"This is how it's got to happen"
- Authors: Northam, Holly , Cruickshank, Mary , Hercelinskyj, Gylo
- Date: 2014
- Type: Text , Journal article
- Relation: Transplant Journal of Australasia Vol. 23, no. 1 (2014), p. 9-13
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- Description: Organ transplantation is the most effective treatment for end-stage organ failure and is a much sought-after therapy. Efforts are under way to maximise the number of families who agree to organ donation on behalf of a newly deceased relative in Australia, with the hope of easing the burden for dying and incapacitated patients and to reduce health care costs. Objective: To present initial findings from a study which asked families who had been required to make a deceased organ donation decision about their experience, and the factors that contributed to their decision to either agree to or decline organ donation. Methods: Following ethics approval, an exploratory multiple case study was conducted. Twenty-two family members from nine families who had experienced the death of a relative within the previous three years from five of Australia's state and territories contributed to the study in 17 recorded, transcribed and analysed interviews. Findings: Broad themes emerged that included the importance of time and location, perceptions of suffering, information and help for the families, and the need for families to assure themselves that the deceased's needs were addressed before and after death. Conclusion: The findings suggest families require trust that their family member was not suffering before and after death. The affirmation of this trust was helped by prior information about the organ donation process and sensory affirmation that their loved one was at peace. Family decisions about organ donation, hopes and 'deep hopes' were dependent on this trust.
A model of home-based care for people with disabilities : Better practice in rural Thailand
- Authors: Wanaratwichit, Civilaiz , Hills, Danny , Cruickshank, Mary , Newman, Barbara
- Date: 2015
- Type: Text , Journal article
- Relation: Asia Pacific Journal of Health Management Vol. 10, no. 2 (2015), p. 44-51
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Background and objective: People with disabilities living in rural areas often require considerable support to meet their complex needs. This study investigated a best practice model in home-based care for people with disabilities in rural Thailand.
Design and Setting: A case study method was adopted to investigate a best practice model of home-based care for people with disabilities in Nakhonthai District, Phitsanulok Province, Thailand. Data were collected from 30 participants through in-depth interviews, focus groups, direct observation and document analysis. Content and thematic analyses were conducted for qualitative data. The Wilcoxon Signed-Rank test was used for the outcome measurement of activities of daily living (ADL) scores.
Results: This model of home-based care for people with disabilities, as an integrated network model, brings together the community, health professionals and other organisations. The role of trained community health volunteers was mainly to deliver home-based personal care for people with disabilities, while health professionals focused mainly on controlling the quality of care, managing the knowledge and skills of volunteers, and co-ordinating the network. The difference between ADL scores before and after the implementation of the model (n=20) was statistically significant (p<0.01). Conclusion: This best practice model of home-based care for people with disabilities in rural Thailand shifts responsibility in the main service decisions from professionals to the community and other stakeholders and engages and empowered all stakeholders in the provision, co-ordination and management of care.
An exploration of the role that expert knowledge plays in the assessment of undergraduate clinical competence: registered nurses' experiences
- Authors: Paliadelis, Penny , Cruickshank, Mary
- Date: 2003
- Type: Text , Journal article
- Relation: Rural and remote health Vol. 3, no. 2 (2003 2003), p. 191-191
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- Description: INTRODUCTION: This phenomenological study, conducted in rural Australia, explored the experiences of registered nurses (RNs) responsible for assessing the clinical competence of undergraduate nursing students. The purpose of the study was to gain insight into the experiences of a group of registered nurses who assess student competence by exploring how they perform the assessment process. A key assumption on which this study was based is that the participants are 'expert nurses', as defined by Benner. METHOD: Participants were recruited using purposive sampling from a population of registered nurses who assessed the clinical performance of undergraduate nursing students studying at a rural university in New South Wales, Australia. Individual unstructured interviews were conducted and audiotaped with the participants' permission. The analysed data were given to all participants to check for accuracy and validation and a thematic analysis of the data was conducted. RESULTS: Four themes were identified; the major theme, described in this article, was identified in all the narratives. The participants all acknowledged that they use their expert nursing knowledge to assist them when assessing the clinical competence of nursing students. The participants used a variety of terms to describe this type of knowledge such as intuition, instinct, gut feeling and 'just knowing'. CONCLUSION: While the findings of this study confirmed that experienced nurses unconsciously use their expert nursing knowledge when making decisions about students' competence, the findings also indicated a lack of awareness or underestimation of the value of expert clinical knowledge. These findings reinforce the need for further investigation to determine the role of expert nursing knowledge in the clinical competency assessment process. This is particularly significant for rural registered nurses employed in small health-care facilities, who often assume the role of assessors of student clinical competence.
