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NURSING AND MIDWIFERY RESEARCH CANDIDATE CONFERENCE 2010
Auspiced by the Victorian Deans of Nursing and Midwifery
Hosted by the School of Nursing and Midwifery, Monash University,Monash University Conference Centre
Level 7, 30 Collins St
A warm welcome to this conference, we hope that you have an enjoyable and educative few days. If you have any questions or concerns please feel
free to contact the organisers:
Conference ChairDr Simon Cooper
Associate Professor Monash University
Conference AdministratorBelinda Schill0408 63 1745
KEYONTE SPEAKERS
Professor Tracey Bucknall – Cabrini Health and Deakin University
Tracey is a Professor at Deakin University and the new Head of the Cabrini-Deakin Centre for Nursing Research at Cabrini Hospital. Prior to this appointment, she was an Associate Professor at the School of Nursing, University of Melbourne, and Director of Nursing Research and Development at Western Health. Tracey has clinical qualifications and extensive experience in critical care nursing, and has held a variety of clinical, educational and research appointments in both private and public hospitals, and in the tertiary sector.
She teaches in undergraduate and postgraduate nursing education programs, and supervises Masters and PhD students in decision making research.
Her primary research interest has been clinical decision making. She has concentrated on understanding how individuals make decisions routinely and in uncertainty, understanding the environmental and social influences in health care. Tracey also researches the implementation of research into practice in areas such as pain and sedation management, medication safety and health maintenance for the elderly. More recently she has incorporated patient involvement in decision making as a means of influencing clinician uptake of research evidence.
Professor Margaret O’Connor AM – Monash University
Professor O’Connor is the inaugural Vivian Bullwinkel Chair in Palliative Care Nursing, School of Nursing and Midwifery, Monash University in Melbourne, a position she has held since 2003. Prior to this she has enjoyed a long and diverse career in palliative care, in roles that have encompassed the establishment and management of mainly community-based palliative care services. Her current position formally encompasses three clinical partners where Professor O’Connor is actively involved in developing staff research projects.
Professor O’Connor is responsible for the Palliative Care Research Team in the School and manages a number of clinical research projects, which have received more than $500,000 in funding from internal and external sources. The growing research team includes a post-doctoral fellow and nine PhD students. Research projects are centered on key areas - service system and policy issues and issues of culture and palliative care. All projects involve the clinical partners and many research questions have arisen from within the clinical setting. She is well published in these research areas.
Professor O’Connor sits on many State and National committees, including the Australian Health Ethics Committee of the National Health & Medical Research Council. She is a board member of the International Association for Hospice & Palliative Care, the Asia-Pacific Hospice Network and on the working party for the World Palliative Care Alliance. She became President of Palliative Care Australia in September 2006.
In 2002 and 2008 Professor O’Connor was awarded the Nina Buscombe Prize from the Motor Neurone Disease Association of Victoria. In 2005 Professor O’Connor accepted the national honour of Member of the Order of Australia, for service to the development and establishment of palliative care services in Victoria, an acknowledgement of Margaret‘s 20 year contribution to palliative care.
Professor Sanchia Aranda – University of Melbourne
Sanchia Aranda is Professor/Director of Cancer Nursing Research at Peter MacCallum Cancer Centre and Head of Nursing, Melbourne School of Health Sciences at the University of Melbourne. She has
worked in cancer and palliative care since 1979, predominantly in research and teaching roles since 1989.
Sanchia’s research interests are supportive care, symptom management and practice change. Sanchia has received funding from the NHMRC, The Cancer Council, the National Breast Cancer Foundation and Government sources. She is conducting a $3.5 million Government funded project with Professor Patsy Yates to develop a framework for cancer nursing education and the production of readily accessible learning materials. She has more than 100 publications (refereed journal articles, book chapters and conference proceedings) and is an editorial board member of four international journals in cancer and palliative care and is a reviewer for many more.
Sanchia is the President of the International Society of Nurses in Cancer Care and is on the Advisory Council for Cancer Australia. She received the Oncology Nursing Society (USA) International Award for Contributions to Cancer Care in 2001 and in 2009 was made a Fellow of the American Academy of Nurses and received the Inaugural Excellence in Cancer Nursing Award from the Cancer Nurses Society of Australia.
