Nursing assessment of older people who are in hospital : Exploring registered nurses' understanding of their assessment skills
- Authors: Penney, Wendy , Poulter, Nola , Cole, Clare , Wellard, Sally
- Date: 2016
- Type: Text , Journal article
- Relation: Contemporary Nurse Vol. 52, no. 2-3 (2016), p. 313-325
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- Description: Background: Nurses worldwide are expected to take a leading role in caring for older people. Considerable literature dedicated to the range and application of assessment skills used by nurses vary. There is limited knowledge of registered nurses' (RNs) views of their assessment of older adults.Aim: The aim of this project was to explore RNs current perceptions of nursing assessment, and the core skills they identified as necessary.Design: A qualitative descriptive design study was conducted in three inpatient units in one regional hospital in Victoria.Method: Date were collected through participant observation of RNs (n = 13) followed by 1:1 semi-structured interviews. Data were analysed thematically.Conclusion: This research has illuminated that an ill-defined repertoire of skills was used by RNs when assessing older persons. Skills identified appeared to be based on years of personal-professional experience. Differences were noted between the descriptions nurses gave and what was observed during interactions with older persons.
Integrating renal and palliative care project : A nurse-led initiative
- Authors: Smith, Vicky , Potts, Carita , Wellard, Sally , Penney, Wendy
- Date: 2015
- Type: Text , Journal article
- Relation: Renal Society of Australasia Journal Vol. 11, no. 1 (2015), p. 35-40
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- Description: Renal nurses working in dialysis settings in Australian regional and rural locations face challenges in facilitating advance care planning (ACP) and providing quality physical and psychological symptom care at the end of life (EOL) for a growing population of older and sicker people with end-stage kidney disease (ESKD). Following concerns raised by patients, families, renal and palliative care nurses early in 2009 in one regional setting, gaps in service delivery were identified. These identified gaps were supported by an emerging literature that identified the need for integrated, palliative, supportive care earlier in the disease trajectory. This care, provided on a needs basis, incorporates ACP, and identifies and addresses complex symptom and psychological issues to improve quality of life (QOL) and planning EOL care for patients and their families/carers. This approach to care, now called renal supportive care, is in varying stages of implementation across Australia for all renal patients, predominantly in metropolitan centres. With limited financial resources, a successful multi-professional collaboration and coordinated approach was established in January 2009 in Ballarat, a large regional setting in Victoria. An implementation framework was developed, addressing the continuum of care from pre-dialysis to withdrawal/cessation from renal replacement therapy (RRT), with an integrated palliative supportive approach during active treatment or EOL care. This project has provided a step forward in improving confidence and responsibility for palliative care by renal nurses working in dialysis settings, helping them to address the challenges faced in evaluating symptom burden, facilitating ACP and delivery of quality EOL care for patients, their families and carers with ESKD.
Problematising autonomy and advocacy in nursing
- Authors: Cole, Clare , Wellard, Sally , Mummery, Jane
- Date: 2014
- Type: Text , Journal article
- Relation: Nursing Ethics Vol. 21, no. 5 (2014), p. 576-582
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- Description: Customarily patient advocacy is argued to be an essential part of nursing, and this is reinforced in contemporary nursing codes of conduct, as well as codes of ethics and competency standards governing practice. However, the role of the nurse as an advocate is not clearly understood. Autonomy is a key concept in understanding advocacy, but traditional views of individual autonomy can be argued as being outdated and misguided in nursing. Instead, the feminist perspective of relational autonomy is arguably more relevant within the context of advocacy and nurses' work in clinical healthcare settings. This article serves to highlight and problematise some of the assumptions and influences around the perceived role of the nurse as an advocate for patients in contemporary Western healthcare systems by focusing on key assumptions concerning autonomy inherent in the role of the advocate. © The Author(s) 2014.
Who speaks for whom? Can nurses be patient advocates in renal settings?
- Authors: Wellard, Sally
- Date: 2014
- Type: Text , Journal article
- Relation: Renal Society of Australasia Journal Vol. 10, no. 2 (2014), p. 81-83
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- Description: Nursing texts laud the role of nurses as advocates for patients. With increased acknowledgement of patient-centred care, is it appropriate or desired for nurses to presume this as their role? An examination of concepts of advocacy and autonomy highlight potential conflicts between the nurses' adoption of the roles of advocate and surveyor in renal care. There is no clear and definitive answer to 'who can speak for whom' when considering advocacy for people involved in renal replacement therapies. It is evident that what is required is clearer articulation of how renal nurses can act as advocates for patients within the context of their multiple roles and with a goal of partnerships in care.