An exploratory study of factors influencing pakistani physicians' retention and resettlement career decisions
- Authors: Arif, Muhammad , Fraser, John , Cruickshank, Mary
- Date: 2022
- Type: Text , Journal article
- Relation: Journal of Ayub Medical College, Abbottabad : JAMC Vol. 34 , no. 3 (2022), p. S649-S659
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- Description: Background: The recruitment, retention and migration of health workers is a global phenomenon. The literature shows push factors associated with leaving rural areas and developing countries in general are explored in depth. However importantly, some health workers behave differently and decide to stay in or return to a developing country. Less is known about the reasons/ pull factors of this groups' decision making. Methods: This paper aims to explore the perceptions of Pakistani physicians regarding their career decisions to remain in their country, or resettle back after working abroad for some time. Thirteen Pakistani physicians were interviewed via telephones who were working in Pakistan and Australia. Results: The motivation for Pakistani physicians to remain or resettle back into their country stems from the perceived better quality of life in Pakistan compared to the better standard of life overseas. Other reasons include a perceived differentiation between locals and non-locals abroad and the availability of a permanent job in Pakistan. Conclusion: The main factors that contributed to Pakistani physicians' retention and resettlement decisions were mostly personal and family or societal factors and there was a minimal role for professional or health system related factors in their career decisions, except for the availability of permanent jobs in Pakistan.
An integrative review of enablement in primary health care
- Authors: Frost, Jane , Currie, Marian , Cruickshank, Mary
- Date: 2015
- Type: Text , Journal article
- Relation: Journal of Primary Care & Community Health Vol. 6, no. 4 (2015), p. 264-278
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- Description: Objectives: To review how enablement is conceptualized and practiced in primary health care and to explore the factors that influence patient enablement in this setting. Method: A narrative integrative literature review was undertaken. Results: Twenty-four articles specifically relating to enablement in primary health care were identified. Three literature reviews, 4 qualitative studies, and 17 quantitative studies were included in the analysis. Conclusions: In the primary health care setting, the concept of enablement is well defined as an outcome measure of quality. The literature exploring the practice of enablement is sparse, but 2 randomized controlled trials suggest enablement is linked to better outcomes for patients with asthma and diabetes. Primary factors influencing enablement included the practitioners’ open communication style, the degree to which the practitioner is patient centered, and longer consultations. Other factors found to be associated with enablement were the presenting health issue, general state of health, ethnicity, the patient’s own coping strategies and degree of independence, and socioeconomic status. The association between enablement and patients’ expectations and satisfaction is less clear. The majority of research on enablement was carried out among general practitioners. Further research into the degree to which patients are enabled by a wider range of health care providers is needed. Additional qualitative research would provide a deeper understanding of the attributes of enablement in the primary health care setting.
Caring for each other: How do nurse managers 'manage' their role?
- Authors: Paliadelis, Penny , Cruickshank, Mary , Sheridan, Alison
- Date: 2007
- Type: Text , Journal article
- Relation: Journal of Nursing Management Vol. 15, no. 8 (November 2007), p. 830-837
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- Description: Aim: This article will report on one aspect of a larger study that explored the working lives of nursing unit managers in Australia. The support of nursing unit managers is the focus of this article. Background: There is evidence in the recent literature that nurses are not generally supportive of each other and that nursing unit managers are not adequately supported to manage their expanding administrative and managerial responsibilities. Method: A qualitative feminist approach was used to conduct individual interviews with 20 nursing unit managers employed in the public healthcare system in Australia. Results: The results indicated that participants did not feel supported by the wider organization, but gained support from within their own ranks. Conclusions: The results showed a strong support system within the participant group, despite evidence in the literature that nurses, generally, are not supportive of each other. The results of this study may be used in the development of more effective support mechanisms for nurse managers.