PROGRAM
Nursing and Midwifery Research Candidate Conference
Conference Program
Day 1: Tuesday 28 September
Arrival and Registration (morning tea available)
9.15-10am
Session One
10-10.15am: Welcome and introduction – Chairman Dr Simon Cooper
10.15-10.45am: Keynote speaker Professor Tracey Bucknall, Cabrini Health and Deakin University, ‘Deteriorating patients and decision making in nursing’
10.45-11am: Questions to speaker
Morning Tea
11-11.20am
Session Two (A) – Acute Care
Chair: Associate Professor Lisa McKenna
11.20-11.40am: Malcom Elliot, Australian Catholic University, ‘An examination of factors contributing to adverse events in patients recently discharged from ICU’
11.40am-12pm: Mohammed Aljohani, Monash University, ‘Emergency department triage in Saudi Arabia: towards five-level national triage system’
12-12.20pm: Glenn Eastwood, Deakin University, ‘Oxygen therapy: a detailed analysis of the factors that influence practice in an ICU setting’
12.20-12.40pm: Michele Hepponstall, University of Melbourne, ‘Randomised controlled trail of remote ischemic preconditioning in children undergoing heart surgery methodological considerations’
12.40-1pm: Questions to speakers
Session Two (B) – Workforce
Chair: Dr Virginia Plummer
11.20-11.40am: Zainah Mohamed, Monash University, ‘Belongingness: great motivation for graduated nurses’
11.40am-12pm: Isobel Moase, Australian Catholic University, ‘Workplace satisfaction, wellbeing and nurse employment intention: an investigation of retention with year two to five registered nurses in rural Victoria’
12-12.20pm: Grainne Lowe, Monash University, ‘What policy or organisational issues prevent increasing utilisation of nurse practitioners in healthcare organisations?’
12.20-12.40pm: Kate Kay, Australian Catholic University, ‘An exploration of nurses’ beliefs, attitudes and experiences relating to manual handling utilising the knowledge-to-action framework’
12.40-1pm: Questions to speakers
Lunch
1-2pm
Session Three (A) – Acute Care
Chair: Associate Professor Tony O’Brien
2-2.20pm: Elise Sullivan, Monash University, ‘All hands on deck: a collaborative practice model to delivering emergency care in rural hospitals’
2.20-2.40pm: Ruth Crampton, Deakin University, ‘Exploring the experience of registered nurses caring for prisoner patients in an acute environment’
2.40-3pm: Yousef Al- Both’hi, Monash University, ‘Nurses’ preparedness to practice in emergency departments in the Kingdom of Saudi Arabia: an ethnographic study’
3-3.20pm: Stephen McKeever, University of Melbourne, ‘Changes in Amplitude-Integrated Electroencephalogram (aEEG) And Spectral Edge Frequency (SEF90) during paediatric general anaesthesia’
3.20-3.45pm: Joanne Porter, Monash University, ‘Evaluating the implementation and practice of family presence in the emergency department setting: a mixed methods design’
3.45-4.10pm: Questions to Speaker
Session Three (B) – Elderly Care / Mental Health
Chair: Dr Sonia Allen
2-2.20pm: Kusrini Kadar, Monash University, ‘Promoting and maintaining wellness among the elderly in South Sulawesi, Indonesia: an action research study’
2.20-2.40pm: Joan Ostaskiewicz, Deakin University, ‘Residential aged care staff knowledge and beliefs about incontinence: a grounded theory study’
2.40-3pm: Barbara McKenzie-Green, Australian Catholic University, ‘Living in residential aged care: a process of continuous adjustment’
3-3.20pm: Joanne Grainger, Australian Catholic College, ‘Empathic engagement in the provision of nursing care to the person living with advanced dementia in residential care’
3.20-3.40pm: Brett McKinnon, Monash University: ‘Treatment planning and outcome measurement in mental health made easy’
3.40- 4pm: Questions to speaker
Closing Session
4pm: Christine Smith, Nurses Memorial Centre - presentation on scholarships
Afternoon Tea and Networking
4.15pm
Close
4.30pm
Conference Dinner
7pm
Day 2: Wednesday 29 September
Session Four
9-9.15am: Welcome and introduction
9.15- 09.45am: Keynote speaker Professor Margaret O’Connor AM, Monash University, ‘Understanding ethical requirements on research: new and emerging processes’
9.45-10am: Questions to speaker
Morning tea
10-10.20am
Session Five (A) – Midwifery
Chair: Associate Professor Phil Maude
10.20-10.40am: Helen Hall, Monash University, ‘Midwives and complementary and alternative medicine: a grounded theory study’
10.40- 11am: Gayle McLelland, Monash University, ‘Using a mixed methodology to investigate the clinical obstetric profile encountered by Victorian emergency paramedics’
11-11.20am: Sharon Licqurish, Australian Catholic University, ‘Applying a contemporary grounded theory method to explore Bachelor of Midwifery Students’ Experiences of Achieving Competencies’
11.20-11.40am: Meredith McIntyre, Monash University, ‘Discourses influencing policy direction of the reform of maternity services in Australia’
11.40-12pm: Questions to speakers
Session Five (B) – Palliative care
Chair: Dr Ken Sellick
10.20-10.40am: Christina Searle, Australian Catholic University, ‘The palliative approach within the acute hospital setting’
10.40- 11am: Pathma Namasivayam, Monash University, ‘Caring for families of the terminally ill in Malaysia: a grounded theory from palliative care nurses’ perspective’
11-11.20am: Melissa Bloomer, Monash University, ‘End of life care in the acute hospital setting’
11.20-11.40am: Joan Yalden, Monash University, ‘How do practice development strategies enable the implementation of evidence-based palliative approach guidelines in residential aged care?’
