Professor Lesley Wilkes is a Professor of Nursing at the Clinical Nursing Research Unit (Joint appointment with the School of Nursing and Midwifery, UWS and the Sydney West Area Health Service) as well as the Dean of Research Studies at UWS. Professor Wilkes has contributed significantly to the growth and enhancement of nursing research in Australia. She has successfully led a number of research projects including NHMRC and ARC Linkage grants. She has expertise in both qualitative and quantitative research methods and has undertaken a number of studies related to nursing issues. In addition, she has supervised and is currently supervising a number of Masters and PhD students. Professor Wilkes is one of the UWS top researchers for 2004-2006 triennium in the top 40 by publication and in the top 20 by higher degree research student completions. She is a prolifically active researcher and has a high track record of successful research grants. Her research has received high community recognition nationally and internationally through extensive media coverage showcasing her research expertise in areas such as organisational violence, family and community health, prostate cancer, and child-to-mother violence, through both radio and television networks. She is one of the most prolific publishers of nursing research in Australia.
Abstract: Since the transfer in Australia of preparatory nurse education from the hospital to the university sector, debate and discussion have continued regarding the perceived benefits and failings of the current system. In this paper we consider issues related to student clinical practicum from the perspectives of the student learner, the educational provider, the health service sector, the health consumer and the profession as a whole. The aim of this paper is to generate further discussion about clinical learning, a critical component of undergraduate nursing education. We argue that all stakeholders have a role to play in contributing to optimising all the clinical learning experiences for students in Bachelor of Nursing programs -- the professional nurses of the future.
Abstract: This study used the medium of videotaping to investigate the verbal and nonverbal communication that takes place between nurses and patients during chemotherapy administration. Eight chemotherapy sessions were video recorded and then analyzed for emerging themes. In addition, the videotapes were used in a reflective process with nurses. The findings showed that nurses were efficient in communicating about the physical and medical care of patients but were hesitant in exploring emotional issues. This study highlights the focus on physical symptoms and side effects by nurses in this setting. It also supports the need for further education and training in psychosocial assessment during chemotherapy administration.
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 preserva-tion 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 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: This project aimed to explore the application and relevance of a PhD to nurses working in the clinical area. The complexity of nursing practice requires clinical nurses to be competent as investigators and professional leaders who could help structure nursing practice in more efficient ways. Research proposes that a PhD offers Limited employment opportunities, is mainly research oriented and tends to direct a nurse away from the clinical field. A mixed method study design utilising surveys and interviews was chosen to collect data for this study. Participants were nurses with a doctoral degree working/having worked in a clinical area after obtaining their PhD Nurses were recruited through student databases from Australian universities that offer doctoral degrees in nursing and also by using a snowball sampling technique. The majority of the 19 nurses who participated in the study had: varied expectation of doing a PhD; maintained their clinical positions after obtaining their doctoral degree, considered that the degree helped them to obtain better jobs/promotions and acknowledged the value of the PhD in patient care, in improving research and informing health policy. This study has exposed the positive aspects of completing a PhD and identifies its constructive application in the clinical area. It is essential to provide support and opportunities for nurses working in the clinical area to pursue doctoral degrees in order to enable them to enhance knowledge and build confidence and leadership skills and contribute to the improvement of nursing practice and the continued development of the profession.
Abstract: This paper reports the findings of a qualitative descriptive study, which explored the meaning of 'positive attitude' for a group of oncology nurses. Unstructured interviews were conducted with eight female nurses who volunteered to participate in the study. The importance and impact of attitude to patients with cancer and definitions of positive and negative attitude as perceived by nurses were key concepts addressed. The audio-taped interviews were transcribed and analysed for themes that related to positive attitude and cancer. The nurses perceived hope and positive attitude as similar and used three broad themes to describe this multifaceted construct: acceptance, a fighting spirit and looking on the bright side. The nurses perceived to have a major influence on the positive attitude of the cancer patient. However, they acknowledged their obligation to support and encourage patients to maintain a sense of positivity based on patient's values and beliefs.
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 qualitative study aimed to explore and describes clients' experiences of receiving care from community nurses. BACKGROUND: Understanding of the experiences of clients with chronic and complex conditions receiving community nursing care can provide insight into their needs. International studies have identified experiences clients have had of receiving care from community nurses. However, no Australian study was found that had specifically explored with clients who had chronic and complex conditions and their experiences of receiving care from community nurses in an area health service. DESIGN: A qualitative descriptive study conducted during 2005 explored and described clients' experiences of the nursing care provided by community nurses. METHOD: A purposive sample of 13 volunteer participants with chronic and complex conditions was interviewed and the transcripts analysed. RESULTS: Three main categories were identified that clients used to describe their experiences. These were: the client's relationship with the nurse, care process and being able to stay out of hospital. CONCLUSIONS: Clients strongly indicated their satisfaction with care provided by experienced community nurses and acknowledged that nurses are playing a key role in fostering their self-management and avoiding their readmission to hospital. Areas that require further attention are the professional development of less-experienced community nurses, services at the weekend, the scope of nursing management of clients with chronic conditions and the education needs of community nurses to meet the goals of these clients. RELEVANCE TO CLINICAL PRACTICE: This study highlights the need for nurses who work in strong autonomous clinical roles in the community to have experience in assessment, education, planning and delivery of client care before they can be competent community nurses. The possibility of adverse occurrences during weekends provides the opportunity for managers to review and plan weekday and weekend workloads and staffing.