Experiences of families who help young rural men with emergent mental health problems in a rural community in New South Wales, Australia
- Authors: Wilson, Rhonda , Cruickshank, Mary , Lea, Jackie
- Date: 2012
- Type: Text , Journal article
- Relation: Contemporary Nurse Vol. 42, no. 2 (2012), p. 167-177
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- Description: A qualitative study was conducted in rural New South Wales, Australia, to understand the barriers to helpseeking among young rural men with emergent mental health problems. Participants who had real life experiences of these problems within their families were interviewed. Themes emerged from the data which explained some barriers to early intervention. Despite these barriers, families had developed skills in helping and in providing early mental health help to their sons. The findings of this study showed that a substantial burden on the emotional and social integrity of the family, combined with diminished psychological well-being, caused some parents to question how long they could cope before they reached ‘the end of their strings’. This downward spiralling trajectory of mental health and well-being for both the young men and their families has implications for clinical practice. Current models of mental health service delivery do not adequately capture the early help-seeking dynamics of young rural men and their families. A more flexible approach is needed to identify and help the family and the young men, without the pre-requisite for a formal medical diagnosis. Future research should involve health and well-being solution focused service delivery. Language
Health managers and health reform
- Authors: Briggs, David , Cruickshank, Mary , Paliadelis, Penny
- Date: 2012
- Type: Text , Journal article
- Relation: Journal of Management & Organization Vol. 18, no. 5 (2012), p. 641-658
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- Description: This qualitative study was undertaken with a diverse sample of Australian health managers to examine their perceptions regarding the health system and to understand how they learned to become health managers. The findings showed that they viewed the health system as one of constant change, mostly non-adaptive, and a system of parts controlled by bureaucrats and political interests. While the respondents enjoyed their managerial role, they see it as contested between the professions. This study concluded that greater emphasis on the education and training of health managers and their continuing professional development is required if they are to manage increasingly complex, dynamic and changing health systems. In Australia, the health debate continues with the recently announced national health reform agenda. The perceptions of health managers in health reform and change management are important given that they are said to be central to the implementation of health reform and the management of change.
Home-based care for people with disabilities : role of registered nurses within the district health system in Thailand
- Authors: Wanaratwichit, Civilaiz , Hills, Danny , Cruickshank, Mary
- Date: 2020
- Type: Text , Journal article
- Relation: Collegian Vol. 27, no. 1 (2020), p. 18-22
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- Description: Background: In Thailand, the number of people with physical disabilities (PwD) has been increasing. Following sweeping health care reforms in 2002, efforts were made to improve accessibility to health care by greatly increasing the number of Registered Nurses (RNs) working in local community health centres. Little is known, however, about the role of RNs in improving accessibility to home-based care and the outcomes of care for PwD in Thailand. Aim: To explore the role of RNs in providing high quality home-based services for PwD who have severe limitations in movement. Methods: A case study design was used to explore and describe the role of RNs in home-based care for PwD in one rural and one urban area in lower north Thailand. There were 73 participants, including PwD and their family members, community health volunteers, primary care providers, local government officers and members of the District Health management team. Data were collected from in-depth interviews and focus groups, which were analysed using thematic analysis. Results: The roles of RNs in home-based care for PwD were found in four domains, as case manager, rehabilitation care provider, manager of the community health volunteers and broader care coordinator. Conclusion: The full scope of the RN role in the provision of home-based care for PwD, in the district health system of Thailand, not only involves direct nursing care. The role also encompasses planning and co-ordination of the broad range of professional and non-professional services to meet the needs of PwDs in rural and urban settings. © 2019 Australian College of Nursing Ltd
Identifying challenges and barriers in the delivery of primary healthcare at the district level : A study in one Thai province
- Authors: Tejativaddhana, Phudit , Briggs, David , Fraser, John , Minichiello, Victor , Cruickshank, Mary
- Date: 2013
- Type: Text , Journal article
- Relation: International Journal of Health Planning and Management Vol. 28, no. 1 (2013), p. 16-34
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- Description: In 2001, the universal health coverage policy was adopted by Thailand with primary healthcare (PHC) as the major focus of the policy. In order to understand the structural and institutional factors affecting the implementation of PHC in rural Thailand, a qualitative study, utilising individual interviews with national and provincial policy decision makers, community health directors, heads of hospital primary care units, chiefs of district health offices, heads of health centres and community representatives, from one rural province was undertaken. Findings showed that the sustainability of PHC service provision under the administration of community hospitals is problematic as barriers exist at the policy and operational levels and access to PHC for all citizens may not be achieved until these barriers are addressed. Furthermore, although PHC needs to be acknowledged and implemented by all stakeholders within the health industry and government, the roles and responsibilities of the stakeholders in health services management at the district level need to be clarified. Copyright © 2012 John Wiley & Sons, Ltd.