11.40am-12pm: Questions to speakers
Lunch
12 -1.15pm
1.15 – 1.45pm: Keynote speaker Professor Sanchia Aranda, University of Melbourne, ‘Designing and testing nursing interventions’
1.45-1.55pm: Questions to speaker
Session Six (A) – Caring, Quality of Life and Decision Making
Chair: Professor Wendy Cross
2-2.20pm: Bridget Fussell, Australian Catholic University, ‘Factors influencing the process of decision making for registered nurses working in residential aged care facilities when a resident’s health status changes’
2.20-2.40pm: Sophie Jones, University of Melbourne, ‘Quality of life assessment of children requiring long-term oral anticoagulant therapy’
2.40-3pm: Mei Chan Chong, Monash University, ‘Malaysian nurses’ attitudes towards e-learning’
3-3.20pm: Tracey McConnell-Henry, Monash University, ‘How do you ‘do’ phenomenology? Unravelling the mystery of secret phenomenologists’ business!’
3.20-3.40: Questions to speakers
Session Six (B) – Workforce and Attitudes
Chair: Professor Karen Francis
2-2.20pm: Vicki Yarker-Hitchcock, Monash University, ‘Professional supervision as a model for untrained healthcare workers’ 2.20-2.40pm, Elisabeth Jacob, Monash University, ‘ENs in Australia – different role or just another name?’ 2.40-3pm: Saleh Altallal, Monash University, ‘Impact of hospital organisational structure on patient outcomes and nurse job satisfaction in Saudi Arabia’
3-3.20pm: Mohammad Al-Motlaq, Monash University, ‘Children’s attitudes towards their peers with asthma in primary schools’
3.20-3.40pm: Questions to speakers
Afternoon Tea and Final Session
3.40-4pm
Conference Closure
4pm
ABSTRACTS
ACUTE CARE
An examination of factors contributing to adverse events in patients recently discharged from ICU
Malcom Elliot Australian Catholic University
Biography:Malcolm Elliott is a PhD candidate in the School of Nursing, Australian Catholic University. He has clinical experience in Intensive Care, High-Dependency and Coronary Care nursing. He has taught at both the undergraduate and postgraduate levels and published on issues relating to quality and safety of care, and nursing education.
AbstractAn examination of factors contributing to adverse events in patients recently discharged from ICU
Background: Up to a third of patients will experience an adverse event soon after discharge from ICU. More than half of these events have been deemed preventable with improved standards of care. Many factors affect the quality of care delivered and these include factors unique to the organisation, the patient and individual clinicians. It is not known how these factors contribute to adverse events in patients recently discharged from ICU.
Objective: The aim of this PhD programme is to examine the relationship between system, human, patient factors and adverse events, to improve the short term outcomes of patients recently discharged from ICU.
Method: A mixed methods multi-phased approach is being used. The first phase was informed by grounded theory and examined nurses’ experiences of ICU readmissions. The second phase will employ a survey design.
Results: Thus far five factors have been found to contribute to ICU readmissions: premature ICU discharge, heavy workloads, delayed medical care on the wards, lack of qualified staff and clinically challenging patients.
Recommendations: Given the initial findings and high cost associated with adverse events, further examination of these events after ICU discharge is warranted. Hence the second phase of this PhD programme will involve a survey of ICU liaison nurses. A questionnaire informed by the literature and the findings of phase one will be used for data collection.
Emergency department triage in Saudi Arabia: towards five-level national triage system
Mohammed Aljohani Monash University Peninsula Campus Biography:Mohammed Aljohani has an extensive work experience in emergency department(ED) in Saudi Arabia. He worked in ED for more than 17 years as a staff nurse and acting head nurse. His interest in ED triage research has begun in 2006 during his master of nursing. The master thesis examined the consistency and accuracy of ED triage decisions among clinicians using a standard 5-point urgency scale in one Saudi Arabian emergency department.
Abstract:Emergency Department Triage in Saudi Arabia: Towards Five-level National triage System
Background: The number of patients presenting for care in emergency departments (ED) in Saudi Arabia (SA) is increasing every year. Given this increase, it is essential that EDs utilise a systemic way to prioritise patients’ care based on clinical urgency. Despite the increase in demand for ED services, formalise triage system is not common practice in most of the public EDs in Saudi Arabia.
Aims: This paper reports on a 3 stage research study to explorer the current triage practice in public EDs in Saudi Arabia and to develop a national five-level triage system
Methods: Study one, 15 paper-based simulation scenarios were used to examine the consistency and accuracy of
triage decision making among ED clinicians in public EDs. Study two, document analysis was conducted for triage policy and procedure and education documents
in Saudi Arabia. Study three, a modified Delphi technique was utilised to develop a triage scale and identify the clinical
descriptors for each triage category Results: The findings of study one and two illustrate that triage and its related works is not well organised in public EDs in SA. More than 50 percent of the study participants believed that formal triage does not exist in their EDs. Moreover, agreement in triage ratings among the ED clinicians was only fair (unweighted kappa =0.25). Against the international recommendations, the current triage policy recommended a 3-level triage scale.
Conclusion:Current triage practice in public EDs is ad hoc and implementation is reliant on local interest. Regardless the limited reliability and validity of the 3-level triage system recommended by the MOH triage policy, it seems that public EDs do not adhere well to the policy. This study developed a five-level triage system to replace the current system.
