regarding their impending fatherhood. Background.  Several studies indicate adolescent fatherhood is associated with multiple risk factors. Despite this, it is well documented that these young males have a potentially vital role in the lives of their child/ren and partners. Adolescent pregnancy has often been viewed with a particular emphasis on the mother and relatively little is known about the experiences and expectations of young males facing imminent fatherhood. Design.  Narrative methods were used to collect qualitative data. Method.  Narratives were elicited through in-depth interviews with seven adolescent expectant fathers aged 16-22 years. Results.  Impending fatherhood presented these young men with mixed emotions and many challenges. The pregnancies were all unplanned and though participants were all willing to face the responsibilities associated with fatherhood, they also reported feeling ill-prepared for the challenges that lay ahead. Impending fatherhood had caused the young men to reflect on the quality of fathering they had received themselves. The young men were hoping to provide their own infant with a better quality of fathering than they had experienced. Conclusions.  Nurses and midwives are ideally placed to provide support to young men facing impending fatherhood to better prepare them to meet the demands of their forthcoming role. Relevance to clinical practice.  Prenatal classes should include specific sessions for prospective fathers and provide opportunities to assist young men to discuss their thoughts and concerns about impending fatherhood. It could also be useful to encourage young expectant fathers to engage in discussions with their own fathers and grandfathers. For those young men who do not have effective relationships with their own fathers, it could be useful to organise mentoring with experienced mature men who have successfully engaged in the fatherhood role.
Abstract: There is a considerable body of literature scrutinising and theorising negative and hostile behaviour such as violence and interpersonal conflict in the nursing workplace. However, relatively little empirical work has examined the experiences of undergraduate nursing students in the context of negative workplace cultures, and even fewer studies have explored how students develop and enact strategies to counter hostile behaviours in the clinical workplace. Based on qualitative analysis of open-ended survey questions, this study explored undergraduate students' experiences of negative behaviours in the clinical environment to identify strategies used to manage and resist such behaviours. While dominant individuals in the clinical environment sought to enforce and uphold their version of legitimacy--one where students were relegated to complete subordination--the tenacity and resourcefulness of students was evident in their attempts to counter this oppression with acts of resistance. Our findings provide new and valuable insights into organisational aggression and acts of resistance in the nursing workplace. The resistance offered by these students draws attention to the struggles for legitimacy within institutions. In drawing attention to organisational aggression as a mechanism by which students are 'othered' through pejorative behaviour, homogenisation, and de-authentication, and the dynamics of resistance offered by these student nurses, we provide an alternative explanation of nursing socialisation.
Abstract: In this qualitative study, the experiences of a small cohort of registered nurses (RN) during the first 2 years of mental health employment were documented. A total of 13 semistructured interviews were completed from within a specialist mental health setting. Eleven issues were identified: (i) teamwork; (ii) experiential learning; (iii) self-development; (iv) confidence; (v) listening; (vi) rapport; (vii) keen observation; (viii) patience; (ix) empathy; (x) learning from colleagues; and (xi) maintaining a positive approach towards patients. The nurses focused on the here-and-now circumstances, rather than on future plans, or past preparation, and were able to elucidate the qualities and skills that they brought to their clinical work. Participants were most proud of achievements that bridged the personal and professional, such as self-development, working closely with patients to develop rapport, experiential learning, and teamwork. Findings highlight the importance of teamwork to newly-graduated RN entering the mental health environment. It is known that teamwork can convey a sense of belonging and help create an environment in which applied experiential clinical learning can occur. Therefore, it is important that efforts are made to facilitate team building and opportunities for teamwork when new graduates are transitioning into the mental health clinical practice environment.
Abstract: OBJECTIVE: to describe women's experiences of having an emergency hysterectomy following a severe postpartum haemorrhage. DESIGN: a qualitative research approach was used to guide this study. Data were collected through semi-structured, tape recorded face to face, email internet and telephone interviews. SETTING: three States in Australia: New South Wales, Victoria and Western Australia. PARTICIPANTS: twenty-one Australian women who experienced a severe post partum followed by an emergency hysterectomy participated in the study. The median age of participants at time of interview was 42 years and the median time since having the hysterectomy was four years. FINDINGS: a process of inductive analysis revealed the major theme, 'between life and death' and three sub-themes, 'being close to death: bleeding and fear', 'having a hysterectomy: devastation and realisation' and 'reliving the trauma: flashbacks and memories'. CONCLUSION: formulating a plan of care for women identifiably at risk of PPH and ensuring appropriate follow-up counselling is made, is key to help reduce the emotional and psychological symptoms experienced by these women in the aftermath of severe postpartum haemorrhage and hysterectomy.
Abstract: Aim.  To describe the experiences of women who have had an emergency hysterectomy following a severe postpartum haemorrhage and the impact on their early mothering experiences. Background.  Postpartum haemorrhage and subsequent hysterectomy is a traumatic birth event. Traumatic birth experiences have the potential to impact on a woman's experience of motherhood and her initial relationship with her baby. The relative rarity of this event makes it easy to dismiss the experiences of women having a hysterectomy following childbirth. Little is known about a woman's early mothering experience in the context of having an emergency hysterectomy. Design.  Qualitative naturalistic inquiry approach. Method.  Data were collected through semi-structured qualitative interviews from 21 Australian women who had an emergency hysterectomy following a severe postpartum haemorrhage. Results.  Findings revealed three themes in relation to early mothering experiences in the context of having a hysterectomy following a severe postpartum haemorrhage. They were 'initial separation: lost bonding time', 'feelings of failure' and 'relinquishing care of the infant'. Conclusions.  This paper highlights the ways undergoing emergency hysterectomy following childbirth can impact on the experience of early mothering in the postnatal period. Relevance to clinical practice.  Greater recognition and attention to the specific needs of women who have an emergency hysterectomy following childbirth is required. Providing women with an opportunity to talk, debrief and ask questions related to their birthing experiences, will help women to reconcile their feelings. Giving women the opportunity to have their infants with them in intensive care unit, together with ongoing emotional support and anticipatory guidance, may also be useful approaches in assisting women during this difficult and traumatic time.
Abstract: The aim of this study was to generate insight into younger women's experiences of recovery from breast cancer-related breast surgery and to contribute to the knowledge base for clinicians practising in this field.
Abstract: AIM AND OBJECTIVE: This study sought to explore the nature of bullying in the Australian nursing workplace. BACKGROUND: While there is widespread concern about the extent and consequences of bullying among nurses, to date, there have been no published reports cataloguing the types of behaviours that constitute bullying. DESIGN: Reported here are findings from the first stage of a three-stage sequential mixed methods study. METHODS: The first, qualitative stage of this study employed in-depth, semi structured interviews with 26 nurses who had experienced bullying from two Australian area health services. Content analysis of the verbatim interview transcripts was performed using the nvivo 7 software program. RESULTS: The analysis identified six major categories and constituent sub-categories. The typology of bullying behaviours reported here is one of these major categories. CONCLUSION: The typology of behaviours developed from the study provides detailed insights into the complexity of bullying experienced by nurses. The behaviours were labelled: personal attack, erosion of professional competence and reputation, and attack through work roles and tasks. These themes provide insight into the construct of bullying by providing a detailed catalogue of bullying behaviours that show that bullying is frequently masked in work tasks or work processes and focused on damaging the reputation and status of targets. RELEVANCE TO CLINICAL PRACTICE: The detailed catalogue of bullying behaviours draws attention to the breadth of the bullying experience. It is anticipated the typology will be of use to nurses, managers and other professionals who are interested in responding to the problem of bullying in nursing.
Abstract: This paper is a report of a study conducted to explore the reasons behind the decision to blow the whistle and provide insights into nurses' experiences of being whistleblowers.
Abstract: This paper is drawn from a larger study that sought to identify and examine issues around the employment of sessional academic staff in baccalaureate nurse education. Twelve sessional teachers and 12 continuing academics participated in the interviews. Examination of the data revealed the PhD was perceived as a hurdle to continuing employment in nurse education in the university sector. In the current climate, sessional teachers continue to be an essential part of the nursing academic workforce and are necessary to meet the teaching and learning demands associated with implementing nursing curricula. Findings suggest a need for scrupulous processes in relation to the recruitment of sessional staff, and highlight the difficulties that sessional teachers may have in securing continuing academic employment. We provide recommendations to facilitate the appointment of appropriate individuals into sessional roles and highlight the need to mentor and support sessional teachers wishing to pursue a career as nurse academics. Questions are raised about how nursing can plan for future academic workforce needs in a context of an aging academic workforce, the demand for doctoral training for nurse academics, and widespread casualisation of the nursing academic workforce.
Abstract: Violence against nurses is an on-going issue in healthcare settings, and is regularly documented in the literature. Assessing the potential for violence against nurses in the emergency department is essential to maintain their safety. The aim of this study was to develop a violence assessment tool by refining a list of predictive cues identified from both a previous study and existing literature. Using the Delphi technique, a panel of 11 expert nurse academics and clinicians developed a 37-item questionnaire and used three rounds of Delphi to refine the violence assessment questionnaire. The resulting tool comprises 17 cues of potential violence that can be easily observed and requires no prior knowledge of the perpetrators' medical history.
Abstract: AIMS AND OBJECTIVES: To evaluate nurses' knowledge of adolescent sleep and sleep disturbance and the strategies they employ to facilitate sleep in adolescent patients. BACKGROUND: Sleep disturbance in adolescents is common and associated with potentially devastating outcomes and co-morbidities. Despite this, little literature exists that reports nursing interventions related to facilitating sleep, and no literature could be located that explored what Australian nurses know about adolescent sleep and sleep disturbance. DESIGN: Qualitative. METHOD: Eight nurses routinely involved in the care of adolescent patients were interviewed via email and instant messaging over a five month period. Explored was the formation and extent of knowledge held by these nurses about adolescent sleep and sleep disturbance and the strategies they used to facilitate sleep in adolescent patients. Data were analysed thematically. RESULTS: Three main themes were identified: 'A patchwork of experiences', 'Traditional remedies, personal beliefs and commonsense' and 'Drugs, doctors and disempowerment'. CONCLUSIONS: Despite a lack of formal education about adolescent sleep and sleep disturbance, through life and professional experience the nurses in this study had formulated effective strategies to assist the sleep of adolescent patients. RELEVANCE TO CLINICAL PRACTICE; There is a need for nursing education regarding adolescent sleep issues. Providing rationales for nursing strategies would afford nurses greater confidence to strongly advocate for a more non-pharmacological approach to managing certain types of sleep disturbance. Initiating routine assessment of adolescent sleep in both hospital and community settings could be beneficial to detecting a range of difficulties adolescent patients may be experiencing.
Abstract: This paper is a report of a literature review of qualitative empirical research investigating women's experiences of mothering disrupted by illness.
Abstract: Stories convey values and emotions, and can reveal the differences and similarities between people's experiences. Elucidating personal stories involves sharing which can help form bonds and supportive networks. With reflection, these can help to develop resilience. While the literature recognises the potential cathartic and therapeutic benefits associated with storytelling in research, links between the development of personal resilience and storytelling for research purposes have not been drawn. This paper argues that storytelling aids the development of personal resilience and provides opportunities to celebrate the hardiness of research participants who contribute to knowledge by recounting their stories of difficulty and adversity.
