Professor Philip Darbyshire is internationally recognized as a leader in nursing and health care research and practice development. Philip is the ‘go-to’ person for hospitals and health care organizations who want research and evidence-based practice demystified and moved out of the ‘too-hard basket’ and into the hearts and minds of clinicians who will use it make a real difference. He enables the best in staff potential to solve problems, think creatively and 'raise the bar', to improve the condition of organisations. For 13 years he led one of Australia’s most successful practice-based research departments, described by ACHS as being an “example of excellence in research leadership”. His programme of research explored children and adolescents’ experiences of a wide range of health and social issues. He is an Adjunct Professor at University of Western Sydney, an Honorary Visiting Professor at the University of Swansea and a Visiting Professor at Bournemouth University.
Abstract: Background
The Vivian Bullwinkel Oration honours the life and work of an extraordinary nurse. Given her story and that of her World War II colleagues, the topic of nursing heroism in the 21st century could not be more germane.
Discussion
Is heroism a legitimate part of nursing, or are nurses simply 'just doing their job' even when facing extreme personal danger? In this paper I explore the place and relevance of heroism in contemporary nursing. I propose that nursing heroism deserves a broader appreciation and that within the term lie many hidden, 'unsung' or 'unrecorded' heroisms. I also challenge the critiques of heroism that would condemn it as part of a 'militarisation' of nursing. Finally, I argue that nursing needs to be more open in celebrating our heroes and the transformative power of nursing achievements.
Summary
The language of heroism may sound quaint by 21st Century standards but nursing heroism is alive and well in the best of our contemporary nursing ethos and practice.
Abstract: Despite the love that exists between children with disabilities and their parents and the positive contribution that children with a disability make to families and communities, caring for a child with a disability can be difficult and demanding for parents, carers and the family. Their interaction with the many and varied health professionals they encounter can serve to either ameliorate or exacerbate these difficulties. In this paper we report on a qualitative needs analysis undertaken as part of a project to develop disability awareness resources for generic health professionals (GHP). Data were collected through focus groups (n = 5) and individual interviews (n = 7) with 34 parents â carers and was analysed using a process of thematic analysis. âPartnershipâ was identified as the overarching theme that answers the question âWhat do parentsâcarers want from a GHP?â Three further themes were identified that together tell the partnership âstoryâ. These are: âThe GHPâparent partnershipâ, âQualities of a GHPâ, and âThe role of advocacy in the GHP-parent partnershipâ. Implications are presented that highlight the importance of advocacy in GHPâparent partnerships and suggest improvements in GHP education and preparation.
Abstract: BACKGROUND: This paper reports the findings of a South Australian qualitative, exploratory study of children and young people living with a chronic disease, and their perceptions and experiences of physical activity. The perceptions and experiences of their parents were also explored. The chronic diseases were type 1 diabetes, asthma and cystic fibrosis. METHODS: Multiple qualitative data collection techniques were used to elicit the children and young people's perspectives and experiences of physical activity, including focus groups, maps, photos and 'traffic light posters'. The children's parents were interviewed separately to ascertain their views of their child's participation in physical activities. RESULTS: Children and young people described their active participation in a wide variety of physical activities including organised sports and play, but made very little mention of any negative influence or impact due to their disease. Their parents' stories described the diligent background planning and management undertaken to enable their child to participate in a wide range of physical activities. CONCLUSION: The results of this study suggest that for these children and young people, having a chronic disease was not perceived as a barrier to participation in organised sport and recreational activities. They were physically active and perceived themselves to be no different from their peers. Their positive beliefs were shared by their parents and the level of participation described was enabled by the high level of parental support and background planning involved in managing their child's health care needs.
Abstract: Empathy is an essential component of professional nursing practice. In order to empathise appropriately with patients, it is crucial that nurses appreciate, understand and respond to their patientsâ experience of illness. This study sought to explore the experiences of 16 people with end stage renal disease on haemodialysis therapy in Ireland. A hermeneutical phenomenological methodology was employed incorporating qualitative interviews. The data were analysed using qualitative interpretive analysis. The experience of waiting was significant for the participants in the study. The experience of waiting was constituted by two themes labelled and . It is suggested that the participantsâ experience of waiting is reminiscent of HeideggerâÂÂs existential account of boredom. Moreover, the existential perspective of boredom contained within the participantsâ accounts is also depicted by Beckett in his play . Consequently, the literature of both existential writers is incorporated to provide a more in-depth description of the participantsâ experience of waiting. It is hoped that the insights provided in this paper will enable practitioners to gain a new awareness and understanding of patientsâ experiences of end stage renal disease and haemodialysis therapy. This would subsequently enable these professionals to empathise more effectively with their patientsâ situation and respond more appropriately to their care needs.