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: 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: 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: 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 reports a case study of nursing practice model redesign in a surgical ward at a large metropolitan acute care hospital in Sydney, Australia. BACKGROUND: Literature suggests that factors such as financial restraints and shortage of nurses necessitate redesign of nursing care. METHOD: A descriptive case study design was used. The nursing practice model was changed from a patient allocation model to a team-nursing model and a new role of Clinical Activities Coordinator was introduced. RESULTS: This study has confirmed that people need to be able to empower themselves to ensure an effective change process. It was also apparent in the case study that the staff were resistant to the redesign. CONCLUSIONS: Change is a difficult process, which needs to involve all stakeholders. The planning process needs to consider the characteristics of the context such as workload and skill required, and the measures such as patient and staff satisfaction and health outcomes.
Abstract: BACKGROUND: This paper reports on the experiences of the children (nieces and nephews), volunteers (aunts and uncles) and parents involved in the Aunties and Uncles Co-operative Family Project in Sydney, Australia. The project has run for 30 years as an extended family network of community volunteers and has never been evaluated. METHODS: A survey comprising open-ended and closed questions relating to the service was administered to all stakeholders. Demographic data were collected on all respondents. The text from answers to open-ended questions on the survey was coded for similarities and differences and was categorized. From the categories, the experiences of children, volunteers and parents were written with exemplars from the respondents' text. RESULTS: Three major categories emerged from the text: enjoyment/satisfaction of the experience for volunteers, children and parents; family relationships; and the difference it has made to me (children, parents and volunteers). CONCLUSIONS: The long-term benefits of a supportive 'extended family type' relationship were recognized by all participants. Although the children were the primary focus of the project, parents and volunteers also described the rewards they experienced. The volunteer element was integral to providing the wide-ranging, ongoing supports which would not be possible from a paid staff basis.
Abstract: AIMS: This paper reports phase one of a two-part study in a New South Wales area health service, which aimed to evaluate the grading system for clinical nurse consultants. BACKGROUND: Since its inception in 1986, the role and scope of practice of clinical nurse consultants in New South Wales has been viewed with differing expectations leading to role conflict from the nurse consultants themselves and others in health care including managers and other clinicians. METHOD: A quantitative approach was used for this study. A survey comprising of open and closed questions was mailed to all clinical nurse consultants (n = 42) employed in the area. RESULTS: The data presented suggest that ambiguity continues about the role, the scope and the differences within the grading system of clinical nurse consultants. CONCLUSIONS: Clinical nurse consultants need leadership training and support from their managers to fulfil their role. More work is required to clarify the role of clinical nurse consultants.
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: 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: The care of people with mental illness often rests with their families. The way families manage this experience has been explored widely in the literature; however, the added complexity of migration has been given little attention. The difficulty of conducting research with people from non-English-speaking backgrounds often precludes their voices and experiences from being heard, further compounding marginalization and misunderstanding of their needs. The aim of this study was to understand the experience of Egyptian families caring for a relative with mental illness in Australia. Seven participants from Egyptian background, caring for a relative with mental illness, were included in this study. A hermeneutic phenomenological approach, informed by the work of Heidegger, was used. Data were collected through in-depth audio-taped interviews conducted in the Arabic language, which were then translated and transcribed in English. Data analysis revealed five themes: Why did it happen? How do I protect my loved ones? What has it done to me? What has it done to us? How do I survive? Findings of the study have the potential to raise health-care professionals' awareness of the needs of Egyptian families, their beliefs, values, and coping with mental illness.
Abstract: People from Egypt have cultural belief systems about mental illness and its causes that are at variance from Anglo-Saxon-derived understandings that predominate in Australian psychiatry. These differences in understanding can affect how mental health services are experienced and accepted by this cultural group. This paper is a review of the literature on Egyptians' beliefs about mental illness and how families in Egypt cope with a relative with mental illness. Because of limited literature on Egyptians' experience with mental illness in Australia, this paper will be used to shed some light on the way in which people experience mental illness and communicate this suffering in the Australian context, based on what has been known to occur in Egypt. The Zar cult and related practices focusing on belief in the evil eye, magic, and evil possession will be explored. Historical and contemporary mental health care systems in Egypt, and the influence of education and religion are discussed. In order to provide culturally sensitive care, nurses need to be aware of possible influences on belief systems about mental illness. This paper has the potential of helping nurses to gain a deeper understanding of cultures that differ from theirs and to provide care to clients and their families based on respect for the others' beliefs, values, and practices.