Implementing family-centred care : An exploration of the beliefs and practices of paediatric nurses
- Authors: Paliadelis, Penny , Cruickshank, Mary , Wainohu, Donna , Winskill, Rhonda , Stevens, Helen
- Date: 2005
- Type: Text , Journal article
- Relation: Australian Journal of Advanced Nursing Vol. 23, no. 1 (2005), p. 31-36
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- Description: Objective: This study explored paediatric nurses' perceptions of how they include and involve parents in the care of hospitalised children. Design: This qualitative study used individual unstructured interviews to gather data, the data was analysed using thematic coding. Setting: Paediatric wards within two regional area health services of New South Wales, Australia. Subjects: Fourteen paediatric nurses were asked to describe their beliefs and practices regarding the clinical application of family-centred care. Main outcome measure: Paediatric nurses' beliefs and practices about family-centred care were explored in an effort to explain how the concept was implemented. Results: The findings are presented as four interconnected themes. The first describes how participants either allocated tasks to parents or retained them, the second relates to the nurses' professional identity, the third theme identifies barriers and constraints to the implementation of family-centred care, while the fourth describes the nurses' beliefs about their responsibilities when delivering family-centred care. Conclusions: Together these findings suggest that while nurses endorse the concept of family-centred care, the implementation into practice is more problematic. While it is not possible to generalise these findings to other paediatric nurses, the authors believe the insight gained will resonate with paediatric nurses internationally. The findings from this study are being used as the basis for the development of clinical practice guidelines to assist paediatric nurses to more consistently apply the concepts of family-centred care to their practice.
Models and interventions to promote and support engagement of first nations women with maternal and child health services : an integrative literature review
- Authors: Austin, Catherine , Hills, Danny , Cruickshank, Mary
- Date: 2022
- Type: Text , Journal article
- Relation: Children Vol. 9, no. 5 (2022), p.
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- Description: Background: Studies show that participation in maternal and child health (MCH) services improves health outcomes for First Nations families. However, accessing MCH services can be associated with fear, anxiety, and low attendance at subsequent appointments. Objective: To identify the existing knowledge of models/interventions that support engagement of First Nations women with MCH services in the child’s first five years. Methods: An integrative review was undertaken of full-text, peer-reviewed journal articles and grey literature, which were analysed to identify barriers and enabling factors that influenced the engagement of First Nations families with MCH services. Results: Enabling factors that influenced the engagement with MCH services included service models/interventions that are timely and appropriate, and effective integrated community-based services that are flexible, holistic, culturally strong, and encourage earlier identification of risk and further assessment, intervention, referral, and support from the antenatal period to the child’s fifth birthday. Barriers to engagement included inefficient communication, lack of understanding, cultural differences between the client and the provider, poor continuity of care, limited flexibility of service delivery to meet individual needs, and a health care model that does not recognise the importance of the social determinants of health and wellbeing. Discussion: Timely, effective, holistic engagement with First Nations women during their child’s first 2000 days, which respects their culture and facilitates genuine partnerships built on co-design and shared decision making with the indigenous community, needs to be an essential part of the MCH service model if health care providers seek to practise within First Nations communities. Conclusion: Improving engagement with MCH services is important for First Nations families, the nursing practice, and public health. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
Motivational factors influencing retention of village health workers in rural communities of Bhutan
- Authors: Tshering, Dolley , Tejativaddhana, Phudit , Siripornpibul, Taweesak , Cruickshank, Mary , Briggs, David
- Date: 2019
- Type: Text , Journal article
- Relation: Asia-Pacific Journal of Public Health Vol. 31, no. 5 (2019), p. 433-442
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- Description: Village health workers (VHWs) are the first contact extending vital health services to unreached and underserved communities in Bhutan. VHWs truly embody the principles of primary health care and are effective catalysts in promoting community health. This study identifies and confirms factors motivating VHWs to remain in the health care system. This is a quantitative study with a cross-sectional survey design. Two-stage cluster sampling was used with VHWs from 12 districts representing 3 regions of Bhutan. Data were collected using pretested semistructured questionnaires. Confirmatory factor analysis was used for data analysis. Findings reveal a 4-factor model of motivations among VHWs that includes social, personal, job related, and organizational factors. Among these, the social factor most significantly motivates VHWs to remain in the health care system. VHW motivation can be further fostered by providing a holistic combination of financial and nonfinancial incentives that recognize intrinsic needs and empower innate altruism. What We Already Knowwe already know that there are varied of motivating factors for village health workers to remain in the health care systems in different countries. What This Article Adds This article adds a new body of knowledge. The current study found that social factor is the main motivating factor for village health workers in Bhutan, which requires due consideration by health managers and policymakers during the decision-making process.