Abstract: This study took place in an inner metropolitan Adelaide school and a rural school on Kangaroo Island off the South Australian coast. We compare 33 eight- to 10-year-old childrenâÂÂs accounts of what the area is like for them. What are the rules and boundaries and who sets them? Metropolitan children were found to have tighter boundaries and required adult supervision to use facilities that rural children could use unsupervised. Rural children negotiated freedom of movement by considering broad principles about safety. Findings increase our understanding of how children perceive movement within their communities, and suggest policies and environmental changes to increase freedom of movement. Study findings raise concerns about the way the environment is designed for social planning, and the importance of childrenâÂÂs engagement and interaction with the natural environment.
Abstract: OBJECTIVE: to explore fathers' experiences of the breast feeding of their very-low-birthweight preterm babies from birth to 12 months of age. DESIGN: a qualitative study using interpretive phenomenology. Data were collected via longitudinal in-depth individual interviews. SETTING: publicly funded tertiary level hospital, Australia. PARTICIPANTS: a purposive sample of 17 Australian parents took part in the broader study. This paper reports on data from the seven participant fathers. FINDINGS: this paper explores the discursive changes in fathers' accounts of their perspectives on and support of the breast feeding of their preterm baby. The fathers' accounts highlight their marked influence on breast feeding, their ambivalent experiences related to breast feeding and their struggle in negotiating a parenting role related to baby feeding. KEY CONCLUSIONS: this study highlights the role and influence that fathers of preterm babies have on breast feeding, and explores the tensions and paradoxes inherent in promoting the ideology of breast feeding while valuing the practice of bottle feeding. IMPLICATIONS FOR PRACTICE: this study highlights the need to encourage and involve fathers in breast-feeding education including the impact of bottle feeding on breast-feeding outcomes. The active and positive contribution that fathers make towards preterm breast feeding should be acknowledged and encouraged.
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: Nurses were found to concentrate on technical aspects of care which prevented the development of the supportive relationship that patients on dialysis wanted.
Abstract: Aims and objectives. The Family Support Program was created to support children and parenting when one of the parents has incurable cancer. We chose a family-based approach to support parent's coping and to help families pull together, identify strengths in the family and learn how to seek help. Background. Cancer is usually a new experience for young families. In most cases, parents do not have the necessary knowledge about their children's need for information and support about their parent's serious illness and impending death. Design. A qualitative evaluation study based on data collected through in-depth interviews focusing on parent's experiences with the Family Support Program. Methods. Participants were patients with incurable cancer and their partners and ex-partners with children aged between 5-18 years. Thirteen parents were in-depth interviewed. Results. Parents described how the Family Support Program helped them gain greater insight into their children's thoughts and reactions and into how the situation affected their daily living. Parents reported that conflicts were reduced, they could talk more openly about the situation in the family and that they were shown how to support their children's coping. Conclusion. The Family Support Program met the parents in the study's needs for more information and support about how to cope with their children during the patient's terminal illness. Relevance to clinical practice. The Family Support Program is described in detail in a manual that makes it easy for other health workers to use the same programme. The Family Support program was in use in outpatient clinics, oncology wards and palliative care units and was provided both from nurses and social workers trained in cancer care. Parent's in the study would like the Family Support Program to be available to all patients who receive the poor prognosis that their cancer cannot be cured.
