Being a parent, but not : the role of foster and kinship carers in supporting children and young people
- Authors: Cooper, Kimberlea
- Date: 2020
- Type: Text , Thesis , PhD
- Full Text:
- Description: Home-based carers play an important role in the lives of children and young people. In Victoria, Australia, home-based care is now the most common form of alternative care, reflecting national and international trends. However, home-based care does currently face some challenges, such as shortages of carers. Therefore, strengthening this form of care through the training and support of foster and kinship carers is a key priority of Victoria’s reforms of child and family services. In the context of a university-industry collaboration, the current research drew upon the expertise of sixteen foster and kinship carers in the Central Highlands region of Victoria. Using constructivist grounded theory, the research sought to understand how carers support children and young people and how they see their role. In addition, the research sought carers’ perspectives on their interactions with the Out-of-Home Care (OOHC) system, including what they find supportive and challenging. The research revealed that home-based carers see some elements of their role as parenting, and others as going beyond parenting. The carers utilise principles of trauma-informed care to support children and young people, but do not experience trauma-informed support from the OOHC system. This discrepancy suggests that the implementation of trauma-informed care has the potential to increase pressure on home-based carers if it is only encouraged at the interpersonal level between carers and children and does not incorporate associated systems-level change. Therefore, this research proposes that whilst micro-level support and training for carers is necessary and useful, it is crucial to move beyond such initiatives to make macro-level reform. This research also raises doubts regarding the capacity of home-based care to become fully trauma-informed due to potential incompatibilities with the current risk-averse and deficit-oriented paradigm of the child protection system.
- Description: Doctor of Philosophy
- Authors: Cooper, Kimberlea
- Date: 2020
- Type: Text , Thesis , PhD
- Full Text:
- Description: Home-based carers play an important role in the lives of children and young people. In Victoria, Australia, home-based care is now the most common form of alternative care, reflecting national and international trends. However, home-based care does currently face some challenges, such as shortages of carers. Therefore, strengthening this form of care through the training and support of foster and kinship carers is a key priority of Victoria’s reforms of child and family services. In the context of a university-industry collaboration, the current research drew upon the expertise of sixteen foster and kinship carers in the Central Highlands region of Victoria. Using constructivist grounded theory, the research sought to understand how carers support children and young people and how they see their role. In addition, the research sought carers’ perspectives on their interactions with the Out-of-Home Care (OOHC) system, including what they find supportive and challenging. The research revealed that home-based carers see some elements of their role as parenting, and others as going beyond parenting. The carers utilise principles of trauma-informed care to support children and young people, but do not experience trauma-informed support from the OOHC system. This discrepancy suggests that the implementation of trauma-informed care has the potential to increase pressure on home-based carers if it is only encouraged at the interpersonal level between carers and children and does not incorporate associated systems-level change. Therefore, this research proposes that whilst micro-level support and training for carers is necessary and useful, it is crucial to move beyond such initiatives to make macro-level reform. This research also raises doubts regarding the capacity of home-based care to become fully trauma-informed due to potential incompatibilities with the current risk-averse and deficit-oriented paradigm of the child protection system.
- Description: Doctor of Philosophy
Patients’ experiences of acute deterioration and Medical Emergency Team (MET) encounter : a grounded theory study
- Authors: Chung, Catherine
- Date: 2021
- Type: Text , Thesis , PhD
- Full Text:
- Description: Globally, considerable effort has been made to ensure hospital patients whose clinical condition deteriorates receive timely and appropriate care. Research suggests that hospitals have increasing numbers of patients who are more likely to become seriously ill during their admission due to complex problems. Recently, patient experience has been recognised as a means of assessing healthcare delivery with healthcare services across the world gathering patient experience or satisfaction data. Acute deterioration is unique and complex for all involved. However, little is known about this experience from the patient’s perspective. The purpose of this study was to generate theory about processes patients engage in when experiencing acute deterioration and MET encounter. Also, the research aimed to recognise and explain the factors that mediate patients’ experiences. The findings of this study contribute to a growing body of knowledge that will improve patient care and practice guidelines for healthcare professionals. Underpinned by the theoretical framework of symbolic interactionism, grounded theory was employed for this study. From it ontological, epistemological, and methodological underpinnings, constructivist grounded theory was considered the most suitable approach. Using purposive sampling, in-depth semi-structured interviews were conducted with 27 patients across three Australian healthcare services. Data were collected over a 12-month period, between May 2018 – May 2019 and analysed using constant comparative analysis. The theoretical model ‘Unravelling a complex experience: contextualising patients’ experiences of acute clinical deterioration and Medical Emergency Team (MET) encounter’ emerged, offering a possible explanation of patients’ actions and processes. Most patients began their journeys feeling something was wrong which triggered emotional changes (experiencing changes-before the encounter). Patient experience was influenced by a combination of physical and psychological changes and a MET response (perceiving the reality - the encounter). After the MET encounter, some patients searched for deeper understandings about their illnesses and the events that occurred, whereas others managed without further reflection (reflecting on the event-after the encounter). Contextual conditions emerged influencing patients’ experiences with three broad mediating factors identified. Some participants identified that their acute deterioration and subsequent MET encounter was unexpected, and they perceived the nature of their illness (before their acute deterioration) as stable, based on what they had been told by medical staff (expectations and illness perception). Many participants acknowledged that their experience was dependent on the health care professionals who were caring for them at the time (relationship with the MET). Past experiences of illness and hospitalisation played an important role in participants’ abilities to conceptualise their experiences of acute deterioration and MET encounter (past experiences). These factors exerted a significant influence on participants’ experiences and helps to explain the differences between them. Unravelling a complex experience: Conceptualising patients’ experiences of acute deterioration and MET encounter offers a possible explanation of patients’ meanings, actions and processes when experiencing acute deterioration and MET encounter. The theory leads to recommendations that healthcare organisations gather data about patients’ experiences of acute deterioration and MET encounters, as these provide insights and opportunity to identify challenges that can be addressed.. Findings provide an explanatory framework for similar phenomena and increase awareness of patients’ experiences to ultimately inform health policy and improve patient care. The findings highlight the need for healthcare services to instigate strategies that support patients who have experienced acute deterioration. Further research could evaluate the effectiveness of implemented strategies.