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: 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: 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: 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: The importance of observing patient vital signs in emergency department (ED) practice has been stressed in the literature. Failure of clinicians to respond to abnormal vital signs (AVS) has been described as a potential reason for delayed management in ED practice, with a likelihood of increased morbidity. This study aimed to explore and describe clinicians' responses to AVS in a busy ED. A qualitative descriptive approach was used with three focus groups being conducted with 18 volunteer registered nurses (RNs) and medical officers (MOs) who worked in the ED of an area health service in Western Sydney. Transcribed focus group interviews were analysed using a process of constant comparison and contrast and a description of clinicians' responses to AVS written. An analysis of text from focus groups revealed three main categories of clinicians' responses to AVS: identification, reporting and implementing action. Clinicians in this study recognised, reported and acted on AVS. However, delays in responding to AVS occurred due to a variety of reasons. The main reasons identified were issues with documentation and the ability to seek advice of appropriate staff, ineffective communication, fear of reprimand, inexperience of working in EDs, workload, distractions and interruptions. In conclusion, environmental and human factors contribute to inappropriate delays regarding AVS in the ED. These factors can be acted on by initiating appropriate education programmes and establishing improved communication networks. Better use of the existing medical emergency team (MET) in the ED can act to alleviate situations associated with delays in managing AVS.
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: This study explored the practical needs of patients and their families travelling from rural areas in New South Wales, Australia to cities for cancer treatment. Practical needs were information, accommodation, transport, and economic impact. A cross-sectional design was employed; data were collected by questionnaire and focus group interviews. Findings showed that practical needs impacted on the ability of the patients and families to cope with diagnosis and treatment for cancer. The greatest unmet practical need of the patients and their families was for comprehensive information that is provided before travelling and by someone, for example, nurse or social worker who can help them decipher it if required.
Abstract: Parents of children with chronic illness experience multiple stressors associated with their numerous roles. For parents who are working full time and caring for a child with chronic illness, the stressors related to managing work and caring responsibilities are magnified. Although the impact of caring for a child with chronic illness has been widely investigated, the literature reveals a paucity of research on the experiences of parents who are also in full time employment. This paper shares qualitative findings of a study involving interviews of twelve parents who were working full time while caring for a child with chronic illness. Data was collected through in-depth semi structured interviews and thematic analysis was then used to develop and categorise themes. Two intertwined themes are reported: (1) grief and (2) dealing with professionals. In this study, parents revealed the chronic grief they experienced in relation to their child's condition, which often recurred at various stages of the child's illness. The child's initial diagnosis was found to be the most stressful part of the grieving process, with most feeling their voices as parents were not being heard or valued by health professionals at this time. This affected parents' confidence in the health care system and triggered the re-emergence of grief, aggravating an already stressful situation. The findings illustrate that the grief experienced by these parents can be exacerbated by their dealings with health professionals. Implications for various health professionals are drawn from the findings in order to highlight avenues where guidance and support can be provided to these parents.
Abstract: OBJECTIVE: to describe nurses' experiences of the change associated with redesign of the model of nursing practice in an acute care ward in the preparatory and implementation phases. DESIGN: descriptive case study SETTING: a surgical ward in an acute care hospital in Greater Western Sydney SUBJECTS: fourteen registered and six enrolled nurses working on the surgical ward volunteered to be interviewed, eight in the preparatory phase and twelve six months into the implementation phase MAIN OUTCOME MEASURE: descriptions of nurses' experiences in the preparatory phase and six months into the implementation phase of the redesigned nursing practice model RESULTS: many nurses felt apprehensive in the preparatory phase, however, six months into implementation phase their willingness to trial the model was evident. Negativity pervaded both phases, as did their concerns for the quality of care being given. In the preparatory phase nurses described the clinical activities coordinator (CAC) role as having potential to be beneficial and this was realised to some degree six months into implementation phase. A preference for registered nurses over enrolled nurses as a dominant component of the staff was evident in both phases CONCLUSIONS: the struggle with the change that nurses experienced suggests redesign needs to be a more collaborative process involving strong communication and supportive education so nurses can empower themselves within the change.
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: 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: 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: 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: 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: This paper reports an evaluation of the Aunties and Uncles Co-operative Family Project Ltd, founded 30 years ago, that connects community volunteers (aunts and uncles) with disadvantaged children in the Sydney area, New South Wales, Australia. A postal survey was used which included both open and closed questions regarding the volunteer aunts, uncles, parents, coordinators, nieces and nephews' satisfaction with the project. Demographic data was also collected. Responses from the survey were statistically analysed using SPSS software. Responses to the open ended questions were transcribed and coded. The findings from the study indicated that the experiences were positive for all stakeholders with volunteers and coordinators finding the project personally rewarding and parents receiving respite and support. The children enjoyed new experiences by going to different places and undertaking activities. Recommendations include increased volunteer training and guidelines for difficult situations, increased support for coordinators and more structured activities for all participants. The findings indicate the reciprocal benefits to all participants. These significant benefits reflect the philosophy of the Aunties & Uncles Co-operative Family Project Ltd.