Abstract: AIMS OF THE PAPER: In this paper I hope to, at least partially, succeed in demystifying the research process, especially as it may be perceived by clinicians, encourage their involvement and participation in clinical research and propose practical and rewarding strategies that all children's nurses can adopt to begin to create a vibrant research culture in any clinical area. BACKGROUND: The professional and organisational expectation that all nurses will, in some way, be involved in research is growing and will not go away. Despite the historic, toxic dualism that has seen research as essentially the prerogative of 'The Academy', clinicians are beginning to take more of an interest and role in research, despite the many obstacles that they face. In today's health care system, children's nurses cannot afford to abdicate responsibility for research or to postpone their involvement until the ideal conditions for their engagement come along. This paper suggests approaches and strategies that clinicians, educators, managers and researchers can use as a basis for productive and mutually beneficial collaborative research initiatives. DESIGN: Position paper. CONCLUSIONS: Developing clinical-focused, collaborative, interdisciplinary research is now a worldwide policy and practice imperative. There is no reason why children's nurses cannot take a leading role in this movement. Previous models of research where research has been undertaken by academics and then 'disseminated' to clinicians who are expected to 'implement' it (and who are then subsequently blamed for failure) has been less than successful and small wonder. RELEVANCE TO CLINICAL PRACTICE: Where clinicians are directly involved as genuine research partners in both the research process and the project from day 1, there is a real prospect that both the benefits of the inquiry process and any research findings will be more readily adopted by the clinical areas concerned.
Abstract: For a child, facing the imminent death of a parent is a highly stressful situation. This study assessed a preventive support program for children aged between 5 and 18 years and their families when a mother or father has an incurable form of cancer. We chose a family-based approach to reduce risk factors and enhance protective factors by increasing positive interactions between parents and children and by increasing their mutual understanding of the illness and its family impact. In this article, we focus especially on the children's experiences of how the Family Support Program met their needs and supported their coping. The qualitative study involved collecting descriptive data via in-depth interviews with children of cancer patients in palliative care after participation in the Family Support Program. The program helped the children to feel more secure; increased their knowledge and understanding; helped them become aware of their own role, their family's strengths, and whom they could approach for help; and helped them realize that it was good and helpful to talk about the illness situation. They needed to talk in private without having to think about other family members' reactions, but they also needed to be in dialogue with other family members.
Abstract: The worlds of health care and education have been colonised by 'The Audit Society' and managerialism. Under the benign guise of 'improving quality' and 'ensuring value for money' a darker, more Orwellian purpose operates. Academics had to be transformed into a workforce of 'docile bodies', willing to scrutinise and survey themselves and their 'performance' as outcome deliverers and disciples of the new 'Qualispeak'. This paper critiques the current obsession with audit and performativity, the constant and often pointless 'change' is that held to be so self-evidently 'a good thing' and the linguistic wasteland that so often passes for discussion or policy in the Brave New Worlds of health and education.
Abstract: What is happening to our children's childhoods? Is childhood itself disappearing as children become increasingly 'adultified' and commodified and as the lives and worlds of children's experiences seem to shrink in the name of protection and safety? Are contemporary concerns justified about children becoming less active and more comfortable playing Gameboys rather than games and exploring 'Sim City' rather than their own real one? Or, are these simply adult 'moral panics' about childhood based on little more than nostalgia for a mythical childhood suffused with innocence and happiness? This article explores some of the current concerns regarding the changing state of childhood and links these to some of our current child health and well-being concerns. It concludes by suggesting some small-scale 'local' initiatives that parents and adults could support relatively easily, which would help to enrich childhood.
Abstract: PASSIVE RESISTANCE: Early experiences of midwifery students/graduates and the Baby Friendly Health Initiative (BFHI) 10 steps to successful breastfeeding. RESEARCH QUESTION: What factors, in relation to the BFHI 10 steps to successful breastfeeding, influence the development of breastfeeding support practice for beginning practitioner midwives? PROCEDURES: Newly graduated midwives about to commence a Graduate Midwifery Program (GMP) were recruited from two South Australian universities and one Western Australian hospital to participate in the study. METHODS: This qualitative longitudinal study used critical incident technique for a series of three semi-structured interviews with each participant. The theoretical framework of the project was Bandura's Social Learning Theory with Boyatzis' Data driven approach used to thematically analyze the data. FINDINGS: Participants highlighted experiences such as time pressure and the established clinical practices of experienced midwives that undermined their commitment to the BFHI 10 steps. Outdated practices by senior midwives and passive resistance to the BFHI 10 steps were commonplace even in participating hospitals which are BFHI accredited. CONCLUSIONS: The clinical working environment has a major impact on the way newly graduated midwives integrate the BFHI 10 steps into their breastfeeding support practice. Commitment to the BFHI 10 steps should not be taken for granted just because a hospital achieves BFHI accreditation. Many experienced midwives are continuing with outdated practices that confuse breastfeeding mothers and newly graduated midwives alike.