Abstract: AIM: This paper reports a study which evaluated a brief, embedded academic support workshop as a strategy for improving academic writing skills in first-year nursing students with low-to-medium English language proficiency. BACKGROUND: Nursing students who speak English as a second language have lower academic success compared with their native English-speaking counterparts. The development of academic writing skills is known to be most effective when embedded into discipline-specific curricula. METHODS: Using a randomized controlled design, in 2008 106 students pre-enrolled in an introductory bioscience subject were randomized to receive either the intervention, a 4-day embedded academic learning support workshop facilitated by two bioscience (content) nursing academics and a writing and editing professional, or to act as the control group. The primary focus of the workshop was to support students to work through a mock assignment by providing progressive feedback and written suggestions on how to improve their answers. RESULTS: Of the 59 students randomized to the intervention, only 28 attended the workshop. Bioscience assignment results were analysed for those who attended (attendees), those randomized to the intervention but who did not attend (non-attendees), and the control group. Using anova, the results indicated that attendees achieved statistically significantly higher mean scores (70.8, sd: 6.1) compared to both control group (58.4, sd: 3.4, P = 0.002) and non-attendees (48.5, sd: 5.5, P = 0.001). CONCLUSION: A brief, intensive, embedded academic support workshop was effective in improving the academic writing ability of nursing students with low-to-medium English language proficiency, although reaching all students who are likely to benefit from this intervention remains a challenge.
Abstract: OBJECTIVE: to explore midwives' and doulas' perspectives of the role of the doula in Australia. BACKGROUND: doulas are relatively new in Australia; nevertheless, demand for them is increasing. Research has not previously explored the role of a doula in Australia. This research aimed to answer the question: What are midwives' and doulas' perspectives of the role of a doula in Australia? DESIGN: qualitative study using focus groups that were digitally recorded, transcribed and the data analysed using thematic analysis. SETTING: New South Wales, Australia. PARTICIPANTS: 11 midwives and six doulas. FINDINGS: the key theme that emerged was that 'the broken maternity system' is failing women and midwives. The system is preventing midwives from providing woman- centred care. As a result, doulas are 'filling the gap' and midwives feel that doulas are 'taking our role'. Doulas fill the gap by providing continuity of care, advocating for women, protecting normal birth and by providing breast-feeding advice and emotional support in the community. Midwives are concerned that doulas are taking the caring part of their role from them and want the 'broken' maternity system fixed. Midwives described that doulas take their role from them by changing the relationship between themselves and labouring women, by reducing their role to obstetric nurses, by overstepping the doula role boundaries, and by holding the power at births. IMPLICATIONS FOR PRACTICE: despite the conflict reported between midwives and doulas, both groups identified that they see the potential for future collaboration. Taking into account the continued employment of doulas, it is important to improve collaboration between midwives and doulas for the sake of childbearing women.
Abstract: Heavy, pressured workloads are a feature of health workplaces internationally, presenting challenges to communication and contributing to tension and negative emotions. This paper explores supportive and unsupportive workplace conversations between nurses and midwives and their colleagues. The findings focus on qualitative interviews of ten nurses and midwives that were audio-taped and analysed for perceptions about the role of workplace conversations. Conversations between colleagues were significant for building and maintaining collaborative capital, but unsupportive conversations also threatened it. Findings suggest the need for considering the impact of co-worker conversations on workplace culture. Nurse managers and management may play a pivotal role in establishing and maintaining supportive conversations. Recognising the role and potential of workplace conversations for building capacities for support, conflict resolution, job satisfaction and the personal resilience of nurses and midwives can raise the collaborative capital of the workplace.
Abstract: Casualisation of the academic workforce has resulted in an increase in the employment of sessional teachers in Bachelor of Nursing (BN) programs. Many of these teachers are drawn from specialty clinical areas and continue to work clinically while teaching part-time. The aim of this study was to explore the perceptions of sessional teachers about their perceived contribution to an undergraduate Bachelor of Nursing program in a single Australian university. Twelve sessional teachers participated in semi-structured interviews as part of a larger mixed method study exploring the issues related to sessional teaching in the Bachelor of Nursing program. Three themes emerged from the data; (1) "Bringing 'reality' to the classroom", (2) "Privileging experiential knowledge", and (3) "Establishing boundaries with students". Underpinning the narratives was a strong subtext related to the theory-practice gap. Proactive strategies to facilitate the potential of sessional staff are articulated in the paper.
Abstract: Globally, child protection services are under-resourced and unable to meet the demands associated with the increasing numbers of families who are being exposed to child abuse and neglect. Family support and family preservation interventions are the methods cited within the literature as those employed by child protection services to address this issue. Intensive family preservation services and cognitive behavioural therapy are discussed as the most effective interventions currently used by child protection services. This article presents a review of the literature on the efficacy of family-centred interventions for child abuse and neglect. Revealed in this review is that such efficacy remains controversial, with literature affirming that the most successful practice is a combination of interventions applied simultaneously. The literature reviewed suggests that more contemporary research around family-centred interventions for child abuse and neglect is required.
Abstract: This paper reports a two-phased pilot study that explored the concept of 'specialling' older patients with challenging behaviours in acute ward situations. Previous research suggests that the nursing workforce is not equipped with the skills and resources required to provide quality care for these patients. The hospital in which this study was conducted, instigated a model where these patients were closely observed by 'specials'. Phase 1 of the study involved a retrospective analysis of de-identified 'Specials' Observation Charts' and 'Request for Patient Special' forms of patients aged 65 years and above, over 12 months in 2006. Phase 2 involved in-depth interviews with the nurses caring for these patients. Findings revealed inadequacy of the forms, gaps in service provision for this vulnerable group of patients and the need for education of specials and ward staff, with suggestions to improve care for this patient group. Findings suggest the necessity to design and structure the observation forms more efficiently. It is important to formulate clear assessment criteria for these patients and incorporate in-service education programmes for 'specials' and ward staff and adequately prepare and support them to meet the challenges of caring for older persons with behavioural disturbances in ward situations.
Abstract: This paper reports a study aiming to present and describe the effects of whistleblowing episodes on nurses' workplace relationships. Eighteen participants with direct experience of whistleblowing were recruited into the study, which was informed by a qualitative narrative inquiry design. Findings were clustered into four main themes, namely: Leaving and returning to work-The staff don't like you; Spoiled collegial relationships-Barriers between me and my colleagues; Bullying and excluding-They've just closed ranks; and, Damaged inter-professional relationships-I did lose trust in doctors after that. Findings suggest a need to facilitate a climate in which it is safe for nurses (and others) to raise concerns about patient care or organisational wrongdoing, and to eliminate the existing belief that whistleblowing is a negative act fuelled by revenge or sedition.
Abstract: Mentoring relationships are dynamic alliances that can be used as a supportive mechanism for growing nurse leaders and promoting the future of the nursing profession. This article explores imagination as one of the central meanings of being a mentor for nursing leadership. Findings from a hermeneutic-phenomenological study concerned with Australian nurse leaders' experiences and understandings of mentorship for leadership revealed that imagination was a key characteristic of being a nurse leader-mentor. Imagination that moved beyond fantasy to closely connect with reason was essential for nurse leader-mentors to recognize and activate the myriad possibilities available to mentees and the nursing profession more broadly.
Abstract: This paper reports the benefits and challenges of a mentoring programme through which retired and senior nurses continued to support and nurture nurses and midwives currently working in the health system.
Abstract: In this article, we identify key aspects for enhancing real-world research in mental health care clinical settings and broadly discuss some practicalities and issues that must be considered beforehand.
Abstract: Although the global nursing faculty shortage has led to increasing reliance upon sessional staff, limited research has explored the impact of these sessional staff on the quality of teaching in higher education. We aim to examine differences in (a) student satisfaction with sessional and tenured staff and (b) assessment scores awarded by sessional and tenured staff in students' written assignments.
Abstract: Internationally, nursing faculty shortages have been reported and there is a potential for them to worsen into the next decade as existing faculty age. To, in part, address this issue, across disciplines there is clearly an international trend towards the increasing casualisation of the higher education workforce. Despite the potential impact of this two-tiered workforce structure, there has been limited examination of the discipline specific issues related to the employment of a growing number of sessional nursing staff. This paper provides a critical review of the literature related to the employment of sessional teachers in higher education. The paper advances the discourse around the role and implications of employing sessional teachers in undergraduate nursing schools. Recommendations for supporting sessional staff and further research are presented.
Abstract: AIMS: This study aimed to build understandings of women's recovery experiences in the presence of continued pelvic problems extending beyond the puerperium to provide nurses and other health care professionals with information to enhance current practice. BACKGROUND: Trauma to the pelvic floor during childbirth is a relatively common occurrence and can include damage to structures and nerves. A significant number of women will experience ongoing physical pelvic problems resulting from childbirth that extend past the puerperium; however, little is known about the experiential aspects of recovery for these women. DESIGN: A qualitative, phenomenological study. METHOD: Narrative data were collected during conversational interviews with 10 mothers who had sustained pelvic injury during the birth process that persisted past the puerperium. Recruitment was via media releases and brochures distributed through childcare facilities. The data was analysed using Van Manen's thematic analysis. RESULTS: The themes that arose from the analysis were: 'fearing intimacy', 'managing an unpredictable body', 'being resigned' and 'feeling devalued and dismissed'. CONCLUSIONS: Pelvic injuries that extend beyond the postpartum period are distressing for women. They negatively affect women's views of themselves and have an impact on various aspects of life including intimate relationships and social activities. RELEVANCE TO CLINICAL PRACTICE: Currently, postpartum care may have a focus on baby rather than mother and this focus may impede women making full disclosures of ongoing health needs arising from their delivery. Findings of this study suggest that women may have specific needs that extend beyond the puerperium, indicating a need for continued holistic assessments and extending practice to identify and support women experiencing persistent pelvic postpartum complications.
Abstract: Increasing numbers of nurses seek to undertake doctoral education as nursing continues to develop as a discrete area of clinical and theoretical scholarship. Effective supervision is a crucial aspect of doctoral education and has been identified as essential to successful completion of doctoral training. Relatively little, however, is written about the relationship aspects of doctoral supervision in nursing. This paper presents some reflections on doctoral education in nursing from the perspective of four people who have established intergenerational supervisory relationships.
Abstract: AIMS AND OBJECTIVES: The aim of this review was to explore the literature to determine what is known about adolescent sleep, the causes and consequences of disturbed sleep in adolescence and the implications this has for nursing practice. BACKGROUND: Sleep disorders are relatively common in young people. Disturbed sleep can be both a cause and a result of ill health and if recognised can indicate psychosocial, psychological or physical difficulties. DESIGN: Literature review. METHODS: Searching of key electronic databases. RESULTS: Disturbed sleep in adolescents has several potential consequences, including daytime sleepiness, reduced academic performance and substance use/abuse. However, despite its significance and frequency, sleep disturbance is an area of adolescent health that is almost entirely unaddressed within the nursing literature. CONCLUSION: Nursing has a role to play in assisting adolescents and their families to recognise the importance of sleep to the general health and well-being of young people. RELEVANCE TO CLINICAL PRACTICE: There is a need for nursing to develop tools to assess sleep in adolescent clients and non-pharmaceutical interventions to assist adolescents achieve optimum sleep and rest. Nurses may also contribute to educating adolescents and their families regarding the importance of good sleep hygiene.