Abstract: This study aimed to judge the appropriateness of a particular nurse researcher's actions in a vignette from the clinical field, and to explore frameworks used to determine the appropriateness of actions. Twelve experienced nurse researchers were interviewed by telephone. They were given four vignettes of actual research situations and asked to comment and explain their judgement on the appropriateness of the nurse researcher's actions. The findings confirmed blurring of boundaries between professional and research roles for nurses. Nurses appear to use a mixture of frameworks, including scientific/rigour method, ethics, nursing competencies and their own personal-moral values. Frameworks need to be discussed and debated so that neophyte researchers are well-prepared before they enter the field to conduct research.
Abstract: OBJECTIVE: To explore demands made on family members in managing symptoms and providing for the day-to-day care of relatives with cancer in rural New South Wales and how specialist palliative care nurses support these family members. DESIGN: Cross sectional qualitative study. SETTING: Seven health centres across rural New South Wales that cover a broad geographical area and reflect the diversity in economic conditions, population density and distance from three major urban centres in New South Wales. SUBJECTS: The study involved two groups of participants. The first group consisted of one or more members of families of oncology patients who were accessed through health workers at the seven centres. Nineteen family members from 17 families were interviewed. The second group comprised 10 nursing staff working as specialist palliative care nurses across the same geographical area as the families. MAIN OUTCOME MEASURES: Physical care and symptom management were the two main areas of interest. RESULTS: The rural experience of caring for palliative care patients was challenging, with support nurses needing to take into consideration all aspects of the patients' and families' living environments. CONCLUSION: There is a need for equipment and basic resources to be readily available to practitioners, funding for ongoing education and 24-h care.
Abstract: This study aims to describe the experiences of nurses caring for cancer patients in non-specialist wards. The study was conducted in a large (420 beds) and small (32 beds) hospital in an area health service with urban and rural populations in the west of Sydney. A qualitative descriptive approach was utilized to collect data from the nurses. Data were collected using a survey and in-depth interviews of nurses working in non-specialist cancer wards. Transcribed data were managed with Nudist Vivo software and analysed for common themes using process of constant comparison and contrast. Twenty-five surveys were returned and five nurses volunteered to be interviewed. The six major themes that emerged from analysis of data were: emotional nature of care, lack of time, lack of knowledge of cancer treatment, family support, environment not conducive to proper care and dealing with patient's non-acceptance of cancer diagnosis. The nurses in this study wished to provide quality supportive care for cancer patients and their families but the inconducive environment and inadequate relevant training hindered the nurses' efforts. This then presents further need of relevant training for nurses in cancer care and time management, to meet up with these challenges.
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: 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: 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: 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: New South Wales Health introduced the role of the Clinical Nurse Consultant in 1987. A review of the role was undertaken by an area health service in Western Sydney, NSW, Australia in 1992 and a number of issues were highlighted in the review process, including diverse roles and responsibilities. In 2000, New South Wales Health acknowledged the diversity of roles and developed a grading system based on five domains of practice. This paper reports the second phase of a two-part study that investigated the scope of practice and perceived level of organisational support provided for the Clinical Nurse Consultants in the area health service. Focus group interviews, one for managers and two for nurse consultants, were conducted in order to collect data. Ten Clinical Nurse Consultants, representative of each grade and seven managers, covering various clinical streams, took part in the study. Data were analysed using content analysis and coded using constant comparison and contrast of codes. Results of the study reveal a lack of clarity and understanding of the new grading system. There is an indication that the role is very individual and the incumbents are often overloaded by work and the maze of demands put on them by numerous competing forces. Many of the Clinical Nurse Consultants felt they were working at a grade higher than their position classification. There appears to be a significant need to clarify the roles of each of these members of the health care system and to provide a better reporting scheme.
Abstract: OBJECTIVE: To report on the introduction and evaluation of an after hours telephone support service for palliative care patients and their families at home. DESIGN: Descriptive evaluation using an audit of telephone logbook, text analysis of reflective journals, questionnaire and interviews. SETTING: Palliative care call service in Grafton, New South Wales, Australia. SUBJECTS: The participants were health professionals using the Palliative Care Service in Grafton (48 in total) and nurses providing the palliative care service (21 in total). RESULTS: Twelve calls were taken by the nurses during the pilot study. Three major themes emerged from the analysis: preparation involving publishing the after hours telephone support service (AHTSS) and nurse workshop; benefits such as support to families and health service resourcing; and nurses' experiences regarding personal impact and building support for each other. CONCLUSION: It appears from the evaluation responses of health professionals and nurses that knowing the service was there was a great security and reduced the sense of isolation predominant in the experience of rural families caring for a palliative care patient at home. Based on the positive evaluation, the area health service provided ongoing funding for the service and is exploring avenues to extend the program into other areas. The service now requires a re-evaluation at 18 months and will form the second phase of the study that is currently being organised.