Abstract: This paper describes the critical elements that characterise current public policy on child and family care in Brazil and discusses the implications of these changes for the practice and teaching of child and family health nursing in Brazil.
Abstract: AIM: The aims of this paper were to review and critique existing research literature on children's and young people's experiences of chronic renal disease and to propose alternative approaches that may be more fruitful in addressing existing research shortcomings. BACKGROUND: Chronic renal disease, which results in approximately 1.6-4 new cases per year per million population in the 0-15 years age group, is a serious illness that causes severe and irreversible reduction in kidney function. Despite modern medical advances, its significance and implications for the lives of the children and young people concerned are profound. METHOD: Salient literature for this review was obtained using the major health and social science electronic databases such as Medline, CINAHL, Psyclit and Sociofile. Manual searching of relevant books, journals and 'grey literature', combined with the genealogy approach, extended and strengthened the search. CONCLUSIONS: Research in this area focuses mainly on two areas, namely psychological adjustment and adaptation to end-stage renal disease. This research is grounded within a framework of empirical psychology that values objectivity, measurement and quantification. This predominantly psychometric approach is critiqued for simplifying the complex experience of end-stage renal disease and for pathologizing children and young people with this disease. We identify a significant gap in the research literature, namely the lack of research that takes into account these children's and young peoples'own perspectives of their experiences. RELEVANCE TO CLINICAL PRACTICE: Chronic renal disease has a significant impact on children's and young people's lives. Understanding the experiences of these children is important for the provision of effective healthcare. Conducting child-centred qualitative research in this area would allow us to explore vital questions of meaning, perception and understanding. If health and social care organizations claim to provide 'consumer-focused' services, it behoves us to develop first a clearer understanding of the lives and experiences of children and families who seek our help and to use this knowledge and understanding to plan and provide more grounded and responsive services.
Abstract: Youth homelessness is a growing Australian and international concern associated with considerable health disadvantage, including serious mental health problems. This paper reports findings of a qualitative study that explored young homeless people's experiences of mental health and well-being through in-depth interviews. Thematic analysis identified medication use and management as a central issue for the young people. Reasons identified for medication non-adherence included unwanted side-effects, issues of access and storage, and lack of support from health and social agencies. These problems were compounded by everyday stresses of homelessness. Medication adherence was facilitated by social support, consistent contact with supportive health services, and regular medication supply, often resulting in improved mental health and well-being. For these young people, prioritizing management of medication helped stabilize one aspect of their lives. Health professionals can play an important role in helping them achieving this goal.
Abstract: The present qualitative study describes and discusses the perspectives and experiences of young homeless people with mental health problems in relation to their interactions with health and social care services. Working in partnership with Streetlink, a supported accommodation assistance programme in Adelaide, Australia, the authors interviewed 10 homeless young people, aged from 16 to 24 years of age, who had experienced mental health problems. In-depth interviews elicited accounts of the best and worst of the participants' experiences of health and social care services. Access to services was not identified as being a significant problem in comparison with the participants' concerns regarding the quality of the services encountered. The central findings stress the importance of a respectful and supportive climate in relation to the qualities of service provision that the young people identified as valuable for their continuing treatment or consultation.
Abstract: BACKGROUND: A range of strategies have been adopted to prevent early onset Group B Streptococcal (EOGBS) sepsis, as a consequence of Group B Streptococcal (GBS) vertically acquired infection. This study was designed to provide a scientific basis for optimum timing and method of GBS screening in an Australian setting, to determine whether screening for GBS infection at 35-37 weeks gestation has better predictive values for colonisation at birth than screening at 31-33 weeks, to examine the test characteristics of a risk factor strategy and to determine the test characteristics of low vaginal swabs alone compared with a combination of perianal plus low vaginal swabs per colonisation during labour. METHODS: Consented women received vaginal and perianal swabs at 31-33 weeks gestation, 35-38 weeks gestation and during labour. Swabs were cultured on layered horse blood agar and inoculated into selective broth prior to analysis. Test characteristics were calculated with exact confidence intervals for a high risk strategy and for antenatal screening at 31-33 and 35-37 weeks gestation for vaginal cultures alone, perianal cultures alone and combined low vaginal and perianal cultures. RESULTS: The high risk strategy was not informative in predicting GBS status during labour. There is an unequivocal benefit for the identification of women colonised with GBS during labour associated with delaying screening until 36 weeks however the results for method of screening were less definitive with no clear advantage in using a combined low vaginal and perianal swabbing regimen over the use of a low vaginal swab alone. CONCLUSION: This study can contribute to the development of prevention strategies in that it provides clear evidence for optimal timing of swabs. The addition of a perianal swab does not confer clear benefit. The quantification of advantages and disadvantages provided in this study will facilitate communication with clinicians and pregnant women alike.