Exploring staff diabetes medication knowledge and practices in regional residential care : Triangulation study
- Authors: Wellard, Sally , Rasmussen, Bodil , Savage, Sally , Dunning, Trisha
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 22, no. 13-14 (2013), p. 1933-1940
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- Description: Aims and objectives: This study is drawn from a larger project that aimed to identify the staffing and organisational factors influencing the quality of diabetes care for older people living in residential care in regional Victoria, Australia. The focus of the current study is on medication management for residents with diabetes. Background: With a continuous rise in diabetes in the population, there is an associated increase in the prevalence of diabetes in aged care residential settings. However, there is little specific guidance on how to manage diabetes in older people living in institutional settings who experience multiple concurrent chronic conditions. Design: A triangulation strategy consisting of three phases. Methods: A one-shot cross-sectional survey (n = 68) focus group interviews and a case file audit (n = 20). Data were collected between May 2009-January 2010. Findings: Staff knowledge of diabetes and its contemporary medication management was found to be suboptimal. Challenges to managing residents with diabetes included limited time, resident characteristics and communication systems. Additionally, the variability in medical support available to residents and a high level of polypharmacy added to the complexity of medication management of resident. Conclusions: The current study suggests administering medicine to residents in aged care settings is difficult and has potentially serious medical, professional and economic consequences. Limitations to staff knowledge of contemporary diabetes care and medications potentially place residents with diabetes at risk of receiving less than optimal diabetes care. Relevance to clinical practice: Providing evidence-based guidelines about diabetes care in residential care settings is essential to achieve acceptable outcomes and increase the quality of life for residents in public aged care. Continuing education programs in diabetes care specifically related to medication must be provided to all health professionals and encompass scope of practice. © 2013 John Wiley & Sons Ltd.
- Description: 2003011093
Investigation of adaptation after liver transplantation using Roy's Adaptation Model
- Authors: Ordin, Yaprak , Karayurt, Özgül , Wellard, Sally
- Date: 2013
- Type: Text , Journal article
- Relation: Nursing and Health Sciences Vol. 15, no. 1 (2013), p. 31-38
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- Description: In this study we explored the adaptation of transplant recipients in Turkey using the Roy Adaptation Model. A descriptive qualitative design was used with data collected from liver transplant recipients in either individual or group interviews between May 2009 and February 2010. Using deductive content analysis, four themes were identified in the data: physiological mode, self-concept mode, role function mode, and interdependence mode. Each theme included both adaptive and ineffective behaviors of liver transplant recipients. The findings of this study indicate that liver transplant recipients need information and support about their ineffective behaviors in all modes of the Roy Adaptation Model. The findings also support the use of a nursing model in the delivery of nursing care for liver transplantation recipients. © 2012 Wiley Publishing Asia Pty Ltd.
- Description: 2003010860
Framework of intent for selecting research approaches in nursing
- Authors: Wellard, Sally , Ordin, Yaprak
- Date: 2011
- Type: Text , Journal article
- Relation: Deuhyo Edergi Vol. 4, no. 4 (2011), p. 189-195
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- Description: Research in nursing is growing rapidly, and there is increased use of qualitative and mixed methods approaches to investigations. However, frequently researchers’ adopt a research approach with little understanding of the philosophical assumptions underpinning their choice. Using a framework of research intent, this paper aims to identify the different philosophical assumptions associated with different research intents and therefore provide a foundation for more informed decision making in selection of methodologies.