Abstract: AIM: This paper is a report of a study to explore the perceptions and experiences of mothers parenting a child with attention deficit hyperactivity disorder. BACKGROUND: Previous quantitative studies have focussed on parenting styles and treatments, and highlight that attention deficit hyperactivity disorder has a negative impact on family functioning. However, fewer researchers have explored maternal experiences of parenting a child with this disorder. A narrative-based feminist approach can provide greater insights into complex issues related to mothering a child with this disorder. METHOD: Data were collected in 2007 with a volunteer sample of 11 mothers of children with attention deficit hyperactivity disorder via in-depth interviews. Analysis was completed by listening for self-evaluative statements, paying attention to meta-statements and by identifying both consistencies and incongruities within participant's narratives. FINDINGS: Dominant issues identified were: It's been 10 years of being on edge: The caring responsibility as overwhelming; If I had my time over again, I wouldn't tell the truth: Stigmatized, scrutinized and criticized; What have I done? What did I do? How come I've got this child: Guilt and self-blame and He doesn't stand a chance: Mother as advocate. CONCLUSION: Mothering a child with attention deficit hyperactivity disorder is stressful and demanding, and mothers felt marginalized. Media portrayal of this disorder contributes to confusion related to causes, diagnosis and treatment choices. More education for healthcare professionals is needed to enable them to give appropriate guidance and support to enhance outcomes for children and their parents.
Abstract: Violence towards nurses in Emergency Department's is a world wide problem that some contend is increasing in severity and frequency, despite the many strategies implemented to prevent violent events. This paper presents the findings of an instrumental case study in a busy rural Emergency Department. Twenty Registered Nurses participated in the study and data from 16 unstructured interviews, 13 semi-structured field interviews, and 290 h of participant observation were thematically analysed. In addition, 16 violent events were observed, recorded via a structured observation tool and analysed using frequency counts. Thematically there were five attributes rural emergency nurses were observed to use to avert, reduce and prevent violence. The five attributes were being safe, being available, being respectful, being supportive and being responsive. We argue that these attributes were embodied in the emergency nurses routine practice and their conceptualization of caring.
Abstract: AIM: The purpose of the study was to explore the issues surrounding chronic hepatitis C, combination therapy and its impact on personal relationships to enhance understanding of the experiences of patients living with hepatitis C. This paper focuses on the experiences of the patients and their partners' experiences will be published separately. BACKGROUND: Patients with chronic hepatitis C who have active inflammatory changes on liver biopsy may undergo combination therapy with interferon and ribavirin. For some patients, the adverse effects of combination therapy are so severe that it can potentially place an enormous stress on personal relationships. DESIGN: The study was informed by Heideggerian phenomenology. METHODS: Purposive sampling and semi-structured interviews of five patients and their partners were conducted between 2004-2006 in Sydney Australia, to obtain a rich description of their experiences. RESULTS: The findings from this study revealed that chronic hepatitis C and combination therapy had an enormous impact on the lives of the patients, their partners and families. The illness and treatment had significant physiological effects that had an impact on quality of life; however, the social and psychological consequences of living with a highly stigmatised disease with an unknown course and outcome cannot be underestimated. CONCLUSION: The results of this study lend support to the effectiveness of providing equitable services to persons diagnosed with chronic hepatitis C. However, additional research is needed to explore gender, socioeconomic, sexual-orientation, transmission, cultural, religious and genotype differences in this group to address their needs better. RELEVANCE TO CLINICAL PRACTICE: Nurses play a significant role in educating patients with chronic hepatitis C, advocating for them and helping them to achieve a reasonable state of well being. Through deeper understanding of their experiences of illness and treatment, nurses can move beyond the medical oriented approach to care.
Abstract: Mentoring relationships occur across a range of nursing contexts and are shown to have multiple, favourable personal and professional outcomes. Specifically, mentoring has been associated with the development of nurse leaders. This study describes features that are integral to initiating mentoring relationships that focus on nursing leader development. These significant features are addressed in relation to the nursing literature. Thirteen nurse leaders from eastern states of Australia were interviewed during 2005 and 2006 about their understanding and experiences of mentoring for leadership. Their narratives were analysed using a hermeneutic phenomenological methodology. Mentoring relationships for nurse leadership were revealed as developing from esteemed connections between two people. Mentors were shown to unconditionally champion their mentee's careers, and mentees were shown to possess a leadership vision for nursing. The findings of this study have implications for establishing mentoring relationships for nurse leader development. Consideration should be given to the specific focus and context of these relationships to ensure that the full potential of the mentoring process is realised. It is also important to better understand the key aspects that contribute to the phases of mentoring relationships for nurse leader development because they are shown to influence the dynamic and function of these relationships over time.
Abstract: Up to 40 percent of adolescents experience some form of sleep difficulty, with adolescent girls often reporting higher levels of sleep disturbance and daytime fatigue than boys. This article explores the literature surrounding female adolescent sleep disturbance. The findings reveal that sleep problems in young women can be linked to girls being at an increased risk for puberty-related fatigue, sexual abuse, a higher prevalence of mental illness and sensitivity to familial disruption, and increased domestic and grooming expectations. Implications for nursing practice include initiating conversations about sleep, sleep disturbance and sleeping arrangements when working with adolescent girls. Nurses should gather accurate sleep histories, provide adolescent girls and their caregivers with information and recommend interventions to improve sleep if necessary. Nurses should remain sensitive to the confounding effects of pubertal status, menarche and the cyclic release of hormones when designing and conducting future research into female adolescent sleep disturbance.
Abstract: There is an increasing expectation that academic and clinical nurses will contribute to disciplinary and professional discourses through scholarly writing. However, the difficulties and challenges associated with writing for publication mean that many papers will never be written. This current paper describes an innovative approach developed to support skill development and outcomes in writing for publication. Intensive residential writing retreats informed by the principles of servant leadership and incorporating strategies such as mentoring and peer learning were conducted in 2005 and 2007. Positive outcomes and benefits included publications submitted to peer-reviewed journals, as well as positive effects on collegial relationships, and team building. Novice writers benefited from intensive and sustained support and coaching by experienced writers. Organisational benefits included increased participation by staff and research higher degree students in publication activities, enhanced collegial relationships and opportunities for senior established writers to work with inexperienced writers.
Abstract: Providing a safe work environment where nurses can practice without fear or threat of aggression is acknowledged as a critical global issue for healthcare organizations. Although there has been growing recognition that workplace bullying is one of the most concerning forms of aggression experienced by nurses, to date, there has been little progress in developing explanatory models. In this article, we outline our recently validated model of bullying, which specifies organizational characteristics as critical antecedents. The model has important implications for the management of bullying, identifying that to be effective, interventions need to address features of workplace climate.
Abstract: AIMS AND OBJECTIVES: The purpose of the study was to explore the meaning(s) that emergency department nurses ascribe to acts of violence from patients, their family and friends and what impact these meaning(s) have upon how they respond to such acts. BACKGROUND: Violence in the health sector is of international concern. In high acuity areas such as emergency departments, nurses have an increased risk of violence. The literature further suggests that violence towards nurses in emergency departments is under-reported. DESIGN AND METHODS: This study was undertaken in 2005, at a regional Australian Emergency Department with 20 consenting registered nurses. Using an instrumental case study design, both qualitative and quantitative data were generated. Qualitative data were collected using participant observation, semi-structured interviews, informal field interviews and researcher journaling. Quantitative data of violent events were generated using a structured observational guide. Textual data were analysed thematically and numeric data were analysed using frequency counts. Mixed methods and concurrent data analysis contributed to the rigour of this study. FINDINGS: Emergency department nurses made judgments about the meaning of violent events according to three factors: (i) perceived personalization of the violence; (ii) presence of mitigating factors; and (iii) the reason for the presentation. The meanings that were ascribed to individual acts of violence informed the responses that nurses initiated. CONCLUSIONS; The findings show that violence towards emergency department nurses is interpreted in a more systematic and complex way than the current definitions of violence make possible. The meanings given to violence were contextually constructed and these ascribed meaning(s) and judgments informed the actions that the nurses took in response to both the act of violence and the agent of violence. Relevance to clinical practice. Understanding the meaning(s) of violence towards nurses contributes to the discussions surrounding why nurses under-report violence. Further, these findings bring insights into how nurses can and do, handle violence in the workplace.
Abstract: The Australian nursing workforce is ageing and there is a well-documented shortage of nurses. This global phenomenon means that retaining nurses in the workforce is gaining in importance as older nurses retire and leave nursing. The existing literature reveals deficiencies in knowledge about older nurses as they adapt to ageing often within stressful work environments. The aim of this narrative-based study, informed by feminist principles, was to explore the views and experiences of female registered nurses aged 40-60 years, in acute hospital and community health care settings. In-depth semi-structured interviews of approximately 1 h duration were gathered during late 2004. The transcribed narratives were subjected to thematic analysis. Two major themes were identified. The first theme: "Feeling uncared for" contained three sub-themes--Unsupportive work relationships: "We should be helping each other"; Workplace bullying: "It hurts me and I feel really bad"; and, Stress and burnout: "It's just like being in a pressure cooker all the time". The second major theme identified was "Adapting to ageing: my nursing career". Findings of this research suggest some unmet support needs for older nurses in the workforce which could discourage them from remaining in nursing. The findings highlight a need for further research into the support needs of older nurses.
Abstract: AIM: This paper is an exploration of the utility and value of feminist approaches when undertaking narrative-based research with partner dyads (within both heterosexual and same sex partnerships) and when researching sensitive issues. BACKGROUND: Adverse life events or conditions experienced by individuals have been found also to have a negative impact on their partners. Most literature addressing partner issues uses quantitative methods, and existing qualitative research on couples has traditionally interviewed only one person in the partnership or coupled partners together. There is little discussion in the literature about the use of feminist research when researching male perspectives and experiences, and even less discussion of the possibilities that feminist research methods bring to the study of couple dyads. DISCUSSION: Qualitative methodologies informed by feminist perspectives, including issues of reciprocity and self disclosure, can be used to unpack structural, personal and political issues related to couples' experiences. A feminist approach allows us to show that the origin of oppression is not personal but very much about power and that men as well as women, regardless of their sexuality, may experience the effects of oppression. Narrative and story-telling complements feminist research because of the value it assigns to the storytellers. CONCLUSION: To care for women effectively, we must also consider the experiences of their partners as the health of one partner has the potential to impact on the other. The concept of oppression is not absent, but indeed is illuminated, in the lives of some men. Gathering stories using feminist perspectives enhances respect and mutuality in the research process.
Abstract: Use of the Internet, and the opportunity to utilise computer-mediated communication (CMC) provides new alternatives for nurse researchers to collect data. The use of CMC for research purposes is advantageous for both researchers and participants. Through this mode of communication, recruitment of participants can be enhanced through reaching individuals who are geographically distant, and nurses have the opportunity to provide participants with true anonymity, which may be beneficial when exploring sensitive issues. This paper explores the existing literature and draws on healthcare studies that have used CMC as a data collection tool.
Abstract: AIM: This paper is a report of a study to describe residential aged care nurses' and care assistants' perceptions of a multi-faceted palliative care intervention to identify potential areas to be addressed during subsequent action research phases. BACKGROUND: Action research was used to enhance the delivery of a palliative approach in residential aged care. The chronic care model guided the development of a multi-faceted intervention. This involved the: (1) establishment of a 'link nurse' role; (2) learning and development strategies for nurses, care assistants and general practitioners; (3) use of multi-disciplinary team meetings; and (4) access to specialist consultation. METHOD: A purposive sample (n = 28) of aged care nurses and care assistants participated in a series of four focus groups conducted in July 2005. Thematic content analysis of the transcripts was performed. FINDINGS: Four themes emerged: (1) targeted education can make a difference; (2) a team approach is valued; (3) clinical assessment tools are helpful; and (4) using the right language is essential. Participants described increased understanding of palliative care concepts, enhanced competencies, greater confidence to deliver palliative care and a desire to adopt a multi-disciplinary approach to care planning. CONCLUSION: Sustaining a culture that is committed to ongoing learning and development interventions and creating multi-disciplinary teams in the aged care setting is critical to embedding a palliative approach. The chronic care model is a useful framework to guide the development of interventions leading to better palliative care outcomes for residents and their families.