Abstract: AIM: to describe the impact of unrelieved patient suffering on nurses working with palliative care patients. DESIGN: This was a qualitative descriptive design using semi-structured interviews. SAMPLE: nine experienced palliative care nurses were interviewed. RESULTS: nurses acknowledged that the term 'suffering' generally was not used in the workplace. The nurses identified that only a small group of patients died with suffering that could be classified as 'unrelieved' but that the impact of these patients' suffering on themselves was enormous. Nurses describe the impact in terms of perceptions of suffering (difficult situation), feelings (helplessness, distress, feelings of failure), bearing the burden (alcohol consumption, headaches) and effects on their relationship with family. The nurses identified several factors that increased the personal impact of unrelieved patient suffering. The most important strategy for ameliorating the impact of unrelieved patient suffering was informal support from work colleagues. CONCLUSION: the nurses' stories indicate that the personal impact of unrelieved patient suffering could be reduced through acknowledgement of this suffering and better formal and informal support mechanisms.
Abstract: Evidence suggests that single parent families are more likely to be affected by social problems associated with poor health and poverty. Single parent families are growing in number and are overwhelmingly headed by women. Despite their increasing number and their level of vulnerability, the lived experiences of single mothers have attracted little attention in the literature. Still little is known about many aspects of life as experienced by single mothers. Nursing is a profession that is dominated by women, and every year a number of single mothers enroll in undergraduate nurse education programs. Currently, there is little information about the experiences of women who are single mothers, undertaking a nursing degree in a university. This paper reports a study that explored the lived experiences of five single mother undergraduate nursing students. van Manen's phenomenological method informed the design and conduct of the study. Findings were grouped into the following themes: being exhausted all the time; being overwhelmed with worries; and being hopeful of the future. Findings of this study revealed that the single mothers' major health concerns were chronic tiredness and overwhelming worries. However, their being in the university was perceived as being health promoting and restoring to their self-esteem. Implications for educators, health providers and women's health services are drawn from the findings.
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: 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: PURPOSE/OBJECTIVES: To describe what being positive means for patients undergoing treatment for cancer. RESEARCH APPROACH: Qualitative, descriptive approach. SETTING: Specialist cancer clinic in a large metropolitan hospital in Sydney, Australia. PARTICIPANTS: 11 patients with cancer currently being treated at a cancer clinic for a variety of cancers. METHODOLOGIC APPROACH: Semistructured interviews that were audiotaped, transcribed, and thematically analyzed for content related to being positive. MAIN RESEARCH VARIABLES: Patients' definitions of positive and negative attitude, their perceptions of the importance of attitude during their cancer journey, and any factors that influenced their perceived attitude. FINDINGS: For patients, positive attitude was defined as optimism for the day and getting though everyday events of the journey by taking control rather than focusing on the future. Factors that affected patients' positive attitude were their relationships with their specialists, people around them being positive and supportive, and having a pleasant environment at home and at the treatment center. Patients found expectations of them to be positive as being detrimental. CONCLUSIONS: Patients with cancer must be positive for the present rather than the future. INTERPRETATION: Nurses need to inspire and support patients' positivity while undergoing treatment for cancer. Nurses should not force their own value system on them nor treat them differently if they do not conform to societal expectations to be positive and optimistic for the future.
Abstract: OBJECTIVE: This cross-sectional qualitative study used semi-structured telephone interviews with palliative care nurses working in urban and rural settings in Australia to explore their experiences of dealing with patients with malignant, often malodorous, wounds. METHOD: This paper was the second phase of a research project examining the care of patients with malignant wounds. Of 71 palliative care nurses in New South Wales invited to participate, 26 took part, 17 of them working in community positions. The data from the telephone interviews were transcribed and analysed, using content analysis, and coded for themes relating to the nurses' experiences of caring for this patient group. RESULTS: Nurses working in this setting strove to do the best for patients and their families under circumstances that are emotionally and physically difficult. Some of them suffered personal distress as a consequence. Patient isolation and altered body image are significant challenges for these nurses. CONCLUSION: The nature of the work these nurses do, in particular the fact that they are dealing with cancers, tends to push them into literal and practical silence. But the researchers question whether this is always the best option. They ask if hiding feelings could be bad for nurses and patients alike. In qualitative research it is not appropriate to generalize the results, although lessons can be learnt from the experience of this group.
Abstract: This study aimed to determine whether the health status of patients with chronic pain improved after attending the pain center. The study used a pre-post survey design and was conducted at a pain center in Western Sydney. A convenience sample of patients with chronic pain who attended the pain center between December 1998 and February 2000 were involved in the study. The Medical Outcomes Study Short-Form 36 measured health status of the participants in eight general areas, including physical functioning, role limitations resulting from physical health problems, bodily pain, general health, vitality, social functioning, role limitations resulting from emotional problems, and mental health. A significant improvement in bodily pain was demonstrated by the total group. The other variables measured remained unaffected. The study sample was divided into subgroups based on gender, age, and presenting symptom. Within the subgroups, a significant improvement in bodily pain was shown by the male participants, patients younger than 65 years of age, and those who presented with different types of chronic pain other than back pain. This preliminary study was done to monitor the health status of people with chronic pain. A holistic approach to improve the health status of people with chronic pain seems to be necessary. Further studies should use a combination of generic outcome measures and disease-specific indicators to measure health outcomes.