- Description: 2003009387
Quality of life in recipients before and after liver transplantation in Turkey
- Authors: Ordin, Yaprak , Dicle, Aklime , Wellard, Sally
- Date: 2011
- Type: Text , Journal article
- Relation: Progress in Transplantation Vol. 21, no. 3 (September 2011 2011), p. 260-267
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- Description: Context: Liver transplantation has become the treatment of choice for patients with end-stage liver disease. Most studies show a positive effect on quality of life after liver transplantation, but most studies are based on data from Western countries and little is known about quality of life in liver transplant recipients in Turkey or other developing countries. Objective: To investigate liver transplant recipients' quality of life and factors affecting it, before and 3 months after transplantation in western Turkey. Design: Descriptive and comparative, with data collected prospectively. Setting: Two medical centers in Western Turkey. Patients: Sixty-five adult recipients of a liver transplant between May 15 and December 31,2007. Instruments: Quality of life was measured by using the Nottingham Health Profile Turkish version, and sociodemographic and clinical data were collected from patients' records. Results: Scores on all subscales of the Nottingham Health Profile differed significantly from before to after liver transplantation. The differences between the mean scores for quality of life before and after transplantation varied significantly with the patients' sex and disease severity.
Are laboratories useful fiction? A comparison of Norwegian and Australian undergraduate nursing skills laboratories
- Authors: Wellard, Sally , Heggen, Kristin
- Date: 2010
- Type: Text , Journal article
- Relation: Nursing & Health Sciences Vol. 12, no. 1 (2010), p. 39-44
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- Description: Drawing on the findings from studies in Australia and Norway that explored the use of laboratories in the preparation of nursing students for entry to practice, this article identifies the pedagogical challenges for the undergraduate education of nurses. The findings from both countries are compared and, in spite of distinct differences in the level of financial investment, there are striking similarities between the ways in which laboratories are used in the two countries. The laboratories were designed to predominately represent acute care hospital environments. The participants demonstrated a high level of commitment and strongly held beliefs in the laboratory as a safe place to facilitate self-paced learning and as an environment where students can practice until they become competent and confident. However, at the same time, there was a striking lack of evidence to support these views. The participants in both countries reported a common approach to instruction: a proce! ss of teacher demonstration, followed by student repetition and practice. Variability in students' motivation also was reported and the participants especially expressed concern for those students with a low level of interest in the basic skills associated with personal care. The possibilities and limitations of using skill laboratories as part of the practical preparation for nursing are discussed, using the metaphor of laboratories as "fiction".
The impact of fatigue on daily activity in people with chronic kidney disease
- Authors: Bonner, Ann , Wellard, Sally , Caltabiano, Marie
- Date: 2010
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 19, no. 21-22 (2010), p. 3006-3015
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- Description: Aims and objectives: To examine the impact of fatigue on the daily activity levels of people with chronic kidney disease, compare whether being predialysis or receiving different renal replacement therapies had any effect on fatigue and activity and identify whether any items in the fatigue severity scale were more predictive of daily activity levels. Background: Chronic kidney disease is a complex and long-term disease where people commonly experience fatigue and reduced levels of fitness; both of which impact on an individual's ability to carry out routine activities of daily life. Design: A descriptive cross-sectional design. Methods: A convenience sample of 112 people completed the fatigue severity scale and Human Activity Profile. Participants differed in their renal history and were either predialysis or receiving renal replacement therapy. Results: Women or older participants were significantly more fatigued and less active than men or younger participants. A significant difference between mean fatigue and activity scores was found for type of renal replacement therapy, with participants receiving peritoneal dialysis being the most fatigued and the least active. Additionally, lower levels of albumin were significantly correlated with greater levels of fatigue and the ability to engage in fewer activities. Conclusion: People with chronic kidney disease regardless of whether they are predialysis or receiving either peritoneal or haemodialysis experience high levels of fatigue and are able to engage in fewer daily activities. The fatigue severity scale and the Human Activity Profile are useful indicators of fatigue and physical activities which can be used in routine assessment practices. Relevance to clinical practice: Renal nurses are ideally positioned to engage in early identification and regular monitoring of both fatigue and activity levels in people with chronic kidney disease. Individual care plans can be developed to incorporate supportive rehabilitative strategies which aim to reduce fatigue and maximise activity levels.
- Description: 2003008244
Moving dialysis treatment into people's homes
- Authors: Wellard, Sally
- Date: 2009
- Type: Text , Journal article
- Relation: The Renal Society of Australasia Journal Vol. 5, no. 2 (2009), p. 102-104
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- Description: Home based dialysis treatments were among the earliest high technology treatments widely adopted in Australia for home use. Advances in membrane technology together with the development of access devices and delivery systems provided the opportunity of extending dialysis as a treatment to a wider group of patients. The evolution of home dialysis was infl uenced by serendipity. The right people and technology came together at the same time. Dr John Dawborn, supported by Sue Evans, trained with the fi rst home haemodialysis patient Peter Morris in Melbourne, who subsequently transferred to Sydney.
