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Consumer participation in acute care settings : An Australian experience

  • Authors: Wellard, Sally , Lillibridge, Jennifer , Beanland, Chris , Lewis, Michele
  • Date: 2003
  • Type: Text , Journal article
  • Relation: International journal of nursing practice Vol. 9, no. 4 (2003), p. 255-260
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  • Description: Consumer partnerships have been embraced as an important component of building high quality health care services. While nurses have the greatest contact with clients in hospital, little is known of their views about consumer participation or how they facilitate that participation at the bedside. Using focus group interviews and participant observation methods, this project explored nurses' approaches to working with consumers to support their participation in health care delivery. Findings indicate a sharp contrast between the ideas that nurses expressed and the actions observed in practice. It was clear from the interviews that nurses had adopted the rhetoric surrounding consumer participation, yet observational data revealed nursing practices that excluded active participation by consumers. Factors influencing nurses' facilitation of consumer participation were identified as the division of nursing labour in the setting, limited communication between nurses and patients and environmental constraints.
  • Description: C1
  • Description: 2003000409

Validation of physical activity measurement for people on dialysis treatment

  • Authors: Wellard, Sally
  • Date: 2003
  • Type: Text , Journal article
  • Relation: EDTNA/ERCA Journal Vol. XXIX3, no. (2003), p. 140-142
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  • Description: Chronic illness frequently contributes to diminished levels of activity, a consequent increased dependence on health related support services and reduced quality of life. Surprisingly few studies have described activity among people with end-stage renal disease (ESRD). The current study examined the utility and validity of the Human Activity Profile (HAP) for describing activity in a sample of Australians with ESRD. A descriptive design supported the primary objective of validating the use of HAP for an Australian renal population. Data was collected from 65 adults with ESRD under the care of one regional and one metropolitan renal unit in Victoria. The HAP measures physical activity across a range of activities of daily living, including a dyspnoea scale. The Sickness Impact Profile (SIP) describes activities associated with daily living in the areas of physical, psychological and independence. The HAP, SIP and a questionnaire summarising demographic and diagnostic details were administered while each person was undergoing dialysis and the results subsequently compared. This study demonstrates that HAP is a valid measure of activity levels for people with ESRD undergoing maintenance haemodialysis. Additionally, scores on SIP and HAP indicate that this group have low levels of daily activity. These findings support the use of HAP in research to understand the activity levels of ESRD patients and the factors associated with decline.
  • Description: C1
  • Description: 2003000407

Discursive influences on clinical teaching in Australian undergraduate nursing programs

  • Authors: McKenna, Lisa , Wellard, Sally
  • Date: 2004
  • Type: Text , Journal article
  • Relation: Nurse Education Today Vol. 24, no. 3 (2004), p. 229-235
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  • Description: Clinical teaching is a vital, yet multidimensional component of Australian undergraduate nursing courses. Unlike other parts of curricula, clinical teaching relies on the both higher education and health care sectors to meet prescribed goals and for effective student learning to occur. As such it is influenced by discourses from within both education and health. Whilst there is considerable literature related to undergraduate nursing clinical teaching; it mainly deals with practical aspects such as effectiveness of clinical teaching or discussions of models employed. Only a small pool of literature exists that discusses the construction of clinical teaching including the factors that have influenced the development of practices both in the past and present. Using the work of Foucault, this paper examines dominant and competing discourses influencing clinical teaching through their constructions within the literature. These are discourses of academia, nursing, and economics. The discussion situates these discourses and discusses how some of the resultant issues surrounding clinical education remain largely unresolved. Crown Copyright © 2004 Published by Elsevier Ltd. All rights reserved.
  • Description: C1
  • Description: 2003000838

Increased unintended patient harm in nursing practise as a consequence of the dominance of economic discourses

  • Authors: Heggen, Kristin , Wellard, Sally
  • Date: 2004
  • Type: Text , Journal article
  • Relation: International Journal of Nursing Studies Vol. 41, no. 3 (2004), p. 293-298
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  • Description: Caring is characterized by close and fragile relations between nurses and patients. At times, even with good intentions, nurses cause unintended harm of patients. We argue that the dominance of economic discourses in health care and their subsequent influence on service delivery and health care practices has the potential to increase unintended patient harm. Similar techniques and practices can result in either desired outcomes or harmful outcomes. We explore the notion of unintended harm and some of the ways it arises in nursing practice. We argue there is a clear link between the dominance of economic discourses and an increased risk of unintended harm. As a consequence of the dominance of economic rationalist discourses and the subsequent systems of control introduced, the practice of nursing has been significantly influenced. The challenge for nurses and the nursing profession is to develop strategies to refuse to give in to the dominance of economic interests over the need to prevent harm.
  • Description: C1
  • Description: 2003000837

Constructions of chronic illness

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

Clinical nursing professoriate : Reflections on Australian experiences

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

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.
  • Description: C1
  • Description: 2003002546

Editorial: Challenges for health professionals in working with consumers in partnership