Oxygen Therapy: A detailed analysis of the factors that influence practice in an ICU setting
Glenn Eastwood Deakin University
Biography:Glenn is currently a PhD candidate in the School of Nursing (SON) at Deakin University. In addition, Glenn currently works at Austin Health where he is the ICU Research Manager. The focus of his doctoral thesis is the administration of oxygen therapy in the intensive care unit. This is Glenn’s final year of candidature and he has in the process of writing up his thesis.
AbstractOxygen Therapy: A detailed analysis of the factors that influence practice in an ICU setting
Prolonged untreated severe hypoxaemia is lethal. Patients admitted to the intensive care unit (ICU) are at an increased risk of hypoxaemia because of acute illness, chronic pathology or peri-operative care. Inconsistencies in the oxygen therapy practices of intensive care nurses are problematic, given that practice will influence patient outcome.
The aim of this doctoral program was to provide a detailed analysis of the efficacy of commonly used oxygen delivery devices, intensive care nurses’ oxygen therapy practices, and the contextual factors influencing oxygen therapy in order to inform effective oxygen therapy practices in the ICU.
This doctoral program involved four clinical trials: a randomised crossover trial; face-to-face structured interviews; a retrospective medical record audit; and a clinical practice observational study.
First, for adult patients with low level oxygen supplementation requirements, nasal devices allow for less oxygen consumption and greater comfort than FM while still maintaining SpO2 ≥ 95%. Second, differences between the patients’ and nurses’ perspective of oxygen therapy illustrate the variety of factors that impact on effective oxygen administration. Third, for cardiac surgical patients a lack of early intervention to address hypoxemia and tachypneoa was identified. Fourth, poor documentation of oxygenation and respiratory rate and a lack of oxygen titration in response to hypoxaemia and tachypnoea occurred in ICU despite: high nursing/patient ratios, constant patient monitoring, and escalating of oxygen therapy interventions falling well within the nursing scope of practice.
These findings have clear implications for patient safety, educational training, and quality improvement activities for oxygen therapy in the intensive care unit context. In order to develop a sound evidence base for nurses’ oxygen administration, further research needs to measure the contextual influences on nurse’s oxygen administration decision making and patient outcomes.
Randomised controlled trail of remote ischemic preconditioning in children undergoing heart surgery methodological considerations Michele Hepponstall University of Melbourne
Biography:Michele holds degrees in Biomedical Science (Hons) and Nursing. Her PhD examines cardioprotective strategies in children undergoing repair of cardiac defects. Michele maintains a dual clinical and research focus with particular interest in neonatal cardiorespiratory physiology. Her research focuses on conducting scientific research and translating the findings to clinical practice. She is also a casual lecturer/tutor in the School of Nursing at The University of Melbourne.
AbstractRandomised controlled trail of remote ischemic preconditioning in children undergoing hear surgery
methodological considerations
Background: Cardiac surgery with cardiopulmonary bypass results in significant organ damage from ischemia and systemic inflammatory responses. There is evidence that this injury can be attenuated using a therapy called remote ischemic preconditioning where brief periods of transient ischemia provide protection against an episode of significant ischemia. This intervention has been associated with significantly reduced post-operative inotrope requirement, as well as decreased myocardial and pulmonary injury in children undergoing cardiac surgery. Despite the proven clinical benefits, little is known of the underlying mechanisms responsible for providing this protection.
Aims and objectives: The aim of this study is to explore proteins involved in the protective mechanisms with the hypothesis that a protein or group of proteins is released into the blood following the preconditioning stimulus.
Research methods (actual or proposed): Blood will be collected from children undergoing cardiac surgery at five time points. Proteins in the plasma will be examined using 2D Differential In-Gel Electrophoresis. There are many proteins in plasma a few of which are present in large quantities. The ability to identify candidate proteins necessitates removing these high abundance proteins, in order to allow detection of a larger number of proteins that are found in low abundance. Various techniques are available to deplete plasma of high abundance proteins. A significant methodological focus of this study has become identifying the optimal experimental design to facilitate achievement of the study aims.
Future plans: The future direction of this project is focused on optimising methods of protein analysis as well as recruitment of patients and data collection.
WORKFORCE
Belongingness : great motivation for graduated nurses
Zainah Mohamed Monash University
Biography:Author is a lecturer at School of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM). Major task is teaching undergraduate students. Basically, UKM is a Research University, where all teaching and learning activities are focusing on research oriented, for example, enquiry technique, exploratory and experiential learning, critical thinking and problem based learning. Previous research undertaken: i) ‘Intervention Education of Hub care On Neonates’, and ii) Nurses’ Knowledge and Skin Care Practices of Preterm Infants.
AbstractBelongingness : Great Motivation for Graduated Nurses
The phenomenon of belongingness at nurses’ workplace has played an important role in the outcome of nurses’ satisfaction. Result from previous studies has shown that the need to belong exerts a powerful influence on human outcome including cognitive process, emotional patterns, behavioral response, health and happiness. People deprived of belongingness are believed to experience diminished self-esteem which is lower in self-confidence and difficulty to gain respect by others. This condition if not taken care of will lead to de-motivation of staff. In the nursing literature, while there is paucity of studies about this salient issue, there are inferences that newly graduated nurses expressed the view that being accepted by colleagues was more important than being accepted by patient. While newly graduate nurses aim to be accepted by colleagues, senior nurses seem to be lost in term of belongingness in their own workplace with influence by other multidiscipline healthcare profession.