- Description: 2003007106
Levels of fatigue in people with ESRD living in far North Queensland
- Authors: Bonner, Ann , Wellard, Sally , Caltabiano, Marie
- Date: 2008
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 17, no. 1 (Jan 2008), p. 90-98
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- Description: Aims. Levels of fatigue as experienced by people with end stage renal disease (ESRD), were assessed using the Fatigue Severity Scale (FSS). Background. Fatigue, a common symptom reported by people with ESRD, is a multifaceted, subjective experience, which is readily understood by individuals but difficult to measure. There is limited understanding of the level of fatigue experienced by people with ESRD, with research currently limited to people treated with haemodialysis. Method. The FSS was completed by 92 people with ESRD who were patients of a renal service in far North Queensland, Australia. Demographic and renal health history data were also collected with the self-report survey. Results. Comparisons were preformed between overall fatigue levels and different renal disorders, genders, ethnicity and renal replacement therapy (RRT). Participants in this study were more fatigued than the general population; there was no difference in levels of fatigue between gender and ethnicity. Participants with diabetic nephropathy and those who were predialysis were the most fatigued. A significant difference between mean fatigue scores was found for type of RRT [F(3,88) = 2.4, p < 0.05], with participants using peritoneal dialysis reporting the most fatigue. Additionally, participants categorized according to type of RRT, erythropoietin replacement therapy and current haemoglobin levels revealed significant mean differences on fatigue levels [F(3,88) = 2.74, p < 0.05]. Relevance to clinical practice. People with ESRD experience considerable fatigue; it is particularly important for nurses to understand this level of fatigue impacts on the daily life of patients. These findings provide the preliminary evidence to support the development of renal nursing practice guidelines related to symptom recognition and management of fatigue.
- Description: C1
Assessment of learning in contemporary nurse education : Do we need standardised examination for nurse registration?
- Authors: Wellard, Sally , Bethune, Elizabeth , Heggen, Kristin
- Date: 2007
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 27, no. 1 (2007), p. 68-72
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- Description: In Australia and Norway final examinations to determine eligibility for registration as a nurse were discontinued during the period when nurse education moved into the higher education sector. In response to recent calls for the reintroduction of final examinations we explore the range of knowledge needs for the practice of nursing. These various forms of knowledge demand different forms of mediation and acquisition as well as assessment. There are numerous problems identified in the literature about the shortcomings of examinations as the foundation of assessing clinically based professions. There is a need to develop systems of appropriate assessment to ensure that graduates of nursing demonstrate adequate knowledge and competence to enter their profession. © 2006 Elsevier Ltd. All rights reserved.
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- Description: 2003002546
Editorial: Challenges for health professionals in working with consumers in partnership
- Authors: Wellard, Sally
- Date: 2007
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 16, no. 11C (2007), p. 245-246
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- Description: C1
- Description: 2003002996
Exploring the use of clinical laboratories in undergraduate nursing programs in regional Australia
- Authors: Wellard, Sally , Woolf, Rhonda , Gleeson, Lynne
- Date: 2007
- Type: Text , Journal article
- Relation: International Journal of Nursing Education Scholarship Vol. 4, no. 1 (2007), p.
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- Description: Preparation for clinical practice is arguably a vital component of undergraduate nursing education with clinical laboratories widely adopted as a strategy to support student development of clinical skills. However, there is little empirical evidence about the role laboratories play in students' learning or how they assist in linking theory to practice. This study aimed to explore the current clinical laboratory practices in Schools of Nursing in regional Victoria, Australia through site visits, interviews and review of curricula. Findings revealed that approaches to laboratory learning are based on traditions rather than evidence, and have evolved in response to fiscal and environmental challenges. The predominance of teacher talk in the laboratory, has lead to acute care over other areas of practice. This study indicates a need for rigorous investigation of pedagogies that can support nursing students in preparation for clinical practice. It remains unclear if laboratory learning experiences assist students in the translation of theoretical knowledge to practice. Copyright ©2007 The Berkeley Electronic Press. All rights reserved.