Abstract: AIMS AND OBJECTIVES: The aim of this paper is to explore maternal views and experiences of stimulant pharmacotherapy in children with attention deficit hyperactivity disorder (ADHD). BACKGROUND: The very nature of ADHD means that it exists in a climate of scepticism and doubt. However, parents must make decisions about how to treat their children affected by ADHD. Of the treatments available, the use of stimulant therapy is the most controversial. DESIGN: Qualitative. METHOD: Snowball sampling was used to recruit mothers (n = 11) of children with ADHD and a narrative-based qualitative methodology was used. RESULTS: Decisions around the use of stimulant medication for children with ADHD were difficult for these mothers. Detailed findings are presented under the themes of: Ambivalence and confusion: everybody would be down on me like a ton of bricks; Influence of the media: so much bad publicity; Deciding against medication: you're changing their whole personality; and, Deciding for medication: he's just been wonderful. CONCLUSIONS: While these mothers revealed that they were discriminating in selecting information to guide their decision-making, many of their friends and family were influenced solely by media reports. Mothers experienced misgivings from family and friends who were sceptical about the need for medication and the implications and ethics of administering stimulant medication to children. RELEVANCE TO CLINICAL PRACTICE: Nurses and healthcare professionals have an important role in providing accurate and current information for parents and families and should be aware of the pressures parents are under when making decisions about treatments for their children with ADHD.
Abstract: This paper aims to report lifestyle factors of Asian Indians in Australia in relation to coronary heart disease. This issue has not been previously explored in the Australian context. This study also seeks to identify factors that could inform health education and rehabilitation programs for migrant Asian Indians in Australia. The qualitative descriptive approach of constructivism was used for this study. Semi-structured, in-depth conversations were conducted with eight patients and five family members. Participants were at risk for coronary heart disease either due to unhealthy diet and/or lack of physical exercise and irregular health checks. Although lifestyle modifications were implemented by participants after the cardiac event; these changes were implemented inconsistently and without continuity. Knowledge of the beneficial effects of a healthy diet did not deter the participants from continuing to follow unhealthy dietary habits. The introduction of any exercise or physical activity by participants in this study lacked consistency. A positive aspect revealed from this study was the influence of culture and religious faith, which helped patients and family members to cope with the illness trajectory. The results of this study suggest that health education and rehabilitation programs need to be designed specifically for this high-risk group would be beneficial when initiated early in life and need to be targeted to the individual.
Abstract: Marie Hutchinson, Lesley Wilkes, Margaret Vickers and Debra Jackson describe an Australian study of bullying that provides a putative model for further testing in nursing and other contexts.
Abstract: AIM: This paper is a report of a study of the health and ageing concerns and self-care strategies of older female Registered Nurses currently working in direct care-giving roles in acute public hospitals and community facilities. BACKGROUND: Nursing is a rapidly ageing, and female-dominated workforce. However, despite the ageing of the nursing workforce, little is known about the needs and health concerns of older nurses. METHOD: A feminist perspective was used and 12 female Registered Nurses aged 40-60 years, employed in various acute hospital and community health settings in Australia took part in qualitative interviews in late 2004. Narratives were audio taped, transcribed and analysed thematically. FINDINGS: Two major themes were identified. The first theme -Aches and pains of ageing- had four subthemes: Neglecting self: 'You don't think of yourself first'; Physical changes: 'The body is wearing out'; Living with pain: 'You just work around it'; and Tiredness: 'I'm just tired all the time'. The second theme -Evolving lifestyles: works in progress - had three subthemes: The power of exercise: 'I feel great...and I'm enjoying life'; Healthy eating: 'Low fat, lots of fruit and veg, little processed food'; and Adapting to ageing: 'I think it's quite a good time of life'. CONCLUSION: Further research is needed to explore the need for protective work practices and promoting healthy lifestyle practices for ageing nurses. Managers need to recognize the changing health needs of older clinical nurses and offer, for example, flexible rostering and tailored exercise programmes to promote their health.
Abstract: In the current professional climate, research activities are highly valued with nurses in all sectors actively encouraged to participate. However, working environments for many nurses are such that it can be difficult to privilege research activities in any sustained way. A number of organisational challenges coalesce to impede participation in research activities, including limited resources, lack of skills, knowledge and opportunities, and a culture of individualism. Strong, effective research leadership is essential to help mediate some of these negative aspects of organisational life, and promote creative environments to facilitate the development of research capacity. Servant leadership is a service-oriented approach that focuses on valuing and developing people, and offers a participatory and collaborative framework within which to build creative and productive research communities. Such communities can encourage connectedness between people, deepen the capacity for supportive collegiality, and foster a holistic social learning milieu to support researchers of all levels, including early career researchers and research higher degree candidates.
Abstract: Overweight and obesity in children is a major and ongoing public health concern and the negative physical, social, and psychological sequelae of childhood obesity are well documented. Parents, particularly mothers, are implicated in discourses around childhood obesity; however, little is known about women's experiences of mothering an overweight or obese child. This article reports findings from a narrative-based study that sought to develop understandings into women's experiences of mothering an overweight or obese child. The findings provide insights into the experiences of mothering an overweight or obese child, and reveals how the climate of blame associated with mothering an overweight or obese child complicated the mothering experience for the women in this study. These insights can assist health, welfare and child care workers to understand the importance of establishing supportive and no-blame relationships with mothers of obese and overweight children, in order to develop supportive therapeutic alliances better.
Abstract: AIM: This paper is a report of a literature review to explore issues influencing condom use in heterosexual adolescents and young people. BACKGROUND: Sexually transmitted infections (STIs) are a major international health issue and adolescents and young people are particularly vulnerable. Efforts to address the rapid spread of STIs have largely focused on promoting the use of condoms as a protective 'safer sex' measure. However, use of the male condom is still inconsistent and the incidence of STIs continues to increase. METHOD: A search of the literature using EBSCO Host databases was undertaken in 2006, with a focus on women, young people, condoms and STIs. Papers published in English from 1992 to 2006 were sought. Only research papers are included in this review. RESULTS: Factors impeding decisions to use protection by young people include lack of knowledge about prevalence of STIs, ambiguity around contraception and safer sex practices, and the difficulty faced by young women in particular in negotiating safer sex. The notion of romantic love confounds the assessment of risk and can render young people, particularly young women, ineffective in negotiating safer sex practices. CONCLUSION: Adolescents and young adults are particularly vulnerable in relation to STIs. There is a need to ensure that accurate messages are delivered about safer sex and contraception to this very vulnerable group. Furthermore, it is important to recognize that romantic love comprises strong emotions that have a role in decision-making and options for reducing personal-health risk during sexual activity.
Abstract: The recent wave of immigrants to Australia includes people from countries where female genital mutilation (FGM) is predominant. FGM is the terminology used by the World Health Organisation to describe all procedures involving partial or total removal of female external genitalia. A review of the literature has found that FGM still exists and the influx of immigrants to Western countries such as Australia has seen more women in these countries with the physical and psychological after-effects of the procedure. Findings of this literature review highlight the need for heightened awareness of issues around FGM so as to better provide adequate physical and psychological support to women affected by FGM.
Abstract: AIM: This paper is the report of a study to explicate the components of observable behaviour that indicate a potential for violence in patients, their family and friends when presenting at an emergency department. BACKGROUND: Violence towards nurses is a contemporary, multifaceted problem for the healthcare workforce globally. International literature identifies emergency departments as having high levels of violence. METHOD: A mixed method case study design was adopted, and data were collected by means of 290 hours of participant observation, 16 semi-structured interviews and 13 informal field interviews over a 5-month period in 2005. Thematic analysis of textual data was undertaken using NVivo2. Frequency counts were developed from the numerical data. FINDINGS: Five distinctive elements of observable behaviour indicating potential for violence in patients, their families and friends were identified. These elements can be conceptualized as a potential nursing violence assessment framework and described through the acronym STAMP: Staring and eye contact, Tone and volume of voice, Anxiety, Mumbling and Pacing. CONCLUSION: Staring and eye contact, Tone and volume of voice, Anxiety, Mumbling and Pacing provides a useful, practical nursing violence assessment framework to assist nurses to quickly identify patients, families and friends who have a potential for violence.
Abstract: This paper scrutinises the many ways in which 'success' is portrayed in representing assisted reproductive technology (ART) services and illuminates how these definitions differ from those held by participant couples. A qualitative approach informed by feminist perspectives guided this study and aimed to problematise the concept of 'success' by examining literature from ART clinics, government reports on ART, and by analysing narratives of couples who have accessed ART services. As many ART services have varying definitions of 'success' and as statistics are manipulated to promote further patronage of ART services, the likelihood of 'success' is often overstated. This paper is concerned with the effects this promotion has on the participants. We suggest that this very mobilisation of statistical success changes the ability of those who access ART services to make productive decisions about themselves inside these treatment regimes, as the basis for decision-making is hidden by the way numbers, objectivity and clinical reasoning operate to maintain participation in the program. In such an operation, the powerful mix of hope and technology kept participants enrolled far longer than they originally planned. Moreover, how success rates are manipulated raises ethical issues for all involved: clients, counsellors, and nursing and medical professionals.
Abstract: Mental health nursing in remote Australian Aboriginal communities provides opportunities and challenges unique from other experiences of nursing. The purpose of this article was to explore how mental health nurses experience working in remote communities and how they developed relevant knowledge and skills. Six remote area mental health nurses participated in audiotaped conversational style interviews. Narratives were transcribed and analyzed thematically. Themes identified were being focused on relationships, adapting to the culture, struggling with two contexts, being enraptured by place, and being transformed. The participants adapted and developed ways of working at the interface of another culture and also derived personal and professional benefit from the experience.
Abstract: AIM: This paper is a report of a longitudinal study to develop an understanding of the phenomena of Clinical Development Unit (Nursing) leadership by exploring the experiences of the nurse leaders of nine Australian units as they attempted to develop their existing wards or units into recognized centres of nursing excellence. BACKGROUND: The concept of Clinical Development Unit (Nursing) in Australia originated in the British Nursing Development Unit movement, which has been widely credited with introducing innovative approaches to developing nurses and nursing. A network of nine Clinical Development Units (Nursing) was set up in a suburban area health service in Australia. The aim was to develop existing wards or units into centres of excellence by disseminating a new vision for Australian nurses that was based on the pioneering work of the British Nursing Development Unit movement. METHODOLOGY: Principles of Heideggerian hermeneutic phenomenology provided a framework for the study. Nine Clinical Development Unit (Nursing) leaders participated in qualitative interviews from 1998 to 2002. These interviews were transcribed into text and thematically analysed. FINDINGS: Despite attempts to implement a variety of measures to nurture these Clinical Development Units (Nursing) until they had become well established, the new Clinical Development Unit (Nursing) leaders were unable to maintain the Clinical Development Unit (Nursing) vision with which they had been entrusted. This paper discusses their reactions to the problems they faced and the new understandings they developed of their Clinical Development Unit (Nursing) role over time. CONCLUSION: The findings illuminate the difficulties involved in maintaining the commitment of all levels of staff and management when attempting to introduce new nursing projects.