Abstract: In this commentary, the authors encourage a renewed enthusiasm for attention to quality criteria in qualitative health research by poking fun at what they understand to be patterns and themes emerging from data collected in their respective extensive "fieldwork" experiences within the genre. Conceptualizing some of the particularly problematic interpretive turns as land mines in the field (or, alternatively, missteps in the dance, cracks in the pottery, wrong turns in the journey, weeds in the garden, or dropped stitches in the quilt), they challenge researchers' collective relationship to both factual and metaphoric empirical claims. With a warning to those unaccustomed to self-deprecating humor, the authors challenge all to pay serious heed to what does and does not constitute rigorous, high-quality, empirical science within the qualitative tradition.
Abstract: Cultural beliefs and values implicitly and explicitly shape every aspect of the way we parent our children and how we communicate about parenting. To appropriately support parents in this new and challenging role, child health services for parents in Australia need to do more than acknowledge a diverse range of cultural practices. While many health professionals believe they act in culturally sensitive ways, we need to closely examine this belief, question the cultural assumptions implicit in the information we give, and assess the extent to which our interactions are culturally appropriate. In this paper, we present a critical review of the literature on health care provision for migrant women and families. We then suggest a need to re-examine the values, beliefs and attitudes within cultural frameworks that inform how child health professionals communicate. Specifically, communication between child health professionals and migrant parents requires further analysis. We suggest that professionals need to reflect on the cultural self rather than solely on the culture of others.
Abstract: AIMS OF THE PAPER: The paper describes the creation of, the rationale behind and the external funding of a collaborative research-clinical practice development position. The paper also demonstrates the benefits of nursing's collaboration with external funding bodies and the value of moving from our traditional position of assuming that 'the hospital' will always provide. BACKGROUND: There is a constant refrain that nursing must become more 'research-based' and develop an active research culture. In harsh financial times however, funding for research development is scarce. Nurses can respond to this by bemoaning the lack of money or by taking an entrepreneurial approach, creating innovative project proposals that develop new partnerships and attract external funding. DISCUSSION: Institutional support for clinical research is often more verbal than financial as most health care systems are experiencing extreme financial stringencies. Nurses need to reconsider the notion that every initiative must automatically be funded by the institution. In this paper we show how in a busy major hospital, clinicians and researchers collaborated to create and fund the kind of innovative research and practice development position that may be impossible to fund through existing budgets. CONCLUSION: With creativity and determination, nurses can challenge the orthodoxy that they are solely dependent on institutional funding. If there is a clear project vision, a convincing rationale, a strongly argued 'business case' and a passionate and persistent team, then innovative new projects and positions can be realized. RELEVANCE TO CLINICAL PRACTICE: Developing clinical focused, practice based research is now a worldwide policy and practice imperative for nurses. Unfortunately, current levels of institutional funding are unlikely to support research promotion positions and initiatives. This paper outlines an approach to securing funding for research initiatives that can create exciting new positions and develop productive partnerships between researchers, clinicians and external agencies.
Abstract: BACKGROUND: Computerized Patient Information Systems (CPIS) are used increasingly in health care, yet few studies have asked clinicians to describe their experiences of using these systems and what they mean to their practice and patient care. AIMS AND OBJECTIVES: The aim of this study was to explore clinical nurses' and midwives' perceptions and understandings of computerized information systems in everyday practice. The objective was to provide a detailed and faithful account of clinicians' experiences of using such systems. DESIGN: A qualitative design was used, based upon interpretive phenomenology. METHODS: A total of 13 focus groups involving 53 practitioners was conducted in hospitals across five Australian states with nurses and midwives from a wide range of practice settings. The participants ranged from Level 1 RNs to Clinical Nurse Consultants and nurses with an IT project management role. RESULTS: This study focuses specifically on clinicians' experiences of using CPIS to manage clinical information. Clinicians' experiences were characterized by digital disappointment rather than electronic efficiencies. Clinicians reported generally that computerization had neither enhanced their clinical practice nor patient care, nor had it improved patient outcomes. CONCLUSIONS: Participants' experiences were predominantly negative and mostly critical of CPIS and their: perceived inability to capture 'real nursing', difficulty in use, incompatibilities, non-responsiveness and irrelevance to patient care and meaningful clinical outcomes. RELEVANCE TO CLINICAL PRACTICE: Technological 'solutions' to health care problems are endlessly seductive and easily entrance policy and decision makers. Computerization will continue to impact upon clinical practice and cannot be wished away. Today's computerized systems may have been developed with scant regard for clinician end-users. A crucial issue facing everyone in health informatics is how point-of-care systems can be developed in ways that involve clinicians meaningfully and which recognize and respond to the complexity and subtlety of the world of nursing and midwifery practice.