Therefore, this study seeks to explore how graduated nurses value belongingness in their working environment. It aims to see how junior nurses (less than one year working experience) achieve belongingness and how senior nurses (more than one year working experiences) maintain belongingness, and is there any difference between these two groups. This study will examine whether there is a relationship between belongingness and clinical culture, level of nurses’ confidence, years of working experience and education level. A mixed-method approach will be used and participants will be recruited from graduated nurses working in Malaysian hospitals.
Workplace satisfaction, wellbeing and nurse employment intention: An investigation of retention with year 2-5 registered nurses in rural Victoria Isobel Moase Australian Catholic University
Biography:Isobel’s clinical interests are palliative care and aged care. Much of her clinical career has been spent working with people with AIDS and in palliative care settings.
Her research interests include nurse satisfaction; nurse retention; rural and regional nursing issues; nursing education; and, the experiences of palliative care for patients and families.
AbstractWorkplace satisfaction, wellbeing and nurse employment intention: An investigation of retention with year
2-5 registered nurses in rural Victoria
Background:Australia like many other developed countries, experiences major issues with nurse retention. Subsequently there is an overall shortage of nurses that effects health care delivery. Many new graduates do not have an intention of remaining in employment due to job dissatisfaction. In regional and rural areas these issues are compounded by fewer opportunities for ongoing employment, education and career progression, and the need for an expanded skill set, which is sometimes unmet in graduate year programs.
Aims and Objectives: Investigate retention of year 2-5 registered nurses in regional/rural Victoria. Explore workplace satisfaction, wellbeing and nurse employment intention in year 2-5 nurses in
regional/rural Victoria. Develop a retention implementation strategy for nurses in regional/rural Victoria via knowledge
translation. Improve clinical patient outcomes by retaining nurses who are satisfied in their practice.
Research Methodology and Methods:
This research is emancipatory in nature and is thus located in the critical paradigm. A mixed quantitative/qualitative triangulated design, incorporating survey questionnaire, semi-structured interviews and reflective journaling will be utilised to achieve investigation of multiple points of view and ensure strength in rigour, credibility and analysis.
Research outcomes: Future plans:
The expected outcomes and plans for this research are: Greater depth of understanding of the experiences and needs of early career nurses working in
regional/rural Victoria. Development of a workable retention implementation strategy for regional/rural early career nurses. State policy changes in employment for early career nurses focused on workplace satisfaction and
improved retention.
What policy or organisational issues prevent increasing utilisation of nurse practitioners in healthcare organisations? Grainne Lowe Monash University
AbstractWhat policy or organisational issues prevent increasing utilization of Nurse Practitioners in healthcare
organisations?
Background:Improved access to care, patient satisfaction and safety are reported benefits of Nurse Practitioner (NP) models of care compared to traditional care models. It is recognised that for health services to remain sustainable and effective, flexibility, dynamism and reform of workforce design are required. Pressure on healthcare budgets, increasing service demand and workforce shortages have prompted the development of the NP model of care as a potential solution.
Despite the proliferation of NP roles internationally, NP roles have not yet developed significantly in Australian health service provision. This is made apparent by the relatively few NP positions within local healthcare organisations.
Aim:The aim of this research is to establish patterns associated with the continuing development and implementation of the NP role into healthcare organisations. The research objectives are to identify positive and negative perceptions of NP roles, establish issues associated with NP role implementation from key stakeholder perspectives, and to describe barriers in role development.
Methodology:A mixed methods approach will be used. This methodology has been chosen in order to provide a broad perspective across various healthcare organisations through survey data followed by individual interviews.
Conclusion:The need for a continued, cooperative approach by informed stakeholders is paramount for progression of the NP role to assist in delivery of healthcare needs in a variety of settings. The results of this research are expected to be significant in terms of the future direction of NP roles in healthcare organisations in Australia.
An exploration of nurses’ beliefs, attitudes and experiences relating to manual handling utilising the knowledge-to-action framework Kate Kay Australian Catholic University
Biography:Kate Kay is a cardiac nurse with post-basic qualifications in critical care. Her interest in manual handling commenced several years ago when she participated in the introduction of a formal manual handling program within her organization. The challenges of this role led to greater involvement in the manual
handling sphere and she currently holds the position of Manual Handling Training Coordinator at St Vincents and Mercy Private. She commenced post-graduate study in 2010.