Abstract: OBJECTIVE: Father absence is associated with negative child and adolescent outcomes, including early sexual activity, teenage pregnancy, behavioural difficulties and life adversity. However there is a lack of literature that explores the lived experiences of daughters who grew up in father absent environments. This study aimed to generate insights into the lived experience of being a girl-child growing up in a father absent environment through the perspectives of daughters who experienced father absence during their childhood and/or adolescent years. DESIGN: Van Manen's phenomenological research approach informed this study. Participants were recruited through the news media and took part in phenomenological interviews. Narrative was transcribed and analysed using Van Manen's thematic approach. PARTICIPANTS: Nine women aged between 22-46 years who had been raised by their biological mothers and who had experienced father absence due to parental relationship breakdown participated in the study. RESULTS: Four themes that captured the participants lived experiences of father absence were revealed. These are: He always let me down: a constant source of hurt; I have no feelings of closeness: father as a stranger; All men are bastards: negotiating relationships with men; and, I don't want to hate him forever: reconstructing the relationship. CONCLUSIONS: Nurses and other health workers are challenged to meet the needs of increasing numbers of father absent children and young people and to develop supportive strategies to ameliorate the effects of father absence so as to contribute to the best possible outcomes for young people and their families.
Abstract: New reproductive technologies have the capacity to impact on both personal and healthcare relationships. This article utilizes a case study approach to unpack experiences of one couple who encountered immense and unforeseen difficulties as a result of treatment with assisted reproductive technology. Findings of this case reveal both difficulties and breaches in obtaining informed consent and the consequences these breaches have on relationships. Comprehensive information contributes to positive relationships between patients and healthcare providers. Maintaining supportive relationships between all parties concerned with assisted reproductive technology services is essential, as rifts in these relationships can be devastating and long-lasting.
Abstract: Drug or substance abuse by adolescents continues to have a major impact on the health and well-being of young people and poses a serious management problem for health workers. While the majority of the problems surrounding adolescent substance abuse rest on the parents, little is actually known about their experiences. This study aimed to describe and construct an interpretation of the lived experiences of parenting an adolescent who abuses illicit substances. A qualitative approach, underpinned by the tenets of phenomenology, was used to conduct in-depth interviews with 18 parents. Thematic analysis revealed eight themes: confronting the lies, deceit, and suspicion; struggling to set limits; dealing with the consequences; living with the blame and the shame; trying to keep the child safe; grieving the child that was; living with the guilt; and choosing self-preservation. The results indicate that parents struggle to manage the problem, are left to deal with the consequences of the behaviour with little support, and are constantly looking for answers to the questions raised by the problem.
Abstract: This paper reports the findings of a qualitative study that used a hermeneutic phenomenological methodology to develop insights into the experience of parents of young people who engage in self-harming behaviour. Six mothers (and one father who accompanied his wife) participated in the study. Findings reveal that mothers experienced guilt and shame, and that these feelings shaped their reactions and responses. These mothers described experiencing emotional dilemmas, such as the degree to which they could be responsible, uncertainty about how to understand self harm, and the best course of action to take with their child. They also encountered difficulties in combating the negative emotional effects for themselves and other family members. Findings provide insights that can help nurses and family health workers to understand and assist parents with greater effectiveness; by maintaining a non-judgemental stance, acknowledging the difficulties of their experiences, encouraging confidence in their parenting abilities, and promoting effective stress management strategies.
Abstract: AIM: To assess the views and attitudes of aged care staff providing direct care towards palliative care and to identify their learning needs. DESIGN: Survey design using purposive sampling methods. FINDINGS: Nurses and care assistants (n=222) employed within nine residential aged care facilities in regional Australia completed the survey. The majority had received 'on the job training' and were committed to providing end-of-life care. Differences in the level of confidence to deal with patient/family interactions and manage complex palliative care scenarios were evident between nurses and care assistants (p<0.05). Both nurses and care assistants perceived a need for further education in symptom management and communication, yet their content need differed significantly between groups. CONCLUSIONS: Nurses and care assistants in residential aged care facilities demonstrate commitment to the delivery of palliative care and express a need for increased palliative care competencies. The heterogeneity of roles and educational preparation within the aged care workforce indicate that tailored palliative care education initiatives are required to meet the learning needs of aged care nurses and care assistants, particularly in relation to end-of-life care. These data have implications for skill-mix and model of care development.
Abstract: AIM: This paper is a report of a literature review to explore the concept of personal resilience as a strategy for responding to workplace adversity and to identify strategies to enhance personal resilience in nurses. BACKGROUND: Workplace adversity in nursing is associated with excessive workloads, lack of autonomy, bullying and violence and organizational issues such as restructuring, and has been associated with problems retaining nurses in the workforce. However, despite these difficulties many nurses choose to remain in nursing, and survive and even thrive despite a climate of workplace adversity. DATA SOURCES: The literature CINAHL, EBSCO, Medline and Pubmed databases were searched from 1996 to 2006 using the keywords 'resilience', 'resilience in nursing', and 'workplace adversity' together with 'nursing'. Papers in English were included. FINDINGS: Resilience is the ability of an individual to positively adjust to adversity, and can be applied to building personal strengths in nurses through strategies such as: building positive and nurturing professional relationships; maintaining positivity; developing emotional insight; achieving life balance and spirituality; and, becoming more reflective. CONCLUSION: Our findings suggest that nurses can actively participate in the development and strengthening of their own personal resilience to reduce their vulnerability to workplace adversity and thus improve the overall healthcare setting. We recommend that resilience-building be incorporated into nursing education and that professional support should be encouraged through mentorship programmes outside nurses' immediate working environments.
Abstract: This paper grew from a series of conversations about the challenges associated with clinical education for undergraduate nurses. In it we consider clinical education for undergraduate nurses within the current context of increasing resource and industry constraints. Beginning level clinical competence is the major aim of undergraduate nurse education, and therefore clinical education is central to nursing curricula. However, almost 20 years after the transfer of nurse education to the tertiary sector in New South Wales, Australia, concerns about the clinical learning opportunities in undergraduate nursing curricula continue to be raised. Many educational providers have adopted various permeations of the sessional clinical facilitator model. However, this model has inherent problems that threaten its sustainability and usefulness for undergraduate nurse education. We call upon the discipline to explore alternative pathways for undergraduate clinical education, and present sustainable options for future development in this area.
Abstract: There is vigorous research and debate into family violence. However, there is a paucity of enquiry into violence directed from child-to-mother. This paper presents preliminary results from the pilot of a larger study that examines child-to-mother violence in the western suburbs of Sydney Australia. The data are from questionnaires distributed to women who are or have been mothers of children aged 10 to 24 years. Descriptive analysis revealed that an overwhelming majority of the 129 women surveyed experienced some form of threatening behaviour or acts of violence from their child/ren. The main perpetrators were sons and targets mothers. More than half the women had not spoken to anyone about the behaviour previously and a number of women stated their child had witnessed violence in the home. Findings suggest the complexity for women is increased as women are often encouraged to separate from violent partners but their role as mothers prevents them from dividing from a violent child. The incidence appears high, however further evidence from larger samples is required to reveal the full extent of this important social issue.
Abstract: AIM: This paper is a report of an explorative study describing the perceptions and beliefs about palliative care among nurses and care assistants working in residential aged care facilities in Australia. BACKGROUND: Internationally, the number of people dying in residential aged care facilities is growing. In Australia, aged care providers are being encouraged and supported by a positive policy platform to deliver a palliative approach to care, which has generated significant interest from clinicians, academics and researchers. However, a little is known about the ability and capacity of residential aged care services to adopt and provide a palliative approach to care. METHODS: Focus groups were used to investigate the collective perceptions and beliefs about palliative care in a convenience sample of nurses and care assistants working in residential aged care facilities in Australia. Thematic content analysis was used to analyse the data, which were collected during 2004. RESULTS: Four major themes emerged: (1) being like family; (2) advocacy as a key role; (3) challenges in communicating with other healthcare providers; (4) battling and striving to succeed against the odds. Although participants described involvement and commitment to quality palliative care, they also expressed a need for additional education and support about symptom control, language and access to specialist services and resources. CONCLUSION: The residential aged care sector is in need of support for providing palliative care, yet there are significant professional and system barriers to care delivery. The provision of enhanced palliative care educational and networking opportunities for nurses and care assistants in residential aged care, augmented by a supportive organizational culture, would assist in the adoption of a palliative approach to service delivery and requires systematic investigation.
Abstract: Rapid social change has seen increasing numbers of woman-headed single-parent families, meaning that more and more children are growing up without a father resident in the home. Father absence is a term that is not well defined and much of the literature does not discriminate between father absence due to death, parental relationship discord or other causes. This article presents a critical review of the extant literature on father absence, particularly as it relates to adolescent well-being and development. Findings from the literature point to the importance of father presence in children's lives and suggest that father absence has ramifications for children and adolescents. The conclusions drawn from this literature review suggest that father absence and its effects on children and families is an area for further research, with the view of developing strategies to ameliorate the impact of father absence on children and adolescents.
Abstract: Despite the high prevalence rate and significant mortality and morbidity from coronary heart disease in Asian Indians (irrespective of their religious background), very few studies have reported on family members' experiences of caring for a person with coronary heart disease. This paper reports on family members' experiences of coronary heart disease in Asian Indians residing in Australia, and is part of a larger study that explored the experiences and/or understanding of coronary heart disease in Asian Indians from the perspective of patients, family members and 'healthy' participants. Using a constructivist approach semi-structured in-depth interviews were conducted with five family members. Findings are represented under the following main categories: 1. A period of complexity for family members; 2. Indian Culture: Its influence on health/health behaviour & illness experience; 3. Impact of migration and societal discrimination; 4. Disappointment with health care services and the health system; and 5. Strategies to prevent cardiac illness and attain optimal health. Cultural factors had both positive and negative influences not only on the illness experience but also on health behaviour and attitude. The impact of Indian culture in relation to coronary heart disease needs to be understood not only at the cultural level by providing culturally sensitive health care, but also by educating Asian Indians to change their health attitude and behaviour and improve their lifestyle. Asian Indians need education and advice to become more resilient and adaptable to a Western society and also to become aware of the acculturative effects of a Western lifestyle.
Abstract: Drug use in young people has serious ramifications for health and well-being of young people and their families and continues to be an area of major concern for health workers. Though the task of dealing with drug-related problems falls on families, particularly parents, very little literature has explored parental experiences of managing drug use within the context of family life. Eighteen parents of drug-abusing young people were recruited into this qualitative study that aimed to develop understandings into the effects of adolescent drug use on family life. Findings revealed that the experience of having a drug-abusing adolescent family member had a profound effect on other members of the immediate family. Family relationships were fractured and split as a result of the on-going destructive and damaging behaviour of the drug-abusing young person. Five themes were identified that captured the concept of fractured families. These are: betrayal and loss of trust: 'You had to have the doors locked'; abuse, threats and violence: 'there were holes in the wall'; sibling anger and resentment: 'Better off now with him gone'; isolated, disgraced and humiliated: 'You are on your own with it'; and, feeling blamed: 'You are not a good parent'. Implications for practice and further research are drawn from the findings of this paper.
Abstract: There are a variety of structured and unstructured supportive relationships available to nurses. Internationally, nurses commonly use preceptorship, clinical supervision, and mentorship to meet distinct needs and provide differing levels of commitment, intensity, and enabling functions. Of particular interest to the nursing profession is the use of mentoring relationships to support nurses in achieving leadership positions. In Australia, preceptorship and clinical supervision are freely used and understood by nurses however, mentoring relationships are less readily applied, and agreed meanings and understanding are lacking. This paper will explore the range of supportive relationships available to nurses. The terms used to define and describe these relationships, and how these relationships are contextualised, will be explored in order to better understand the position of mentorship for nurses in Australia. The potential value of mentorship in developing nursing leadership in Australia will also be identified.