- Description: Doctor of Philosophy
- Authors: Chung, Catherine
- Date: 2021
- Type: Text , Thesis , PhD
- Full Text:
- Description: Globally, considerable effort has been made to ensure hospital patients whose clinical condition deteriorates receive timely and appropriate care. Research suggests that hospitals have increasing numbers of patients who are more likely to become seriously ill during their admission due to complex problems. Recently, patient experience has been recognised as a means of assessing healthcare delivery with healthcare services across the world gathering patient experience or satisfaction data. Acute deterioration is unique and complex for all involved. However, little is known about this experience from the patient’s perspective. The purpose of this study was to generate theory about processes patients engage in when experiencing acute deterioration and MET encounter. Also, the research aimed to recognise and explain the factors that mediate patients’ experiences. The findings of this study contribute to a growing body of knowledge that will improve patient care and practice guidelines for healthcare professionals. Underpinned by the theoretical framework of symbolic interactionism, grounded theory was employed for this study. From it ontological, epistemological, and methodological underpinnings, constructivist grounded theory was considered the most suitable approach. Using purposive sampling, in-depth semi-structured interviews were conducted with 27 patients across three Australian healthcare services. Data were collected over a 12-month period, between May 2018 – May 2019 and analysed using constant comparative analysis. The theoretical model ‘Unravelling a complex experience: contextualising patients’ experiences of acute clinical deterioration and Medical Emergency Team (MET) encounter’ emerged, offering a possible explanation of patients’ actions and processes. Most patients began their journeys feeling something was wrong which triggered emotional changes (experiencing changes-before the encounter). Patient experience was influenced by a combination of physical and psychological changes and a MET response (perceiving the reality - the encounter). After the MET encounter, some patients searched for deeper understandings about their illnesses and the events that occurred, whereas others managed without further reflection (reflecting on the event-after the encounter). Contextual conditions emerged influencing patients’ experiences with three broad mediating factors identified. Some participants identified that their acute deterioration and subsequent MET encounter was unexpected, and they perceived the nature of their illness (before their acute deterioration) as stable, based on what they had been told by medical staff (expectations and illness perception). Many participants acknowledged that their experience was dependent on the health care professionals who were caring for them at the time (relationship with the MET). Past experiences of illness and hospitalisation played an important role in participants’ abilities to conceptualise their experiences of acute deterioration and MET encounter (past experiences). These factors exerted a significant influence on participants’ experiences and helps to explain the differences between them. Unravelling a complex experience: Conceptualising patients’ experiences of acute deterioration and MET encounter offers a possible explanation of patients’ meanings, actions and processes when experiencing acute deterioration and MET encounter. The theory leads to recommendations that healthcare organisations gather data about patients’ experiences of acute deterioration and MET encounters, as these provide insights and opportunity to identify challenges that can be addressed.. Findings provide an explanatory framework for similar phenomena and increase awareness of patients’ experiences to ultimately inform health policy and improve patient care. The findings highlight the need for healthcare services to instigate strategies that support patients who have experienced acute deterioration. Further research could evaluate the effectiveness of implemented strategies.