AbstractAn exploration of nurses’ beliefs, attitudes and experiences relating to manual handling utilising the
knowledge-to-action framework
Nursing care involves complex patient handling tasks, resulting in high musculoskeletal injury rates. Epidemiological studies from the late 1980’s estimated lifetime prevalence of lower back injuries for nurses between 35 and 80%. Local and international papers continuing to mirror these findings.Implementation activities targeting manual handling injury reduction in healthcare have had limited success. Contemporary guidelines and policy-directed training have proved insufficient as evidenced by systematic reviews regarding their efficacy. Recent research directs attention to multidimensional approaches, as opposed to use of training in isolation, however the critical success factors are yet to be identified.This research will explore the lived experiences of nurses in relation to manual handling in healthcare settings. It will investigate nurses’ beliefs and attitudes towards manual handling, and identify barriers and enablers for successful manual handling strategies.
The research questions are: What are the beliefs, attitudes and perceptions of nurses pertaining to manual handling? What is the context for manual handling experiences of nurses? What are the barriers to implementation of safe handling practices? What strategies have successfully facilitated safe practice?
The research methodology is the knowledge-to-action process. This provides an effective framework to examine manual handling issues and develop appropriately tailored knowledge and interventions. The methods included in this study are focus groups, semi-structured interviews and reflective journalling.
The expected outcome is a greater comprehension of the manual handling experiences of nurses. This will inform knowledge translation interventions in order to improve nurses’ and patients’ safety.
ACUTE CARE
“ All hands on deck” – A collaborative practice model to delivering emergency care in rural hospitals
Elise Sullivan Monash University
Biography:Elise Sullivan is the Director of DPAR Consulting Pty Ltd, a company committed to working with governments, health services and health professionals to deliver health care that responds to the changing
needs of their community. She is also the Project Manager of the South Coast Inter-professional Clinical Supervision, which was recently funded under the Commonwealth Government’s ‘Increased Clinical Training Capacity’ Program.
Elise has worked in the rural health arena developing state and commonwealth government policy, managing programs, and practicing as a clinical nurse and manager. Elise was the Senior Nursing Advisor for the Rural Health Branch in the Victorian Department of Health between 2003 and 2009.
She is undertaking a PhD with Monash University on building collaborative practice in the rural health workforce. Today, Elise is presenting some of the findings of her PhD.
Abstract“All hands on deck” – A collaborative practice model to delivering emergency care in rural hospitals
Background:As workforce shortages grow, rural hospitals in Victoria are increasingly limiting their hours of provision of core emergency care because their model relies on a diminishing pool of visiting medical officers (VMO). Proposed solutions have not tended to challenge the status quo regarding the professional division of labour between nursing and medicine. Despite the stability and prominence of nursing in the rural health workforce (up to 60 per cent), their voice seems conspicuously silent in key discussions and strategies to fix health service and workforce problems associated with emergency care provision.
This study is based on the premise that strict divisions between the roles of nursing and medicine reduce access to rural emergency care. The solution lies in enhancing nurses’ power to negotiate the division of labour continuously, supported by their medical colleagues, advancing clinical scope of practice, hospital policy and legislation so they can operate safely and confidently in a new negotiated division of labour.
Aim:To establish the conditions needed to support a negotiated division of labour between doctors and nurses delivering emergency care from four rural hospitals and one bush nursing centre in Victoria.
Methods:An action research approach was used to engage nurses (15), doctors (3) and managers (8) in four rural hospitals and one bush nursing centre across Victoria to change status quo.
Results:The qualitative and quantitative results indicated that there was opportunity and support to enable nurses to operate at a more advanced level to they could manage more patient presentations autonomously.
There were a range of actions implemented during the course of this 18-month project both at the local health services level and state government levels to enable nurses to operate at this more autonomous level.
The collaboration between the people involved in this project (including between health services and government) was significant in achieve change in the way emergency care is delivered in the health services, and legislative and policy change on a state level.
Conclusion:Nurses and doctors in rural hospitals in Victoria need the capacity and opportunity to negotiate their roles in order to sustain safe emergency care. There are a range of factors that enable nurses and doctors to flexibly negotiate their roles in respect to each other, including advancing nurses’ clinical capacity, adapting hospital and government policy, and creating opportunities for these rural health clinicians to learn, work and plan change together. Action research provides the authority, forums, facilitation and data to support participants in identifying and establishing the conditions needed to enable nurses and doctors to effectively negotiate and enact their roles in delivering emergency care.
Exploring the experience of registered nurses caring for prisoner-patients in an acute environment
Ruth Crampton Deakin University
Biography:Ruth completed her undergraduate degree in NZ and has gained nursing experience in NZ, South Africa, England and Australia in a variety of clinical settings. Following her nursing degree Ruth has completed a BA (anthropology & education), Post graduate diploma (anaesthetics), and a Masters of Nursing (clinical teaching). Currently Ruth is working as a Clinical Educator at St Vincent’s Hospital and is completing a PhD with Deakin University which she hopes to submit late 2010.
AbstractExploring the experience of Registered Nurses caring for a prisoner-patients in an acute environment
Background & Aim:The experience of caring for prisoner-patients is one which presents the Registered Nurse with unique challenges. Fundamental to the nursing experience is the experience of care and caring, the attitude and activity. Past studies have explored the experience of nursing prisoner-patients from a forensic perspective, but there has been no examination to date of the unique circumstances experienced when a prisoner-patient presents to a general hospital where the primary goal is care not custody.