Abstract: Remedial surgery and other treatments are a common feature of disabled childhoods. These treatments are founded on notions of a normal:abnormal divide in which the task of health professionals is to bring such young people as close to societal concepts of normal as possible. Working with new paradigm disability and childhood research young people who are growing up with a disability have been able to contribute to our understanding from their perspectives. The young people identify the physical, social and emotional implications of remediation and identify a personal cost:benefit ratio. Questions of outcomes, definitions of success, and 'how much remediation is enough?' further complicate this. What may be perceived as a successful outcome by the health professional may not result in any functional gain for the young person. In discourses heavily influenced by health professional and parent perceptions the inclusion of the young people themselves contributes an additional dimension to our understanding.
Abstract: Hospitalisation can be a traumatic experience for any child and family but the experience can be significantly more so for Indigenous parents and children from remote areas of Australia. Despite the importance of this issue for child and family health and for Indigenous health, the hospitalisation experiences of Indigenous families and children have received almost no research attention. This paper describes selected findings from a recently completed Honours research study which used the participatory and collaborative Indigenous research approach of Dadirri to explore this question. Following a brief description of the methodology of Dadirri, the paper presents the participating families' depictions of their experiences of 'Coming Down' and 'Being in Hospital', where they revealed the extent and effects of marked culture shock. The significant cultural differences between staff and Indigenous families contributed to the parents' sense of fear, powerlessness and isolation from their child, home community and culture. For these families this isolation was not merely geographic but intricately linked to their health and wellbeing.
Abstract: Decreasing hospital stays, increasing day surgery and the assumption that parents will manage their child at home necessitate research into children's recovery. Given the scarcity of studies seeking parents' perspectives, this exploratory and interpretive study is timely, presenting a detailed account of mothers' experiences of managing their child's recovery in hospital and at home. The study supports the view that recovery begins not with discharge, but with admission and before, as hospital experiences directly shape the recovery process. Mothers' experiences of hospital's recovery enablers and inhibitors suggest that good recovery practices and policies remain erratic. Following discharge, parents help the child 'back to normal' by 'reading the recovering child' and balancing the child's desire for activity with the need for caution and safety. Developing a deeper understanding of parents' recovery experiences and perceptions would help nurses to form an empathic 'grounding' upon which to base improvements in children's recovery care.
Abstract: BACKGROUND: Early-onset group B streptococcal disease is a serious cause of neonatal morbidity and mortality. Although screening protocols for group B streptococcus are common, little is known of women's perceptions of this screening and the disease itself. The purpose of this study was to gain an understanding of women's experiences, knowledge, and perceptions about this bacteria and its screening. METHODS: Nine focus group interviews with 35 women explored their experiences and understanding of group B streptococcus screening. Transcribed interview data were interpreted to identify and articulate the women's experiences. RESULTS: Most women had little knowledge or understanding of group B streptococcus, obtaining their information largely from the stories or experiences of friends or family. Women struggled to understand the meaning and implications, both physical and "moral," of the disease for their baby and for themselves, clearly indicating both the subjective and statistical importance of the concept of risk for pregnant women. CONCLUSIONS: Group B streptococcus continues to be poorly understood by pregnant women who try to understand and weigh up its risks and implications so as to make the best decisions about screening. The women participated in screening ultimately, however, since it was seen to be patently "best for baby," relatively easy for them to undergo, and part of routine antenatal care.