Abstract: Although access to palliative care is a fundamental right for people in Australia and is endorsed by government policy, there is often limited access to specialist palliative care services in regional, rural and remote areas. This article appraises the evidence pertaining to palliative care service delivery to inform a sustainable model of palliative care that meets the needs of a regional population on the mid-north coast of New South Wales. Expert consultation and an eclectic literature review were undertaken to develop a model of palliative care service delivery appropriate to the needs of the target population and resources of the local community. On the basis of this review, a local palliative care system that is based on a population-based approach to service planning and delivery, with formalized integrated network agreements and role delineation between specialist and generalist providers, has the greatest potential to meet the palliative care needs of this regional coastal community.
Abstract: Changes in family structures have resulted in many children growing up in non-traditional families, where their father is not resident in the family home. Father absence that occurs as a result of the breakdown of the parental relationship is associated with life adversity and less than optimal outcomes for children and adolescents. However, little research exists that explores this phenomenon from the perspective of the father absent young person. This phenomenological study was conducted in 2005 and aimed to explore women's perceptions about relationships with their fathers within the context of a father absent childhood. Nine women participated in this study. Findings revealed that growing up without their father present in the family home disrupted the relationship these daughters held with their fathers. Due to the perceived lack of interest these daughters felt from their fathers, they expressed feelings of hurt and diminished respect for their fathers. Furthermore, participants felt that their fathers were unable to provide them with the father-daughter relationship that they sought. The findings of this paper provide insights that can help nurses and other healthcare professionals to recognise the emotional impact that father absence can have on young women. Findings suggest a need for further research to gain greater insights into the experiences of family members who undergo disruption of relationships due to family breakdown.
Abstract: Intimate Partner Violence remains a significant problem globally despite health promotion aimed at raising awareness. In particular, there is a current trend for many young women to view some abusive/violent behaviours as acceptable in their relationships. Intimate Partner Violence has serious implications for its short and long term impacts on the health of women and children. Health workers may find working with women a challenging and sometimes frustrating experience. A way forward is to develop clearer understandings of the complexities of Intimate Partner Violence and to better understand women's investments in romantic relationships. In this paper a secondary analysis of data from a narrative study of women's recovery from IPV relationships is presented in order to illustrate discourses that inform underpinnings of romantic relationships. Transcriptions of audio-taped interviews were analysed using a feminist post-structural approach in order to make visible the ways in which the women negotiated their identities in the discourses of femininity. A critical review of current literature was also undertaken to develop the construct of romantic love. Women revealed that cues for Intimate Partner Violence were present early in the relationship but were not recognised at the time. Two positions within the discourse of romantic love were identified that underpinned their desires to establish and invest in the relationship despite the presence of cues for Intimate Partner Violence. These were 'Desperate for a man' and interpreting jealousy as a sign of love. Romantic love may be desirable for the sharing of warmth, safety and protection, and yet can mask behaviours that are cues for domestic violence. Understanding the complex nature of the ways that women's desires are located in the discourse of romantic love has implications for all nurses working to prevent and reduce the incidence of Intimate Partner Violence.
Abstract: This paper reports some of the findings from the first qualitative stage of a large national study of bullying in the nursing workplace currently being undertaken in Australia. The findings reported here reveal how relationships between bullies were embedded within informal organizational alliances, enabling bullies to control work teams and use emotional abuse and psychological violence as a means of enforcing bully-defined 'rules of work'. Within nursing teams, bullies controlled work roles, tasks, and status in the nursing hierarchy through enforcing their 'rules'. Bullies enforced these rules through a process of ritual indoctrination, destroying the self-confidence and self-image of those targeted, and forcing them to eventually resign their position or acquiesce to survive. The merciless, calculated and deliberate nature of the bullying resulted in profound harm for many of those targeted. The findings of this research have implications for the understanding and management of workplace bullying.
Abstract: Workplace bullying is a significant issue confronting the nursing profession. Bullying in nursing is frequently described in terms of 'oppressed group' behaviour or 'horizontal violence'. It is proposed that the use of 'oppressed group' behaviour theory has fostered only a partial understanding of the phenomenon in nursing. It is suggested that the continued use of 'oppressed group' behaviour as the major means for understanding bullying in nursing places a flawed emphasis on bullying as a phenomenon that exists only among nurses, rather than considering it within the broader organisational context. The work of Foucault and the 'circuits of power' model proposed by Clegg are used to provide an alternative understanding of the operation of power within organisations and therefore another way to conceive bullying in the nursing workforce.
Abstract: Case study as a teaching and research tool has an extensive history in health and social sciences. Despite its suitability for many of the research questions that face nurses, nurses have not fully embraced case study as a comprehensive approach for research. The vagaries of the real-life clinical setting can confound methodologically purist researchers. Case study provides a milieu in which nurse researchers can respond to these vagaries and move towards a paradigmatic openness. In this paper, we argue that case study offers, as yet, under-explored and under-utilised potential as a bridge across the traditional research paradigms. We argue that case study has broad research application and epistemological, ontological and methodological flexibility. When used as a research approach, case study is both the process and end product of research. It provides a delineated boundary for inquiry, and a structural process within which any methods appropriate to investigating a research area can be applied.
Abstract: Violence is an issue that is attracting increasing attention in the nursing literature. There is general agreement that nurses are exposed to unacceptable levels of violence and aggression in the workplace, and that levels of violence are increasing. Despite this attention and awareness, however, violence does not have a standard definition, and theoretical explanations of violence are seldom considered when discussing it in relation to nursing. This paper discusses current issues associated with defining violence, and presents an overview of some of the traditional and contemporary theories of aggression and violence in relation to nursing and the health context. Conflicting issues surrounding predictors and precipitators of violence are examined. We explore the notion that violence is 'part of the job' in nursing. In conclusion, we assert that the current discourses on aggression and violence maintain the status quo, and argue that new explanatory positions on aggression and violence towards nurses are needed.
Abstract: BACKGROUND: Patient advocacy and a desire to rectify misconduct in the clinical setting are frequently cited reasons for whistleblowing in nursing and healthcare. AIM: This paper explores current knowledge about whistleblowing in nursing and critiques current definitions of whistleblowing. The authors draw on published perspectives of whistleblowing including the media, to reflect on the role of the media in health related whistleblowing. CONCLUSION: Whistleblowing represents a dilemma for nurses. It strikes at the heart of professional values and raises questions about the responsibilities nurses have to communities and clients, the profession, and themselves. In its most damaging forms, whistleblowing necessarily involves a breach of ethical standards, particularly confidentiality. Despite the pain that can be associated with whistleblowing, if the ends are improved professional standards, enhanced outcomes, rectification of wrongdoings, and, increased safety for patients and staff in our health services, then the ends definitely justify the means.
Abstract: AIM: This paper reports a study exploring the strategies a group of mothers of overweight and obese children were using and planned to use in the future to assist their children to achieve a healthy weight. BACKGROUND: Over the past two decades, the prevalence of childhood obesity has grown exponentially to become a major public health concern. Extant literature suggests that childhood obesity is associated with a range of physical, social and psychological effects, including poor self-esteem, depression, social isolation, and cardio-vascular and other morbidity. Parents are known to be important in determining early eating and exercise habits, and their involvement is crucial to achieving positive child health outcomes. METHODS: An exploratory-descriptive design informed by feminist research principles shaped the study, which was carried out in 2003-2004. Eleven mothers meeting the inclusion criteria took part in in-depth interviews. These were transcribed, and qualitatively analysed. FINDINGS: Participants revealed sound understandings of the concept and ramifications of obesity. They had initiated a range of strategies including role modelling, developing opportunities for increased physical activity, reducing the use of junk food, and heightened awareness of how they used food. Participants viewed the problem as a family rather than an individual problem, and aimed many of the interventions at the entire family to avoid targeting the focus child. CONCLUSIONS: Further research into how childhood obesity is managed within the context of family life is needed. Specifically, additional perspectives on how mothers from various socio-cultural groups address childhood obesity within family life, and longitudinal studies to explore the efficacy and sustainability of family-based lifestyle changes that are made in response to concerns about child weight issues. Additional research to explore the type and nature of family support that can best assist families to achieve sustainable lifestyle improvements is needed.
Abstract: AIMS: This paper draws on the literature to explore some of the issues of concern to nurses undertaking fieldwork in contemporary healthcare settings. BACKGROUND: The emergence of poststructuralist and postmodern perspectives has raised questions about ethnographic approaches, and problematized the role of researchers in the construction of plausible and credible ethnographic accounts. As a practice discipline, nursing needs to negotiate a thorny path between methodological purity and practical application, with nurse researchers required to take account of both philosophical and pragmatic concerns. DISCUSSION: There is general agreement that researching with an individual or group rather than researching on an individual or group is the more effective way to approach fieldwork. Feminist writers appear to have dealt with this issue best, advocating intimacy, self-disclosure, and reciprocity in encounters with research participants. The duality of the nurse researcher role; power and politics and the moral implications of fieldwork are acknowledged as factors influencing nurses in the planning and conduct of fieldwork. Nurses as researchers may be better equipped than other social researchers to deal with contingencies in the field. CONCLUSIONS: Laying the epistemological ground for the participant observer role during fieldwork and understanding its impact on the resultant ethnographic account is essential to methodological rigour in field research. Consideration of some of the practicalities and predicaments experienced by nurses as researchers when conducting fieldwork prior to going out into the field is an important research strategy and will facilitate methodological potency.
Abstract: The aim of this paper was to review the literature on factors related to role stress in nurses, and present strategies for addressing this issue based on the findings of this review while considering potential areas for development and research. Computerized databases were searched as well as hand searching of articles in order to conduct this review. This review identified multiple factors related to the experience of role stress in nurses. Role stress, in particular, work overload, has been reported as one of the main reasons for nurses leaving the workforce. This paper concludes that it is a priority to find new and innovative ways of supporting nurses in their experience of role stress. Some examples discussed in this article include use of stress education and management strategies; team-building strategies; balancing priorities; enhancing social and peer support; flexibility in work hours; protocols to deal with violence; and retention and attraction of nursing staff strategies. These strategies need to be empirically evaluated for their efficacy in reducing role stress.
Abstract: Drug use and abuse carries risk in people of all ages. However, adolescents are particularly vulnerable to substance misuse. Adolescent drug use continues to be an area of concern with a number of adolescents developing problems associated with the use of various drugs. Negative sequelae associated with adolescent drug use include areas such as schooling, health, and family relationships. Difficulties with the legal system, schooling, or within the family are commonly the triggers for recognition of substance misuse problems in a young person. However, problems are usually well-established before they are recognized. The challenge of dealing with these problems will fall on families, particularly parents. This is a crisis for families, and ongoing support is needed if they are to overcome the challenges. Health workers (including nurses) are well-positioned to support families who are dealing with adolescent drug problems. In this paper we propose the adoption of a strengths approach as a strategy for developing resilience in families.
Abstract: In this article, the benefits of using the arts and humanities as teaching and learning strategies are explored. Their contribution to undergraduate nursing curricula, as a means of promoting a deeper understanding of the experiences of loss, suffering and death, cannot be undervalued. They need to be present equally alongside the physical and social sciences in nursing curricula. More than ever, is the need for all undergraduate nursing students to participate in self-reflection of these experiences, in order that they may meet the needs of their patients and families adequately, in a range of healthcare settings.