Method & Methodology:This phenomenological study used researcher journaling, 2 audio-taped in-depth interviews and observations of practice of 12 registered nurses, to identify what it was like for them to care for prisoner patients in an acute care peri-operative setting. The researcher, who was intimately familiar with the research setting, used the philosophy of understanding espoused by German philosopher Hans Georg Gadamer to draw out the participant’s prejudices (their verbalizations of their experiences); and their horizons (summations about what the participants expressed); to develop fused horizons (understandings that conveyed the essence of caring for prisoner patients from the participants’ fused and unique perspectives).
Results &Conclusions:Five key fused horizons or joint understandings resonated for all participants. They were:
Perfunctory care Reactive care Care as an emotionally draining experience Knowing makes a difference
These were then drawn together in a Succinct Statement:
Caring for prisoner-patients is an emotionally draining experience where knowing the prisoner-patients crime automatically creates prejudice and leads to the giving of reactive and perfunctory care.
Nurses’ preparedness to practice in emergency departments in the Kingdom of Saudi Arabia: An ethnographic study
Yousef Al- Both’hi Monash University
Biography:Yousef Al-Both’hi is a PhD candidate at the School of Nursing and Midwifery at Monash University. His research interests include emergency nursing, triage practice, nurses’ preparedness, and leadership. As a requirement of Master Degree at Monash University, Yousef conducted a descriptive study utilising questionnaire in three hospitals in Riyadh titled “An Investigation of Triage Practice in Three Saudi Arabian Hospitals”. He attended and presented in several conferences and health seminars.
AbstractNurses’ Preparedness to Practice in Emergency Departments in the Kingdom of Saudi Arabia:
An Ethnographic Study
In the kingdom of Saudi Arabia (KSA) 73% percent of the nursing workforce are expatriates who have diverse educational and experience backgrounds. The remaining 27% of this workforce are Saudi nurses. There are no post-graduate emergency courses taught by universities in the KSA to prepare nurses for practice in emergency departments (EDs). In an era when the Saudi government has adopted a policy of recruiting Saudi nationals in all workplaces, hospitals are challenged to ensure that staff (Saudi and non-Saudi) are prepared for practice. This study seeks to understand the preparedness and support provided for nurses in EDs in the KSA hospitals.
The research question ‘how are nurses prepared and supported for practice in the EDs in the KSA?’ has been addressed utilising a focused critical ethnographic approach. This study was conducted in three EDs of Ministry of Health Hospitals in Al-Qassim Region in the KSA. Data collection included observation, interviews with key informants, field notation and review of available related documents. All interviews were transcribed verbatim. Thematic analysis which involves a process of data reduction, coding and recoding was conducted.
This presentation will discuss preliminary findings found in this study. These will be related to the preparation and support available for emergency nurses, leadership and management, and education and training.
Changes in Amplitude-Integrated Electroencephalogram (aEEG) And Spectral Edge Frequency (SEF90) during paediatric general anaesthesia
Stephen McKeever University of Melbourne
Biography:Stephens’s career has focused on the care of the critically ill child whilst working in intensive care and emergency paediatric transport environments. Stephen is currently employed part time as a Clinical Nurse Specialist on the paediatric intensive care unit at Royal Children’s Hospital, Melbourne. He is enrolled full time as PhD candidate examining how the brainwaves of children respond to anaesthetics. The ultimate aim of this work is to enhance the delivery of anaesthetics and sedation given to children. As an active member of the Australian College of Critical Care Nurses Stephen is a Victorian representative on the National Paediatric Advisory Panel.
AbstractChanges in Amplitude-Integrated Electroencephalogram (aEEG) And Spectral Edge Frequency (SEF90)
During Paediatric General Anaesthesia
Introduction:Critical to improving the outcomes of children receiving sedation or anaesthesia is achieving the correct titration of somnolent agents. During adult anaesthesia monitoring the electroencephalogram has enabled improvement in peri-operative outcomes. Knowledge of the infant’s electroencephalogram response to anaesthetics is fragmentary. The aEEG and SEF90 parameters have been studied during adult anaesthesia but their relevance in the paediatric setting is unspecified.
Objective:To investigate aEEG and SEF90 during paediatric anaesthesia.
Methods:A prospective observational study was conducted on children, without neurological complications, receiving a general anaesthetic according to usual hospital practice. Sensors were applied in the frontal and biparietal regions. Electroencephalogram data was collected using the BrainZ ReBrim monitor and periods of artefact post collection filtered. The SEF90 and aEEG were analysed according to age and anaesthetic concentrations. Results:178 children (range 24days-14years) were enrolled. Whilst anaesthetised children <18 months showed an approximately linear increase in their aEEG with age, then after 18 months there was a plateau. SEF90 showed no association with age. A multi-comparison analysis demonstrated a consistent significant difference between the children <6 months and all other ages in aEEG but not SEF90.
The aEEG and SEF90 showed little or no correlation with the anaesthetic end-tidal concentrations. This is an unsurprising finding as anaesthetic equilibrium was not established.