- Description: C1
- Description: 2003005867
Hearing what older consumers say about participation in their care
- Authors: Penney, Wendy , Wellard, Sally
- Date: 2007
- Type: Text , Journal article
- Relation: International Journal of Nursing Practice Vol. 13, no. (2007), p. 61-68
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- Description: A study exploring older people's participation in their care in acute hospital settings reveals both consumers' and nurses' views of participation. Using a critical ethnographic design, data were collected through participant observation and interviews from consumers in acute care settings who were over 70 years old and nurses who were caring from them. Thematic analysis identified that older people equated participation with being independent. Importantly, consumers highlighted the complexity of the notion of participation when describing situations where they were unable to participate in their own care. The difficulties in communicating with health professionals and an inability to administer their own medications in inpatient settings were identified as barriers to participation. Understanding what consumers believe participation means provides a starting point for developing meaningful partnerships between health professionals and people receiving care.
- Description: C1
- Description: 2003002538
Issues in the provision of nursing care to people undergoing cardiac surgery who also have type 2 diabetes
- Authors: Wellard, Sally , Cox, Helen , Bhujoharry, Claire
- Date: 2007
- Type: Text , Journal article
- Relation: International journal of nursing practice Vol. 13, no. 4 (2007), p. 222-228
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- Description: There has been little investigation of the issues associated with caring for patients presenting for cardiac surgery with a comorbid diagnosis of diabetes although there is some evidence that the diabetes management is suboptimal. This study aimed to identify issues that patients and cardiac specialist nurses experience with the provision of inpatient services for people undergoing cardiac surgery who also have type 2 diabetes. A qualitative interpretive design, using individual interviews with patients and nurses, provided data about some of these issues. The study found that nurses had high levels of confidence in their cardiac care but little confidence in diabetes management. Patients described concerns about their diabetes care and treatment regimens. A 'typical journey' for a person with diabetes undergoing cardiac surgery was identified. The findings support the need to build increased capacity in specialist nurses to support diabetes care as a secondary diagnosis.
- Description: C1
- Description: 2003005865
Clinical nursing professoriate : Reflections on Australian experiences
- Authors: Wellard, Sally , Heggen, Kristin
- Date: 2006
- Type: Text , Journal article
- Relation: Norwegian Journal of Nursing Research Vol. 2, no. 8 (2006), p. 13-21
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- Description: Nursing, as a new discipline in the academic world, has to combine scientific traditions with its identity as a clinical profession. Joint clinical professorial appointments have been established in order to combine these two worlds.
- Description: C1
- Description: 2003001976
Development and validation of the human activity profile into Chinese language : Lessons in determining equivalence
- Authors: Bonner, Ann , Wellard, Sally , Kenrick, Marita
- Date: 2006
- Type: Text , Journal article
- Relation: Nursing and Health Sciences Vol. 8, no. 1 (2006), p. 36-43
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- Description: The Human Activity Profile (HAP), and associated Dyspnea Scale, is a self-report instrument for assessing levels of human activity. Although it has been used in studies examining the levels of activity in people, it is limited to people who are only able to understand English. However, many countries are multicultural with significant numbers of people whose native language is not English. This study sought to demonstrate the equivalence between the Chinese and English versions of the HAP and Dyspnea scales.Thirty-five bilingual university students completed both the Chinese and English versions of each questionnaire. There was 89% and 85% agreement between items across the HAP and Dyspnea Scale questionnaires, respectively. Although the psychometric evaluations suggested there was equivalence between the Chinese and English versions of both the HAP and Dyspnea Scale, lessons have been learnt regarding the different written forms of Chinese. © 2006 The Authors Journal Compilation © 2006 Blackwell Publishing Asia Pty Ltd.
- Description: C1
- Description: 2003001972
The phenomenon of presence within contemporary nursing practice : A literature review
- Authors: Welch, Di , Wellard, Sally
- Date: 2005
- Type: Text , Journal article
- Relation: Australian Journal of Holistic Nursing Vol. 12, no. 1 (2005), p. 4-10
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- Description: Nursing practice underpinned by humanistic values may promote presence experiences within nurse-patient interactions. These interactions are powerful and beneficial both to nurse and patient. However, the phenomenon of presence is surrounded by competing and confused definitions. Whilst presence is arguably a core aspect of nursing practice, current health care environments significantly influence nurses' opportunities to experience presence.
- Description: C1
- Description: 2003001053