Abstract: BACKGROUND: A review of popular literature reveals a constant message about the healing power of 'being positive'. While there are studies that have examined the link between psychosocial factors such as attitude and cancer survival, very little has been reported about the perceptions of patients and nurses on the meaning of 'being positive'. AIM: To explore the meaning of 'being positive' for patients undergoing cancer treatment and for nurses who care for them. METHODS: A qualitative, descriptive approach within the paradigm of constructivist inquiry was used. Semi-structured interviews were conducted with a self-selected convenience sample of 11 patients and eight nurses. The interviews addressed the following key concepts: definitions of 'being positive' and being negative; how these attributes are manifest in cancer patients; and factors influencing patient attitudes. FINDINGS: Patients defined 'being positive' as maintaining some sort of normality without letting cancer have a detrimental effect on daily living. Nurses identified hope, acceptance, fighting spirit and looking on the bright side as definitions of 'being positive'. Nurses and patients identified environment and support of family, friends and health professionals as factors that influence patient attitudes. Patients also identified other peoples' attitudes as important. CONCLUSIONS: 'Being positive' must be acknowledged as central to being able to cope with cancer and its treatment. The ability of nurses to care for patients with cancer and help them to remain positive will be improved if they develop a better understanding of the meaning of 'being positive' for patients, and how other peoples' attitudes affect their state of mind.
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: The work of the 'Human Research Ethics Committee' (HREC) is expanding as the dimensions of ethical practice and research grow in the clinical arena. Over the past five years, the demands on practitioners and ethics committee members have expanded, as the general public demands accountability on the part of clinical and other researchers. This paper presents a case study of an ethics committee in an Area Health Service in Sydney. It represents the views of the members as to why they see their job as important, what aspects are difficult, how they delineate between ethical/legal and scientific issues, and what are the major stumbling blocks for them in enacting their membership of a HREC. The data for the case study was collected using interviews with nine out of eleven members. The audio taped interviews were transcribed, the text thematically analysed for commonalities and contrasts, and a description of the members' perspective on various issues written. Issues emerging include: amount of material members read prior to the committee meeting, the difficulty in educating practitioners (all researchers) to write information sheets that are simple and comprehensible to laypersons, the payment of subjects for their time, the appropriate amount of monitoring to be applied on each project, the difficulty in letting researchers know that the ethics committee is committed to encouraging research and that its questions are intended to ensure the best possible project answering the researchers' questions/aims is conducted, and the slow or no response by researchers to ethics committee questions. The findings imply that reviewing research proposals for their ethical value is individual and members of human research ethics committees need to synthesise these in a committee context to make informed decisions.
Abstract: Quality support is crucial to the care of women diagnosed with breast cancer. Little qualitative research has been conducted in this area. Semi-structured interviews were conducted with six women in New South Wales, Australia, to explore their experiences of breast cancer. Specifically the study focused on the support the women felt they needed at different times during their illness experience, how this was given and by whom. The qualitative data from the interviews supported previous research in that the diagnosis of breast cancer was devastating. Their primary source of support was family and friends with their surgeon and general practitioner providing some support. Overall the women felt they received physical support. However, emotional support was lacking, especially from nurses.
Abstract: It is vital for nurses to publish in order to provide evidence of their practice and to increase the knowledge base of their discipline. This paper is one of two that reports on an investigation of the nursing research published by Australian authors from 1995-2000 in 11 nursing journals based in Australia, the UK and the USA. The focus of this article is on the researchers drawn from a total of 509 articles that were content analysed and categorised according to topics of research, paradigm, methods used and funding acknowledgment. The researchers were analysed on the basis of gender, discipline, employment base and location. Publications had from one to 10 authors, averaging two, with 26 authors claiming 23.6% of research articles. The most common discipline area was nursing and universities were the leading area of employment. Authorship was not limited to capital cities reflecting the spread of university campuses in rural areas. Research papers made up 12.5% of possible articles, supporting the notion that few nurses publish research papers in the refereed general nursing journals we focused on.
Abstract: AIMS: To analyse the research published in refereed nursing journals by Australian authors from 1995 to 2000. BACKGROUND: Analysis of the research topics and types of methodologies used by Australian nurse researchers has not been recently undertaken. The study was similar to an analysis of United Kingdom (UK) nursing research between 1988 and 1995 to allow comparison between the two countries. DESIGN: A quantitative approach analysed the research abstracts for the topic researched, source of data, location of data collection, paradigm and methodology used and funding source. RESULTS: A total of 509 articles from 11 generalist Australian and UK nursing journals were analysed. The highest numbers of articles were published in Australian Journal of Advanced Nursing and Journal of Advanced Nursing. The most popular topics were education of nurses (18.7%, n=95) and practice issues relating to patient care (15.3%, n=78). However, scant attention was paid to major Australian health issues. Most research was undertaken in the hospital setting (55.8%, n=247). Data were most often drawn from nurses themselves (40.7%, n=206), followed by patients (25.5%, n=129). Both quantitative (41%, n=203) and qualitative approaches (47%, n=230) were employed. A minority of studies acknowledged any funding (14.9%, n=76). CONCLUSIONS: Research findings need to be applied in practice to improve patient care. Nurse researchers need to publish their findings and align their research interests to meet national health priorities. They need to be involved in setting these health priorities to ensure that nursing has a place in health research.