Abstract: Gambling research has contributed much to our understanding of the effects of gambling on families, yet we have only the most cursory understanding of the child's perspective on what it is like to grow up in such a family. The aim of this qualitative study was to gain a deeper understanding of the experiences of Australian children who live in families where a parent or caregiver has a serious gambling problem by exploring the perspectives and understandings of the children and young people themselves. This paper reports a central finding, the experience of 'Pervasive Loss,' from our interviews with 15 young people, 11 males and 4 females, aged between 7 and 18 years. Their sense of loss encompassed both physical and existential aspects of the child's life, including their parent(s), relationships, trust, security, sense of home, and material goods. The dimensions of this experience of pervasive loss are explored from the child's perspective. Children living in families where gambling is a problem experience threats to their overall well-being to the extent that parental problem gambling must now considered to be a significant child health as well as social problem.
Abstract: This paper reports an investigation about 'quality' in qualitative research. For educatorsand students of nursing and midwifery, it serves as an exemplar for tackling vexing research questions, and as a model for creative research reporting. Practising qualitative researchers (post-doctoral nurses and midwives) from different countries were asked to identify the characteristics of what they considered to be a high quality published report of qualitative research. They then commented upon one another's characteristics with a view to comparing and compiling ideas. Four themes were identified from the data, relatingto process, writing, outcome and excellence. The study highlights shifts in thinking about determinants of quality in qualitative research over time, and current challenges for researchers, consumers and others in the face of declining interest in quality criteria.A spider's web is used as a met aphor for the study to illustrate the enmeshment and intrigue that the research and its findings generated for the researchers, participantsand onlookers.
Abstract: Problem gambling is becoming an increasingly widespread and damaging social and health problem. As opportunities for gambling become more accessible, especially through lotteries and electronic gaming machines, it is likely that more people will develop serious gambling problems. Given the worldwide increasing spending on gambling activities and the increasing number of problem gamblers, it is unfortunate but likely that the children who grow up in problem gambling families will become an important area of concern for child health and social workers. Considerable research has been undertaken into problem gambling and the adult problem gambler, but within the gambling and child health literature there is almost no recognition of the experiences of children who live in problem-gambling families. Drawing on the findings of the landmark Productivity Commission Report, this review explores the marked increase in gambling and its social effects, especially from the Australian perspective. The damaging social effects of problem gambling on families and children are reviewed and the comparative invisibility of children and young people in such research is discussed. The pervasive influence of developmentalism is critiqued and highlighted in relation to the exclusion of children's perspectives from our research understandings. The review concludes by proposing that adoption of some of the emerging 'new paradigm' approaches to childhood and children's experiences could markedly enhance our understandings of the lives and experiences of this significant group of children and young people.
Abstract: Despite the plethora of research on nurses and the use of computers and information systems, there have been few attempts to examine the everyday experiences of nurses who use such systems in practice. This qualitative study builds on our limited understanding of practitioners' experiences regarding use of Computerized Patient Information Systems (CPIS). Focus group interviews wer held across Australia with practitioners from a wide range of clinical settings and specialties. The study findings suggest that participants were predominantly critical of systems in almost every area related to "user-friendliness." The perspectives and views of practitioners are important to understand if future generations of CPIS hardware and software are to be developed with a greater appreciation of the needs of the system's front-line users.
Abstract: In a recent paper in Nursing Inquiry and in his other work, Michael Crotty was severely critical of much interpretive nursing scholarship and especially of some nurse scholars' interpretations of the work of Martin Heidegger. In this paper we respond to Crotty's attempt to set out what Heidegger 'actually says' [sic] in relation to tradition, culture, destruction, das Man and everydayness. We suggest that Crotty took a narrow, existentialist view of Heidegger's work and that this view was often misguided and poorly informed. We show not only that an alternative understanding of Heidegger's work in these important areas is possible, but that this interpretation is strongly supported by a deeper and wider reading of Heidegger's own work and of the secondary literature of Heideggerian scholarship.
Abstract: There can be little doubt that nursing, like other arts and sciences, is experiencing an "interpretive turn" (Hiley, Bohman, & Shusterman, 1991). As part of this more global "turn," the curriculum revolution has spurred nurse educators to critically examine their schools, curricula, and everyday practices as teachers and propose alternative pedagogies where appropriate. I argue that what is now being developed as nursing humanities is a valuable approach to interpretive pedagogy which challenges, stimulates, integrates, and develops students' thinking and understanding of the lived experience of patients/clients in ways that more traditional scientific and behaviorist approaches to nursing education are unable to do. In creating courses or learning experiences using nursing humanities, it is essential to attend to both content and pedagogical approach as being inseparable. Ignoring the former will produce no more than a pleasant chat, while ignoring the latter will result in mere "metaphor counting" or rote learning of "what the book, story, or poem means." Nurse educators have used literature to help illuminate health and illness issues in the past, but unfortunately, this has been viewed as an essentially marginal approach. While novels, stories, poems, and other literature can certainly be used in almost any nursing class, I believe that nursing humanities is such a rich seam of pedagogical and critical possibility that it merits development of specific courses and options within all of our nursing courses and programs.