Abstract: BACKGROUND: Childhood obesity is a growing health concern and the literature implicates parents, particularly mothers. AIM: To develop understandings into the views of a group of mothers with an overweight or obese child, about their child's overweight or obesity. METHOD: A qualitative design informed by feminist insights. Eleven English speaking mothers of at least one overweight or obese child were drawn from a large urban community in metropolitan Australia to participate in this study. RESULTS: Participants attributed their child's obesity to factors such as slow metabolism, sedentary lifestyle, familial or cultural factors, genetics, eating habits such as not drinking enough water, or not chewing food adequately. Participants were very concerned about their child's weight problems and their immediate concerns focussed on social problems associated with obesity/overweight. CONCLUSION: Understanding parental views about their children's overweight and obesity is a key step in forming effective liaisons between health professionals and parents.
Abstract: In-depth interviews with nurses who have been bullied depict bullies masking their bullying behavior behind the cloak of legitimate organizational processes, resulting in extensive harm to targets.
Abstract: To shed light on programmatic research through direct experience is highly beneficial to nursing scholarship. Following a recent description of a successful Australian program of research centered around people's chronic illness experience we are inspired to continue the commentary (Koch et al 2005). Koch et al's (2005) case study reported on several 'core elements' they believe have contributed to the growth and effectiveness of their program. In this paper we consider some of these in light of current literature and our own challenging experiences within several Australian universities. Koch et al (2005) also makes a not too subtle distinction between dedicated research units independent of universities and research programs emanating from academia, suggesting the former are more productive. While one of the authors in the above paper, a UK scholar and nursing academic, makes interesting observations about this assertion, we contend that his UK perspective fails to capture the urgency of establishing nursing research programs in Australian universities. Consequently, we have chosen to extend the discussion about nursing research programs from the perspective of Australian academe, including comment on building productive relationships, strengthening a track record, research and practice as symbiotic processes, competitive funding strategies, and the integral role of research students. The entire commentary is located in a celebratory context of 20 years of Australian nursing education in the university sector, a context not without controversy. We give consideration to the best way ahead for the future of nursing research programs and hope our ideas spark further sharing of experiences.
Abstract: BACKGROUND: The success of biotechnology has created moral and ethical dilemmas concerning end-of-life care in the Intensive Care Unit (ICU). Whilst the competent individual has the right to refuse or embrace treatment, ICU patients are rarely able to exercise this right. Thus, decision-making is left to medical professionals and family/significant others. AIM: This study aimed to explore the lived experience of ICU nurses caring for clients having treatment withdrawn or withheld, and increase awareness and understanding of this experience amongst other health professionals. METHODS: Van Manens' (1990) phenomenological framework formed the basis of this study as it provided an in-depth insight into the human experience. A convenience sample of ten ICU Nurses participated in the study. Conversations were transcribed verbatim and analysed using a process of thematic analysis. RESULTS: Five major themes emerged during the analysis. These were: (1) comfort and care, (2) tension and conflict, (3) do no harm, (4) nurse-family relationships and (5) invisibility of grief and suffering. CONCLUSION: The experience of providing care for the adult having treatment withdrawn or withheld in the ICU represents a significant personal and professional struggle. Improvements in communication between health professionals, debriefing and education about the process of withdrawing or withholding treatment would be beneficial to both staff and families and has the potential to improve patient care and reduce burden on nurses.
Abstract: Child-to-mother violence is a common aspect of family violence, and presents nurses and health workers with continuing challenges. Though noted in the literature as early as the 1950's, this phenomenon remains poorly understood. A number of reasons for the lack of research scrutiny are proposed, the most compelling being that child-to-mother violence has been framed within the discourse of juvenile delinquency rather than family violence. Thus, unlike other forms of family violence, it has escaped close examination by health and welfare workers. A literature review was conducted to examine current knowledge of child-to-mother violence. Study of the literature reveals only partial understandings of this neglected aspect of family pathology. Directions for research to address these gaps in knowledge are drawn from the findings of this literature review.
Abstract: Rapid social changes and the pressures of contemporary living have put families under increasing stress. Nurses have the potential to offer support for families experiencing stress. Therefore, it behoves nurses to develop a greater understanding of the stressors affecting families in contemporary Australia. This paper reports an exploratory descriptive study of urban women's experiences of dealing with difficult and demanding situations in their lives as mothers and family carers in contemporary Australian society, and explores women's experiences of seeking support for family issues. Participants' insights about the nature and availability of support for themselves and their families when in these stressful situations are revealed. Participants sought support from various personal networks, community and self help groups, and professional helpers. However, adequate support was not always available. Nurses have the potential to further develop their role in relation to providing support to women raising families.
Abstract: This column is a discussion of nursing in Australia. The authors present current challenges and issues related to recruitment and retention, an aging workforce, violence and bullying, diversity, undergraduate and graduate education, professional development, information technology, clinical pathways, models of care delivery, and funding models. They also present what is happening in Australia in relation to nursing's scope of practice, development of the nurse practitioner role, nursing leadership, and nursing research.
Abstract: Mother blaming has been identified as a pervasive and serious problem and it is known that the professional literature has strong and entrenched mother-blaming messages. Using a feminist approach, this paper explores mother blaming as it has been experienced by a group of mothers themselves. Analysis of narrative exposes mother blaming as a burden that complicates the already-complex responsibilities that comprise mothering. Health providers are among those identified by women as being particularly likely to attribute problems with (even grown) children to maternal fault. Implications for practice and research are drawn from the findings of this paper.
Abstract: A literature review utilising literary databases, World Wide Web and hand checking of written articles was conducted to determine the magnitude of the problem of coronary heart disease (CHD) in Indians with a particular emphasis on those in Australia. Health care professionals need to be aware that Indians have a higher than average risk of CHD at an earlier age and poorer survival and this is impacted on by genetic, social and cultural factors. The experiences of Indians with CHD needs to be researched so that prevention and rehabilitation programs can be individualised for this well developed community group in Australia.
Abstract: Heart disease commonly manifests as acute coronary syndromes (unstable angina pectoris, or myocardial infarction) and heart failure (HF). These conditions are major causes of morbidity and mortality in Australia and internationally. Australian faces particular challenges in health care delivery given the cultural and ethnic diversity of society and unique issues related to rurality. These factors have significant implications for health care delivery. Following an acute cardiac event women have poorer outcomes: higher mortality rates, higher incidence of complications and greater psychological morbidity compared with men. Language barriers, socioeconomic factors, psychological trauma related to migration and alternate health seeking behaviors and varying perceptions of risk are likely to impact adversely on health outcomes. Self-management in chronic cardiovascular disease underscores the importance of models of care that incorporate aspects related to self-care and promotion of adherence to primary and secondary prevention initiatives. Implicit in this statement is the inclusion of the individual in negotiating and developing their care plan. Therefore health professionals need to be aware of the patient's needs, values, beliefs and health seeking behaviours. These factors are strongly influenced by culture and ethnicity. The cultural diversity of Australian society mandates cultural competence in health care. This paper presents an overview of nursing science related to women and heart disease in Australia and suggests directions for culturally-competent research and development and evaluation of models of care to improve health outcomes for all Australians.
Abstract: Coronary heart disease (CHD) is one of the main causes of death and disability in the Aboriginal population, and is the major cause of the twenty-year gap in life expectancy of Aboriginal and non-Aboriginal Australians. This paper explores Aboriginal health in relation to CHD, and suggests self-management as a culturally acceptable therapeutic and sustainable ideology from which positive outcomes may be achieved.
Abstract: Adolescent drug use provides challenges for parents, health professionals and the wider community. Of those adolescents who use drugs, cannabis is often the drug of choice. A number of adolescents will develop problems associated with cannabis use, and the burden of managing these problems will fall on the family, particularly the mother. This paper explores adolescent cannabis use from the perspective of mothers of affected young people. Twelve women took part in conversational style audio-taped interviews. Stories were extracted from the resulting narratives and were analysed guided by the work of Anderson and Jack (1991). Detailed findings are grouped under the themes: First awareness: 'I couldn't deny it was happening'; Constant vigilance: 'I watched his every move'; Cannabis and family life: 'I'd start to shake when he walked into the house'; Disrupted lives: 'I was terrified he'd go to prison'; Shifting aspirations: 'just staying alive'; and, Maintaining a loving relationship: 'always told him I loved him'. Implications for nursing practice are drawn from the findings.
Abstract: In a climate of a declining nursing workforce where violence and hostility is a part of the day-to-day lives of most nurses, it is timely to name violence as a major factor in the recruitment and retention of registered nurses in the health system. Workplace violence takes many forms such as aggression, harassment, bullying, intimidation and assault. Violent acts are perpetrated against nurses from various quarters including patients, relatives, other nurses and other professional groups. Research suggests that nurse managers are implicated in workplace violence and bullying. Furthermore, there may be a direct link between episodes of violence and aggression towards nurses and sick leave, burnout and poor recruitment and retention rates. This paper explores what is known about workplace violence as it affects nurses, and calls for managerial support and policy to act to improve work environments for all nurses.
Abstract: This paper reports the findings of a study which sought to gain insights about the role of clinical nursing staff in the planned clinical experience of undergraduate nursing students. This study differs from others in that the perspectives of students of nursing in their first year of the undergraduate programme are sought, and the role of clinical nurses rather than clinical teachers is of particular interest. Using a story-telling approach, an exploration of students' perspectives on the role of clinical nursing staff in their clinical learning was undertaken. Analysis allowed findings to be grouped into helpful and unhelpful behaviours, Helpful behaviours included understanding and being friendly, showing interest and explaining. Behaviours that students found unhelpful to their learning were often passive rather than active, but they made students feel acutely aware of being unwelcome in the clinical area. Several students described feeling intrusive, uncomfortable and even unwelcome in clinical areas because o the attitudes and behaviour of clinicians. Findings of this study highlight the importance of clinicians and academic nurses working together to ensure that students of nursing, who represent the future of the profession, are provided with the best possible opportunities for clinical learning.
Abstract: Nursing is facing a crisis nationally and internationall, with Australia, the United States, New Zealand, Canada, the United Kingdom and Western Europe experiencing critical shortages of nurses. Problems with recruitment, retention and an ageing workforce means that attempts to ensure a viable nursing workforce must be placed at the top of the professional agenda. Strategies currently used to manage the crisis, such as overseas recruitment, are not sustainable and are ethically dubious. The demographic timebomb is ticking and up to half the current nursing workforce will reach retirement age by 2020. It is vital that there are adequate numbers of skilled and qualified nurses to take their places. Nursing and nurses are facing unprecedented challenges and pressures in the workplace. Job satisfaction is threatened as nurses are pressured to do more with less, Nursing productivity has increased phenomenally over the past ten years in response to increased demands and decreasing numbers of staff. The nursing workplace has disturbingly high levels of occupational violence, and many nurses operate within a culture of blame and scapegoating. There is evidence that organizational change is imposed upon nurses with little or no consultation and the literature reveals that this has a direct and negative effect on job satisfaction and on retention of nurses. This paper explores some of the critical issues that nursing must confront to be successful in establishing and maintaining a vigorous, dynamic and viable workforce.