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

Regional special care nursery environments : Navigating the role of mother

  • Authors: Knox, Kate , Wellard, Sally , King, Rosemary
  • Date: 2007
  • Type: Text , Conference paper
  • Relation: Paper presented at 9th National Rural Health Conference, Albury, New South Wales : 7th-10th March 2007
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  • Description: Premature birth presents challenges for most mothers assuming a parenting role with their infant. Living in rural and regional areas provides additional hardship due to isolation, distances and limited support services. The predominant focus of research in the area of premature birth has been on the survival of infants. There has been limited investigation of the experiences of women with infants in special care nurseries (SCNs), in regional Australia. The ways in which mothers ‘navigate their way’, physically and emotionally, in SCN environments was the focus of this study. Using a qualitative interpretive design data were collected through in-depth interviews with mothers and analysed thematically. Women related a dislocation in their lives as a result of their infant’s hospitalisation. The nursery space and the various ways space was used to marginalise or sanction mothers was revealed and resulted in women adopting conflicting roles throughout this time. These findings provide direction for developing more supportive environments for parents relying on SCNs for the care of their infant. This study provides new insight into the experiences of women and their environmental sensitivity within SCN settings. Findings will increase regional midwives’ understanding of mothers’ interpretations of the neonatal nursery environment. Insights into maternal perspectives will assist in the provision of better family-centred care and improved outcomes for the vulnerable families of premature infants.
  • Description: 2003005864

Renal myth busters : Indigenous people are the least compliant with treatment

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

Perceptions of people with Type 2 diabetes about self-management and the efficacy of community based services

  • Authors: Wellard, Sally , Rennie, Sheree , King, Rosemary
  • Date: 2008
  • Type: Text , Journal article
  • Relation: Contemporary nurse : a journal for the Australian nursing profession Vol. 29, no. 2 (2008), p. 218-226
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  • Description: Self-management has become a key strategy for managing the health care of people with diabetes. This study explored issues people with type 2 diabetes experienced in their self-management practices and access to regional community based services. Using a qualitative interpretative design data was collected from four participants who were interviews about their perceptions of facilitators, barriers and issues they encountered in their diabetes care in a regional setting. The findings indicate difficulties participants experienced in gaining access to quality services in regional areas, including long waiting times, difficulties making appointments, and their perception that healthcare professionals fail to acknowledge patients self-management knowledge and practices. Additionally, participants reported food choices affected their family relationships and experience of social stigma. These issues compromised their self-management decisions. The findings support other studies that show a need for health professionals to develop strategies to improve community based services for people with type 2 diabetes and to increase public awareness of the scope of diabetes management.

Juggling type 1 diabetes and pregnancy in rural Australia

  • Authors: King, Rosemary , Wellard, Sally
  • Date: 2009
  • Type: Text , Journal article
  • Relation: Midwifery Vol. 25, no. 2 (2009), p. 126-133
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  • Description: Objective: to explore the experiences of women with type 1 diabetes, living in rural Australia, while preparing for pregnancy and childbirth. Additionally, we aimed to describe the women's engagement with, and expectations of, health-care providers during this period, and subsequently highlight potential service and informational gaps. Design: qualitative research using a collective case-study design; seven women with type 1 diabetes who had given birth within the previous 12 months participated in in-depth interviews about their experiences of pregnancy and birth. Data were analysed thematically. Setting: The experience of type 1 diabetes, preconception preparation and pregnancy among rural Australian women was explored, including interactions with health professionals. Participants: seven women aged between 26 and 35 years agreed to be interviewed. The woman had one or two children and had given birth within the past 12 months. Findings: rigid narrow control of blood glucose levels before conception and during pregnancy created unfamiliar body responses for women, with hypoglycaemic symptoms disappearing or changing. For example, some women mentioned developing tunnel vision or numbness and tingling around their lips and tongue as different symptoms of hypoglycaemia. Women needed information and support to differentiate between what might be normal or abnormal bodily processes associated with pregnancy, diabetes, or both. The women's preparation for conception and pregnancy was reliant on the level of available expertise and advice. Participants' experiences were coloured by their limited access and interactions with expert health professionals. Conclusion: women with type 1 diabetes experienced significant hardship during their pregnancy, including a higher incidence of hypoglycaemic episodes, a loss of hypoglycaemic symptom recognition and weight gain. These difficulties were compounded by a scarcity of available information to support the management of their pregnancy and a lack of availability of experienced health professionals. Implications for practice: national and international consensus guidelines emphasise the importance of preconception and pregnancy care for women with type 1 diabetes. Close clinical supervision and the development of closer co-operation and partnership between the women and health-care providers before conception and during pregnancy may improve outcomes for these women and their babies. Building confidence in professional care requires increased access to specialist services, increased levels of demonstrated knowledge and expertise and better general community access to information about preparation for pregnancy and birth among women who have type 1 diabetes. © 2007 Elsevier Ltd. All rights reserved.

Mothering : An unacknowledged aspect of undergraduate clinical teachers' work in nursing

  • Authors: McKenna, Lisa , Wellard, Sally
  • Date: 2009
  • Type: Text , Journal article
  • Relation: Advances in Health Sciences Education Vol. 14, no. 2 (2009), p. 275-285
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  • Description: Clinical education is an important component of undergraduate nurse education, in which clinical teachers facilitate students' application of theoretical classroom knowledge into the clinical practice setting. Mothering as part of clinical teachers' work was a major finding from a larger study exploring clinical teaching work to identify what shaped their work and barriers to their work in clinical settings. The study used semi-structured interviews, informed by the work of Foucault. Maternal discourses emerged as a predominant one as participants presented their relationships with students describing examples of nurturing, protecting, supporting, guiding and providing discipline. The unexpected finding contradicted the dominant view of students at adult learners, and potentially positions them as dependent in their learning in clinical environments. Exploration of this discourse in the context of the study forms the basis of this paper. It is argued that the overall impact of maternal discourses on clinical teaching and learning is unclear but warrants more detailed investigation. © 2008 Springer Science+Business Media B.V.
  • Description: 2003006943

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