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:
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:
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:
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:
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:
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:
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:
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".
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:
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:
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.
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:
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:
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:
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:
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:
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.
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.