Perceptions from the front line : Professional identity in mental health nursing
- Authors: Hercelinskyj, Gylo , Cruickshank, Mary , Brown, Peter , Phillips, Brian
- Date: 2014
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 23, no. 1 (2014), p. 24-32
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- Description: In the context of a growing population of people experiencing mental illness worldwide, mental health nurses are a crucial workforce. Their recruitment and retention, however, is in decline. Drawing on qualitative data obtained from interviews with mental health nurses () in ictoria, Australia, the paper employs a range of concepts from role theory to explore professional identity within mental health nursing. The data highlight three key issues in relation to the future recruitment and retention of : (i) the ambiguity of the role; (ii) the weak definition and lack of understanding of the scope of the role by nursing students; and (iii) a lack of communication about as a profession to a wider audience. These findings indicate three avenues through which recruitment and retention in mental health nursing could be improved: (i) public communication; (ii) training and educating of the next generation of ; and (iii) more accurately defining the role of the MHN.
Public perception of medical errors : experiences and risks shared in Australia
- Authors: Kim, Jeong-ah , Terry, Daniel , Jang, Sunny , Nguyen, Hoang , Gilbert, Julia , Cruickshank, Mary
- Date: 2020
- Type: Text , Journal article
- Relation: Universal Journal of Public Health Vol. 8, no. 1 (2020), p. 35-41
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- Description: Background: Research into patient safety has largely focused on healthcare organisations bureaucratic routines, with little research available regarding the impact of patient perceptions on clinical practice. Acknowledging and openly discussing patient perceptions of medical errors may result in improved quality of healthcare. The research study aimed to gain a better understanding of the public's perception of medical errors to drive a structured approach to improve healthcare outcomes. Methods: In this study, we examined the public experiences of medical errors using an anonymous on-line survey to collect empirical data from April to December 2018. A total of 407 responses were obtained with 303 participants meeting the criteria for inclusion in the study. Results: The majority (74.9%) of these participants identified that they had experienced a medical error during receiving healthcare in Australia and 73% of these confirmed that they were harmed as a result of these errors. Conclusion: Findings from this study indicate that many participants have experienced medical errors when accessing healthcare in Australia. These findings provide information and a deeper understanding of patient experiences and perceptions of healthcare service delivery which can be used by healthcare organisations to improve healthcare services and promote patient participation in their care. Copyright©2020 by authors, all rights reserved. Authors agree that this article remains permanently open access under the terms of the Creative Commons Attribution License 4.0 International License
Reviewing tribunal cases and nurse behaviour : Putting empathy back into nurse education with Bloom's taxonomy
- Authors: Doyle, Kerrie , Hungerford, Catherine , Cruickshank, Mary
- Date: 2014
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 34, no. 7 (2014), p. 1069-1073
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- Description: Recent events in the UK and Australia have shown howpoor patient outcomes are achievedwhen the behaviour of nurses lacks empathy. The UK's Francis Inquiry and the Keogh Report both call for an increase in the ‘caring and compassion’ of health careworkers. A reviewof cases presented to the nurses’ disciplinary tribunal in NewSouth Wales' (Australia) also suggests that the majority of complaints against nurses in this jurisdiction is the result of callousness or lack of empathy. Such events reinforce the need for nurse educators to support nursing students to develop the affective attributes of caring and empathy. This paper considers howto raise the awareness of undergraduate students as a first step to developing empathy by using Bloom's Taxonomy of Educational Objectives; and includes a description of how to facilitate interactions with undergraduate nursing students about caring with empathy. Enculturating empathy is an evidence-based method of increasing compassionate care in health organisations generally.