Abstract: This paper reports on the findings from the first part of a three-phase project that aimed to identify nursing strategies used in the management of malignant wounds. The difficulties relating to the management of these wounds and the significant physical and psychological impact on patients are described. A quantitative postal survey aiming to identify the types of dressing used in the care of malignant wounds was sent to specialist nurses working in oncology and palliative care in New South Wales, Australia. Additional qualitative data showed that the major issues were coping with odour and meeting the financial costs of the dressing products. The long list of products compiled for this research demonstrates the complexities nurses face when selecting dressings for the management of malignant wounds. Furthermore, there are no clear recommendations to guide nursing practice. This study provides a framework for subsequent phases of the project and will hopefully lead to the development of guidelines for best practice in malignant wound management.
Abstract: Sixty articles in five Australian women's magazines were analyzed for journalistic qualities, metaphors, narrative features and accuracy of clinical facts related to risk, early detection and treatment of breast cancer. The stories were features, news features or soft news stories. The stories reflected the 'good news' editorial style of women's magazines. A dominant theme in the stories was that early detection of breast cancer is crucial and equals survival. While there were few inaccuracies in the stories, there was little detail of treatment modalities, an emphasis on lifestyle as a risk factor and a prevailing message that a genetic history of breast cancer means you will get it. A major implication of the findings is that nurses, who provide information to women, must be aware of the goals of journalists and the educational power of narrative logic of stories in women's magazines.
Abstract: Nurses often experience positive and negative dimensions of caring for dying clients and their families. This project aimed to compare stress experienced by urban and rural community nurses working with palliative-care clients in the home. Participants included five nurses working in rural Australia and seven nurses working in an urban area. Transcribed data from unstructured audio-taped interviews were coded for common and contrasting themes, and a comparison was made of the stress experienced by the two groups of nurses. The major themes were role conflict and definition, family dynamics, time and workload. For both groups of nurses, the impact of family relationships and role conflict within the community impacted significantly to the stress they experienced. Debriefing opportunities for nurses to discuss stress, including educational and support sessions, is an essential component of best practice. Rural nurses had the additional stress of trying to provide a 24 h service over vast distances with a lack of financial resources.
Abstract: A number of theoretical papers have highlighted the concept of the duality and dichotomy of roles when nurses are carrying out research in the clinical arena. The conflicts that can occur are between the roles of researcher and nurse and in the balance between research integrity and the welfare of the individual. There are various personal accounts in the literature of nurse researchers' experiences of unclear role expectations when doing research. There appears to be no consensus on how nurse researchers should handle these varying expectations. No comparative analysis of the reflections of a collective of nurse researchers on role expectations in different clinical contexts was found in an extensive literature search. This paper attempts to do this by analysing stories of a small group of nurse researchers in different clinical contexts. Data were analysed from written stories and audio-taped interviews with nurse researchers about moving from the researcher to the nurse role in doing clinical research. Thematic analysis indicated that the participants' reactions could be classified as either those of a nurse researcher, always the researcher, or as the nurse researcher, sometimes the nurse. There were no distinct differences in relation to research topic, methodology or context. The study highlights the fact that nurses need better research education, team and management support when conducting research and opportunities to debrief after encountering mixed role expectations in the field. Open debate amongst nurse researchers about role delineation is essential to both novices and experts for them to share their experiences and their solutions.
Abstract: Patients found support in the clinical friendship of nurses. The nurses instilled a sense of normality into their activities, creating a supportive atmosphere. Patients expressed a need for reciprocity in their relationship with the nurses. This relationship should be balanced and sustainable.
Abstract: Nursing research in palliative care is becoming more important as cost effectiveness and evidence-based practice are becoming mandatory. Fifty-nine published and unpublished projects relating to nursing research on palliative care in Australia between 1990 and 1996 were reviewed. Findings indicated that nurses working in palliative care in Australia are interested in researching a range of topics using varied methods. The nurses' primary interests appear to be their own professional issues and management of the patient's pain. Little research on families/carers of palliative care patients was evident. There is a need for future research to focus on projects that justify the nurse's role in the palliative care team, show that nursing interventions for symptom control affect patient outcomes and prove nurses are integral to the psychosocial and spiritual wellbeing of the patient and family during the palliative care journey.
Abstract: A research project examining the support needs of families caring for a relative in palliative care was conducted in New South Wales in 1997. Data were collected from 19 families and 10 specialist palliative care nurses from eight centres throughout New South Wales using audio-taped interviews. The findings show that information was one of the most important support needs for families to enable them to effectively care for their sick relative. The information provided needed to meet the individual and varying needs of families at different stages of their palliative care journey. Often the families described not knowing what their information needs were until a crisis occurred. Lack of information on a range of areas, from practical resources to providing physical care and managing medications, was problematic. Health professionals need to take responsibility in determining if families are aware of the information available, identify the most appropriate medium for this material and provide it at the pace and time wanted by the individual family.