Abstract: Partnership and empowerment are very much in vogue. In this paper the authors question whether the rhetoric of partnership matches the reality as experienced by families of children with special needs. Research in this area is reviewed and models of good practice are examined.
Abstract: Nurse Ratched or 'Big Nurse' in Ken Kesey's counter-culture novel One Flew Over the Cuckoo's Nest is one of popular culture's most arresting and memorable images of the nurse. She is, however, deemed to be remarkable primarily for her malice and authoritarianism. This paper argues that such a purely realist reading fails to fully appreciate the significance of the character of Nurse Ratched. A feminist critique of the novel contends that the importance of 'Big Nurse' is less related to how realistic/unrealistic or good/bad she is as a nurse. Nurse Ratched is important because she exemplifies all that traditional masculinity abhors in women, and particularly in strong women in positions of power and influence. This paper explores the stereotype of 'Big Nurse' and argues that Kesey's vision of her ultimate 'conquest' is not a progressive allegory of 'individual freedom', but a reactionary misogyny which would deny women any function other than that of sexual trophy.
Abstract: In a recent critique of the work of Patricia Benner in relation to expertise, skilled intuitive grasp and the Dreyfus model of skill acquisition, English (Journal of Advanced Nursing 1993, vol. 18, pp. 387-393) uses the tenets of positivism and cognitive psychology to criticize Benner's work for lacking objectivity, validity, generalizability and predictive power. In this response to English's critique I show how he has misread, failed to read, and consequently misunderstood her work, and, equally importantly, its philosophical basis. Benner's work is developed from a philosophical foundation grounded in interpretive and Heideggerian phenomenology. This wholly different 'take' on the world and on human behaviour embodies a strong critique of those very same traditional-science worldviews which English uses to damn her work. English's critique is valuable in highlighting the ways in which Benner's work can be misrepresented and this response tries to remedy this misunderstanding by attempting to clarify the fundamental differences between phenomenological and cognitive understandings. These differences are crucial to understanding Dreyfus's and Benner's work. Here, I also attempt to correct some of English's wilder assertions regarding Benner's work. Finally, I try to show how Benner's work has empowered, enthused and challenged, rather than being 'denigrating to the majority of nurses'.
Abstract: It is often claimed that nursing is both an art and a science, yet nursing education has been reluctant to accord arts and literature a prominent place within nursing curricula. While the discipline of medical humanities has been developing for around two decades, there has been no comparable movement within nursing. This paper describes the development, implementation and initial hermeneutic evaluation of a new course, 'Understanding Caring Through Arts and Humanities' which we believe to be unique in being a fully accredited unit which is offered within a BA (Honours) Health Studies Degree for nurses and other health care professionals.
Abstract: Malcolm Knowles' theory of andragogy has gained increasing acceptance among nurse educators. Andragogy is espoused as a progressive educational theory, adopted as a theoretical underpinning for curricula and is even considered to be synonymous with a variety of teaching techniques and strategies such as 'problem-based' and 'self-directed' learning. This paper offers a critique of the notion of andragogy which maintains that the distinction created between andragogy and pedagogy is spurious and based upon assumptions which are untenable. It is argued that andragogy has been uncritically accepted within nursing education in much the same way that the nursing process and models of nursing were in their day. Finally, it is claimed that true pedagogy has far more radical, powerful and transformative possibilities for nursing education.
Abstract: The desirability of encouraging parents to live-in with their hospitalized child is widely accepted (Department of Health 1991). This review traces the historical development of parental involvement in paediatrics. The literature reviewed shows that parental participation and living-in has been viewed largely as philosophically and professionally unproblematic. These 'cardinal principles' of paediatric nursing have been advocated and operationalized with little or no attempt made to understand what living-in is like for either parents or for the nurses who work with them. It is proposed that research approaches in this area are required which are more hermeneutic and dialogic.