Stereotyping stigma: undergraduate health students' perceptions at handover
- Authors: Doyle, Kerrie , Cruickshank, Mary
- Date: 2012
- Type: Text , Journal article
- Relation: The Journal of nursing education Vol. 51, no. 5 (2012), p. 255-261
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- Description: The World Health Organization (WHO) has recognized that errors in communication are one of the leading causes of adverse patient outcomes. Consequently, the WHO developed the High 5s Project to review, among other variables, handover of patients between shifts, professionals, and organizations. Seven countries were involved in the initial project. Australia responded by using the ISOBAR (Identify, Situation, Observations, Background, Agreed plan, and Read-back) tool as a template. However, none of the countries involved considered the social and emotional effects of handover on the staff or patients, although research has demonstrated that attitudes and values can be handed over from one nurse to another during this process. This article shows how the nurse who hands over care from one shift to the next can transfer stigma and labeling and offers suggestions for nurse educators and clinicians to apply national standards and core values to clinical practice and education.
Supporting new graduate nurses making the transition to rural nursing practice : Views from experienced rural nurses
- Authors: Lea, Jackie , Cruickshank, Mary
- Date: 2015
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 24, no. 19-20 (2015), p. 2826-2834
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- Description: Aims and objectives. To present the findings from the experienced rural nurse participants of a larger study that explored the transitional experiences of newly graduated nurses making the role transition in rural health care facilities in Australia. Background. There are specific and unique aspects of rural nursing practice that influence the nature and timing of support for new graduate nurses that have not been explored or acknowledged as influencing the new graduate nurses’ experience of transition. Specifically, the difficulties and challenges that experienced rural nurses face in providing effective and timely support for new graduate nurses who are making the transition to rural nursing practice is yet to be explored. Design. Using a qualitative case study framework, this study specifically aimed to investigate and describe the nature and timing of support required during the transition to nursing practice that is specific for the rural context and capacity. Methods. Individual in-depth interviews were conducted with 16 experienced rural nurses who, at the time of the study, worked with new graduate nurses in the rural practice environment. Results. The findings from this study showed that the provision of timely on-ward support for new graduates making the transition to rural nursing practice is affected and influenced by the skill mix and staffing allocation within the rural environment. As well, there is a lack of awareness by rural nurses of how to meet the on-ward support needs of new graduate nurses. Conclusions. This study has identified the specific and unique aspects of the rural nurse’s role and responsibilities for which the new graduate nurse requires incremental learning and intensive clinical support. Relevance to clinical practice. The findings can be used by rural health services and experienced rural registered nurses to assist in implementing adequate and timely support for new graduate nurses.
The experience of enablement within nurse practitioner care : A conceptual framework
- Authors: Frost, Jane , Currie, Marian , Northam, Holly , Cruickshank, Mary
- Date: 2017
- Type: Text , Journal article
- Relation: Journal for Nurse Practitioners Vol. 13, no. 5 (2017), p. 360-367
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- Description: Patient enablement after consultations has not yet been adequately investigated among patients of nurse practitioners (NP) in primary health care. The lens of enablement and a qualitative parallel multistrand approach were used to explore patients’ experiences and NPs’ perspectives of consultations. Metainferences made from this study suggest NPs enable patients by creating opportunities for education and knowledge transference and building on patients’ strengths and promoting self-efficacy. Three existential components of the experience of consultations (ie, relationality, temporality, and corporality) also played a role. These findings were used to develop a conceptual framework of how patient enablement is experienced within an NP consultation. © 2017 Elsevier Inc.
The history and evolving image of nursing
- Authors: Cruickshank, Mary , Paliadelis, Penny , Gazula, Swapnali , McAllister, Margaret
- Date: 2019
- Type: Text , Book chapter
- Relation: The road to nursing Chapter 7 p. 99-116
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- Description: The traditional stereotypical image of a nurse is closely linked to that of Florence Nightingale, the founder of modern nursing, who established a training system for nurses to teach them how to be completely dedicated to the taskes of care regardless of personal needs; dependent on and deferential to authorities such as medical doctors and matron supervisors; and modest and feminine. Of course, contemporary nursing is no longer a profession exclusive to females, and nor does nursing work predominantly involve dependent actions. However, these old ideas remain strong in the minds of the public and are often repeated in popular culture.