Abstract: Can or should metropolitan residents research their rural counterparts and if they do are there inherent pitfalls or benefits? Throughout the history of social and anthropological research there has been debate on the insider-outsider/native-stranger controversy as to who should carry out the field work. This discourse will explore the author's personal experiences in the context of planning a rural health project, entering the field, accessing the informants, interviewing the informants and leaving the field.
Abstract: BACKGROUND: We reviewed the process of using concept mapping as a methodology to teach science to RNs in a bachelor degree of nursing program in Australia. METHOD: The technique was used for two classes of students in the science unit during 1995 with work packages and independent student learning being the focus of the unit. RESULTS: Both instructors and students found the experience mainly positive. It helped the students become more independent learners, have a greater confidence in their knowledge of science, and allowed their understanding of science in their practice to become more meaningful and personalized. For the instructors it allowed them to concentrate on students with learning difficulties because they had less face-to-face teaching hours. Major issues arising from the process related to how to balance science content and the techniques of concept mapping and how to more effectively assess the learning outcomes of the students. CONCLUSION: Concept mapping is a useful technique to link science and nursing practice. Not only can it be used in academic programs to teach the science underlying practice, it can be used in the clinical area to teach patients. As a technique it works well in staff development and continuing education where the focus is on elucidating the rationale for inuring practice and providing evidence for the value of this practice.
Abstract: The role of the specialist breast care nurse has not previously been described in the Australian context. A study was undertaken, utilising the Delphi technique and focus group interviews to determine the key elements of the role and to describe how these role elements are enacted by the nurses incumbent in these positions in six Australian states. Three rounds of questionnaires to 16 expert nurses established a consensus view as to the essential elements of the specialist breast care nurse's role. The 11 role elements that became significant during analysis of these data were: specialist nurse, supporter, educator, counsellor, adviser, team member, resource person, caregiver, public advocate, manager and researcher. Focus groups were held with nurses from each state and the findings allowed enhancement of the data from the questionnaires. Analysis of the interview data allowed a fuller description of how the nurses actualised their role. This data showed that the specialist breast care nurse co-ordinated the care of the woman and her family during the breast cancer journey. Integral to the role was the support for the woman and her family. It is concluded that in order to perform successfully in the role nurses require specialist education in supportive care, counselling, pathology and treatment of breast cancer, a broad knowledge of oncology nursing, management, research and teaching techniques.
Abstract: A research project was undertaken to describe how the support needs of women who have had treatment for breast cancer were being met in New South Wales, Australia. Data were collected from both the women and the nurses who cared for them. The findings from the first part of the study examined the nurses' perceptions of the women's needs and how they as health professionals, fulfilled these needs. Analysis was both qualitative and quantitative. Seventy-eight nurses responded to a questionnaire and 15 were interviewed. The findings indicated that the nurses perceived information on disease process and physical aspects of the disease as essential to supporting the women with breast cancer. While they saw providing emotional support to the women as important the nurses themselves often lacked the time and skills to provide it.
Abstract: When science educators teach nurses, their primary aim should be to help them to develop understanding of their world of nursing. From a study of registered nurses' conceptions of the physical science underlying their clinical practice, we assert that nurses' understanding of the physical sciences is inadequate in terms of the competencies required of them as nurses. Rather than respond to this contention by altering the content of physical science units in nursing courses, we propose that those who teach nurse students should look more carefully at factors that influence nurses' learning: these factors are images of nursing, shared experience and shared language. We maintain that these factors should not be ignored but can be used to advantage in teaching science to nurses.
Abstract: Research into caring from the perspective of nursing students is poorly documented. This paper presents a study which described the construct of caring as experienced by students in pre-registration programmes at two universities in New South Wales, Australia. Qualitative data were collected using a questionnaire and semi-structured interviews. From the analysis of the data a model of professional nurse caring from the student's perspective was created. In this model, compassion, as the core of caring is actualized in the students' nursing of patients by communicating, providing comfort, being competent, being committed, having conscience, being confident and being courageous. Communication is not only an actualization of this caring but constitutes an important medium for the expression of caring actions.
Abstract: The nursing management of pressure ulcers has not been extensively reported in the Hong Kong context. This article reports the results of a survey of 34 Hong Kong registered nurses to determine their knowledge and practices in preventing and treating pressure ulcers in the elderly. The findings indicate that, overall, the nurses had a sound knowledge of the prevention and treatment of pressure ulcers, but that there were inconsistencies in their practices. This situation could be improved if standardized systems for assessing patients at risk of developing pressure ulcers and for grading (staging) these pressure ulcers were used.
Abstract: This paper reports on a study which investigated whether nurses from Eastern and Western cultures hold differing definitions of euthanasia and different perspectives of the effect of their attitudes to euthanasia on professional relationships with patients and colleagues. The focus of the study was the lived experience of Chinese and Australian nurses working in palliative care. The results indicate that there were differences between these two groups in their definitions of euthanasia. Lived experience obtained from both groups revealed conflict with patients and colleagues, and a lack of opportunity to discuss the ethical issue of euthanasia in the workplace.