- Description: Doctor of Philosophy
Undergraduate nursing students’ team communication skills within a simulated emergency setting : a grounded theory study
- Authors: Bourke, Sharon
- Date: 2022
- Type: Text , Thesis , PhD
- Full Text:
- Description: Recognising and managing clinical deterioration is considered a high priority in health care with ineffective communication being a significant contributing factor to poor clinical outcomes for patients. Nurses are in a unique position to make a difference in influencing improvements in team communication. In Australia, nurse education has become more complicated and demanding with nursing students focus on behaviour skills, such as communication, becoming more difficult in a saturated curriculum. Simulation-based education has provided an experiential way to learn these complex skills. Although there has been much work in the healthcare literature on clinical teamwork, including communication and its intersection with patient safety, there is still a gap in explaining how individuals within the team contribute to communication. The purpose of this study was to explore and explain how nursing students communicate in simulated emergency settings and how factors, such as culture, language, gender, age and power, affect nursing students’ team communication. This study investigated how transitioning nursing students are prepared with the necessary skills to achieve effective team communication at the point of transition to clinical practice as registered nurses. In order to address the aims of the study, a constructivist grounded theory methodology, informed by Kathy Charmaz (2006), was employed. Using purposive sampling, third year nursing students were recruited from one Australian university, to undertake a structured team simulation experience. Participants worked in teams of three or four to experience the team communication whilst working together to care for a deteriorating patient in the form of a mannequin. Simulations were video recorded after which individual, in-depth, semi-structured interviews were conducted with 21 participants. In line with a grounded theory approach, data collection and analysis were conducted concurrently until theoretical saturation was achieved. In response to the central problem of how nursing students communicate in simulated emergency settings, a core process was established that explained the factors that affect team communication. This problem is conceptualised as Navigating uncertainty: Explaining communication of nursing students within an emergency setting. This theoretical construct helps to explain nursing students’ actions and insights into factors that influence their communication within emergency teams. The core process is represented in three transitional stages of the theory comprising: Finding a place in the team, Understanding and working out differences and Looking to the future: Developing strategies to improve communication. This process was mediated by contextual conditions of the student, the simulation and the team. The phases are reinforced by the three main categories of Having a place in the team, Knowing yourself, and Transitioning from student to registered nurse. These categories represent the key activities that nursing students were engaged with that led to the development of the core category and process. The generated findings and theory offer valuable insights into factors that influence team communication skills within emergency settings. The theory raises awareness of social processes undertaken by nursing students during team communication, and highlights obstacles that can assist educators and academics to structure team communication education to better meet the needs of nursing students transitioning to practice settings.
- Description: Doctor of Philosophy
- Authors: Bourke, Sharon
- Date: 2022
- Type: Text , Thesis , PhD
- Full Text:
- Description: Recognising and managing clinical deterioration is considered a high priority in health care with ineffective communication being a significant contributing factor to poor clinical outcomes for patients. Nurses are in a unique position to make a difference in influencing improvements in team communication. In Australia, nurse education has become more complicated and demanding with nursing students focus on behaviour skills, such as communication, becoming more difficult in a saturated curriculum. Simulation-based education has provided an experiential way to learn these complex skills. Although there has been much work in the healthcare literature on clinical teamwork, including communication and its intersection with patient safety, there is still a gap in explaining how individuals within the team contribute to communication. The purpose of this study was to explore and explain how nursing students communicate in simulated emergency settings and how factors, such as culture, language, gender, age and power, affect nursing students’ team communication. This study investigated how transitioning nursing students are prepared with the necessary skills to achieve effective team communication at the point of transition to clinical practice as registered nurses. In order to address the aims of the study, a constructivist grounded theory methodology, informed by Kathy Charmaz (2006), was employed. Using purposive sampling, third year nursing students were recruited from one Australian university, to undertake a structured team simulation experience. Participants worked in teams of three or four to experience the team communication whilst working together to care for a deteriorating patient in the form of a mannequin. Simulations were video recorded after which individual, in-depth, semi-structured interviews were conducted with 21 participants. In line with a grounded theory approach, data collection and analysis were conducted concurrently until theoretical saturation was achieved. In response to the central problem of how nursing students communicate in simulated emergency settings, a core process was established that explained the factors that affect team communication. This problem is conceptualised as Navigating uncertainty: Explaining communication of nursing students within an emergency setting. This theoretical construct helps to explain nursing students’ actions and insights into factors that influence their communication within emergency teams. The core process is represented in three transitional stages of the theory comprising: Finding a place in the team, Understanding and working out differences and Looking to the future: Developing strategies to improve communication. This process was mediated by contextual conditions of the student, the simulation and the team. The phases are reinforced by the three main categories of Having a place in the team, Knowing yourself, and Transitioning from student to registered nurse. These categories represent the key activities that nursing students were engaged with that led to the development of the core category and process. The generated findings and theory offer valuable insights into factors that influence team communication skills within emergency settings. The theory raises awareness of social processes undertaken by nursing students during team communication, and highlights obstacles that can assist educators and academics to structure team communication education to better meet the needs of nursing students transitioning to practice settings.
- Description: Doctor of Philosophy
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