Abstract: BACKGROUND: The period immediately after discharge from the hospital after an acute myocardial infarction is a stressful and vulnerable time about which little is known. OBJECTIVE: To explore health status, perceptions of coping, and social support among survivors of a recent myocardial infarction in the first 3 weeks after discharge from hospitals in southwestern Sydney, Australia. METHODS: A descriptive, exploratory approach with a triangulated methodology was used to assess the experiences of 38 survivors, detect patterns in these experiences, explore the health-support needs of survivors, and determine changes in health status in the first 3 weeks after discharge. Quantitative data were collected with the Medical Outcomes Study SF-36, New York Heart Association classification, Canadian Cardiovascular Society Angina Scale, and the Jalowiec Coping Scale. A semistructured interview schedule provided additional qualitative data about the experiences of the survivors. RESULTS: The health status of participants was relatively stable during the 3-week period; most had no activity limitation due to dyspnea or angina. However, the subjects' health status was considerably lower than that of their age-matched population. The most common and most effective coping strategies adopted during this period were confrontation, optimism, and self-reliance. In addition, the subjects experienced anxiety, depression, ambiguity and uncertainty, fear of recurrence of the infarction and of deterioration in health, of boredom and of inertia. CONCLUSION: These findings can help nurses in hospital and community settings assist survivors of acute myocardial infarction to prepare for and deal effectively with experiences during convalescence.
Abstract: Although myocardial infarction (MI) is a leading cause of death and disablement for women internationally, little is known about women's recovery. This paper describes an exploratory descriptive study that was informed by feminist principles, and which aimed to explore the recovery experiences of a group of women survivors of first-time MI in the initial period following discharge from hospital. A total of 10 female survivors were interviewed using an open-ended semi-structured interview schedule administered at 7, 14 and 21 days post-hospital discharge. Findings revealed that recovery was experienced as a complex process, initially characterized by fear and uncertainty. Over the duration of the study these feelings were replaced with a more positive outlook, a return of energy, and a sense of confidence in the future. Participants identified an unmet need for reliable information which persisted over the duration of the study. The findings of this study have implications for nursing practice and research. Chief among these is the issue of effective provision of information to women following an acute MI. The importance of providing relevant information to be understood and retained by people experiencing crisis cannot be overstated. Equally important are the provision of opportunities for patients to have regular contact with health professionals to question and seek clarifying information. These findings should now be tested on larger populations.
Abstract: Many Aboriginal people reside in rural and remote Australia. Aboriginal health workers were the informants in this exploratory-descriptive study, which explored issues pertaining to postacute care for older Aboriginal people. Qualitative analysis of interview data revealed several issues were viewed as being of crucial importance in the provision of effective postacute services to older Aboriginal people. These were: (i) identification of Aboriginality; (ii) perceived racism and stereotypical attitudes among hospital staff and healthcare workers; and (iii) effective discharge planning. Other issues which were believed to impact upon service use were identified as: (i) availability of services; (ii) knowledge of services and level of use; and (iii) the notion of mainstream versus Aboriginal-specific services. Findings are discussed in relation to available literature. Implications for further research are drawn from the findings of this exploratory study.
Abstract: Currently in Australia, both Aboriginal and non-Aboriginal Australians are attempting to reconcile themselves with a history of colonization/invasion, which resulted in human rights violations against Australia's indigenous people. Australian nursing has to examine its past in relation to the treatment of Aboriginal Australians. Relationships between nurses and Aboriginal health workers are the most commonly occurring professional relationships between nurses and Aboriginal people and are of key importance to the successful delivery of health services to Aboriginal communities. This qualitative study, grounded in feminism, aimed to explore the professional relationships between Aboriginal health workers and nurses and to develop insights which could assist the Australian nursing profession through a process of reconciliation with Aboriginal Australians. Feminist analysis of narrative text revealed several key themes as being crucial to this process. These were: learning to know and understand; towards workplace equity; and skill sharing -- learning from each other. Implications for nursing, in its journey toward reconciliation with Aboriginal Australians, are drawn from this study.
Abstract: This qualitative study was undertaken to explore the relevance and meaning of the experience of hope for survivors of acute myocardial infarction (AMI). Depth interviews were conducted with eight survivors (n = 8) of AMI at four weeks following discharge from hospital. Analysis of transcribed interviews revealed three distinct narrative themes. These were holding on to human connectedness, finding and harnessing the 'will' to live, and, having faith in the primacy of a higher power. Study findings are discussed in relation to the literature. Findings of the study assist in building knowledge and understanding of the complex phenomenon of hope. Implications for nursing practice and research are drawn from study findings.
Abstract: The practice of midwifery has long been recognized as both art and science. However, educational programmes for midwifery are most often undertaken within an academic health sciences environment, and tend to be based on knowledge derived from the sciences (e.g. life sciences, biomedical sciences, behavioural sciences and social sciences). These scientific perspectives, while essential to the preparatory and on-going education of midwives, do not necessarily fully prepare midwives to fulfil their practice roles. This paper reports a teaching innovation aimed at facilitating student exploration of fundamental, complex and ethereal concepts which are essential to the effective and skillful practice of midwifery. Through the exploration of the arts and humanities, students were encouraged to engage with concepts such as 'caring', 'empathy', 'suffering', 'motherhood', 'pain', 'love', 'attachment', 'health' and 'illness'. Students were also encouraged to explore cultural and social symbols pertaining to parenthood and family life. Evaluation revealed that students valued the course, and that they gained insights which assisted them to develop understanding of key concepts. Implications for practice and education are drawn from this paper.
Abstract: Information and messages concerning health-related issues are not confined to material provided by official figures or sources. Much information exists in the community and comes from a variety of sources. One such source is the media. This paper reports the findings of a study conducted over a 12-month period of advertisements for menstrual products in a selection of four monthly Australian magazines (n = 48) directed towards young women. The study examined the way in which menstruation and the menstrual experience were depicted in terms of page space, textual content and visual images. Findings revealed that advertisements for menstrual products provided confusing, conflicting and paradoxical messages. These included stressing the normality of menstruation while also emphasising the importance of keeping it hidden and secret. Menstruation was depicted as being a state of tainted (idealised) femininity because of the potential for the menstrual silence to be shattered by people finding out. Protection failure was depicted as being the ultimate in tainted femininity and a result of a woman's incorrect choice of product. Choosing menstrual-care products was depicted as simple but, paradoxically, complex and confusing. Women were depicted as liberated and sophisticated but images and language related to infancy were used. Freedom and liberation were conferred by the use of the advertised product. Overall, in common with previous studies, menstruation was depicted as a crisis of hygiene that is a risk to femininity. Advertisements for pantyliners suggest that femininity itself poses a threat to (idealised) femininity. This study demonstrates the crucial role of the media as a source of health information for young women.
Abstract: Lebanese migrants form a significant proportion of the population in southwestern Sydney (SWS), and in New South Wales, Australia. This pilot study was undertaken in south-western Sydney, a rapidly expanding and socioeconomically disadvantaged region, to explore the experiences of English speaking women of Lebanese origin whose spouses had recently experienced an acute myocardial infarction (AMI). Semi-structured interviews were conducted with seven Lebanese-born women at 2- and 4-week intervals, following the discharge of their husbands from hospital. Qualitative analysis of narrative text revealed four distinct themes. These were: struggle to resolve distress; intensive monitoring of the AMI survivor; searching for avenues of support; and reflecting on the future. Study findings are discussed in relation to the literature. Implications for nursing practice and research are drawn from study findings.
Abstract: Holism is claimed to be the signifying feature that sets women's health apart from traditional approaches to health care. As such, articles published in the nursing literature about women's health would, one might expect, reflect the centrality of holism to women's health care nursing. The findings of a study which examined the content and the focus of articles published about women's health in journals indexed by CINAHL in the period 1993-1995 challenge this assumption. It was found that women's health is a taken-for-granted notion and is used interchangeably and synonymously to refer to reproductive health, maternal health, neonatal health, family health and (hetero) sexual health. Confounding the view that holism is foundational to a women's health perspective, the papers forming the study's sample largely depict issues to do with women's health from a narrow and stereotypical perspective and with a bio-medical focus. Women were referred to as fragmented bodies, body parts and diseases, and were depicted as being passive and silent. By contrast, the voice (and the activity) of nurses and nursing's imperative to intervene was clearly discernible.
Abstract: This paper describes a study grounded in feminism, which explored the experiences of three registered nurses who were employed in a residential care institution in which they believed the standard of care to be unacceptably poor. Ultimately, the nurses became 'whistle blowers'. Data surrounding these events were gathered through serial encounters and analysed using feminist interpretive methods. Three distinct phases were revealed: (i) trepidation and optimizm; (ii) barriers and obstacles; and (iii) disillusionment and defeat. It was in this final phase that the whistle blowing occurred. For these women, whistle blowing was an intervention of last resort; a stressful and negative event that carried personal and professional cost. Issues pertaining to professional autonomy and patient advocacy are raised, together with concerns surrounding the appropriation by business people of the language and images of nursing, and the power of these people to negatively impact upon nursing practice.
Abstract: Nurses are under increasing pressure to defend the efficacy, value and cost benefits of professional nursing care. Now more than ever, there is a need for nurses to undertake quality clinical research, through which practice may be shaped and guided. Feminist theory can provide a lens through which nurses may explore clinical issues. It also provides a framework by which socially constructed differences, such as gender and culture, may be incorporated into the design of clinical research projects. Because feminism is an openly political and transformative process, feminist concepts are suitable for use where the aim of the research is to catalyse practice change. This paper explores the use of feminism as a theoretical framework for nursing research.
Abstract: Over the past three years, Australian nurses have witnessed a proliferation of locally published refereed nursing journals. This paper considers the refereed content published in four selected Australian nursing journals over a recent twelve month period. Material appearing in the Australian Journal of Advanced Nursing (AJAN), Contemporary Nurse, Nursing Inquiry and Collegian was categorized according to subject matter and authorship by gender and discipline. Findings indicate that articles pertaining to clinical practice, the practice of research, and professional nursing issues are well represented in the literature. These findings mark a change from earlier analyses of Australian nursing journals, which suggested that the epistemologies of other disciplines were over-represented in Australian nursing journals, and thus exerted a powerful influence over the development of nursing theory and scholarship. The increase in the number of refereed Australian nursing journals is indicative of the dynamic state of Australian nursing, in terms of confidence, scholarship and clinical practice development.
Abstract: The changing composition of Australian society has resulted in the reality of a multicultural workplace. With this comes the need to examine issues related to cultural wellbeing within an occupational setting. Migrant women nurses from non-English speaking backgrounds participated in this phenomenological study, which examined their experiences working as nurses within the New South Wales health care system. Participants described traumatic experiences around entering the nursing work environment. Familiar and comfortable roles such as being a woman, a colleague and a nurse were altered and made uncomfortable by the imposition of disturbing and unfamiliar roles. This discomfort was compounded by what was experienced as an uncomfortable and perilous work environment. The task for these women became one of finding sanctuary and comfort and finally, of establishing a place for themselves. This paper will take the reader on the journey from being a stranger to finding a place and will raise issues for discussion surrounding culture and safety in the nursing workplace.
Abstract: This study explored the everyday experiences of a group of overseas qualified female nurses from non-English speaking backgrounds (NESB) entering the New South Wales health-care system. Migrant women from a variety of NESB participated by describing their experiences in the hospital environment as qualified nurses. Analysed data suggest that the experience of being a migrant woman has a profound effect on how these nurses construct nursing practice. National wealth and the dominant government ideologies operating in a nurse's country of qualification shape the practice of nurses. Nursing therefore is socially and culturally constructed, yet nurses seeking to practise in New South Wales (and other parts of Australia) are assessed against the Australian Nursing Council (Inc) competencies. Do these competencies support the current ideology of multiculturalism or do they reflect a monocultural view of the world? This paper raises questions concerning the use of competencies as an assessment tool for locally qualified and overseas qualified nurses.