Conclusion:Identification of age dependant electroencephalogram variables during paediatric anaesthesia could explain the poor performance of adult derived algorithms in children. These findings contribute to the understanding required to develop an objective measure of paediatric sedation and anaesthesia.
Evaluating the implementation and practice of family presence in the emergency department setting: a mixed methods design
Joanne Porter Monash University
AbstractEvaluating the implementation and practice of family presence in the emergency department setting:
a mixed methods design
Aim: To evaluate the implementation and practice of family presence in the emergency department.
Method: Research conducted in the emergency department is a series of complex interventions which requires both quantitative and qualitative evaluation. 1 A systematic review was conducted of the literature surrounding family presence during resuscitation in the emergency department setting with both adult and paediatric presentations. A mixed methods approach will identify the factors that influence the implementation of family presence during resuscitation and its practice. 2 An Exploratory design will be adopted to explore the phenomenon of family presence during resuscitation. The timing of the data collection will be qualitative followed by quantitative. Semi- structured interviews will be conducted in the United Kingdom, Sweden and Australia to inform the quantitative questionnaire design.
Conclusion: An exploratory design will be utilized to explore family presence in the emergency department and inform the quantitative questionnaire design.
1. Cooper, S. Porter, J. & Endacott, R. (2010). Mixed methods research: a design for emergency care research? Emergency Medicine Journal.
2. Creswell, J. & Plano Clark, V. (2007). Designing and Conducting Mixed Methods Research. SAGE Publications, London.
ELDERLY CARE / MENTAL HEALTH
Promoting and maintaining wellness among the elderly in South Sulawesi, Indonesia: an action research study
Kusrini Kadar Monash University Biography: Mrs. Kadar is currently a PhD candidate at School of Nursing and Midwifery at Monash University and
also an academic staff at School of Nursing, Medicine Faculty, Hasanuddin University, Indonesia. Areas of teaching and research interest are community health and family nursing, nursing education and nursing research.
Professor Francis is a recognized nationally and internationally for her contribution to the development of the discipline of rural nursing. Professor Francis has expertise in nursing leadership and management and has presented a series of workshops on Thailand and Malaysia on these issues. Professor Francis has served on many state/national committees and participated in forums examining and developing policy and/or guidelines on nursing education and practice
Dr. Sellick has a long career as a nurse educator, researcher and academic in the university sector in Australia and overseas. Professional qualifications include registration as a general and psychiatric nurse and as a clinical psychologist. Areas of teaching expertise are health psychology; counseling; community and community mental health nursing; and nursing research, especially quantitative research design, methodology and data analysis.
AbstractPromoting and maintaining wellness among the elderly in South Sulawesi, Indonesia:
An Action Research Study
Meeting the health needs of the elderly has become a major challenge for most countries globally as the proportion of elderly within the population rises. This phenomena is not restricted to developed nations, developing nations such as Indonesia are experiencing the similar demographic profile changes. Until recently, providing aged care services has not been a high priority for the Indonesian Health Department. Elderly persons living in rural areas of Indonesia have been notably neglected by Department of Health initiatives.
Methods: Two data collection methods were use: firstly interviews were undertaken with key staff from the three health organizations responsible for age care services in the area. Secondly a self-report questionnaire was distributed to health professionals working in local community health centres, independent health practitioners, and volunteers. The questionnaire was designed to obtain demographic details and information on the programs and services offered to the elderly.
Findings:Interviews were conducted with three staff from the District Health Office, two staff from the local hospital, and managers of 23 community health centers. A total of 18 questionnaires were completed by health professionals. The results from the survey found that majority of the health professionals still do more curative rather than promotive and preventive work for elderly in the community. Lack of budget and multitasks at the community centers seems to be the main barriers; continuity training related to elderly and more facilities are two main needs for the health professionals in providing services for elders in the community. Information obtained from this survey will be considered by the action research team to design, implement and evaluate supporting programs to meet the health needs of the elderly in rural South Sulawesi, Indonesia.
Residential aged care staff knowledge and beliefs about incontinence: a grounded theory study
Joan Ostaskiewicz Deakin University
Biography:Joan has a clinical background in continence care in the frail aged. She works as a Research Fellow at Deakin – Southern Health Nursing Research Centre and is undertaking a PhD study on continence care in residential aged care settings. Joan is involved in research activities on issues associated with quality and risk management in the context of ageing. Her recent work has resulted in a set of evidence-based continence assessment and management tools for use in the residential aged care sector.
AbstractResidential aged care staff knowledge and beliefs about incontinence: A grounded theory study
Background: More than 50% of individuals living in residential aged care facilities (RACF) are affected by urinary incontinence and between 10% and 30% experience faecal incontinence [1]. Managing incontinence consumes one third of the residential aged care subsidy [2]. Despite the significance of the issue, little is known about how continence care is provided, the issues and strategies that staff encounter and staff knowledge and beliefs that inform practice.
Aims and Objectives:The aim of this study is to explore and describe how RACF staff determine, deliver and communicate continence care to individuals living in RACF. This paper focuses on early coding analysis concerning staff knowledge and beliefs about incontinence and continence care.
Research Methods:Using grounded theory methods, data are derived from: In-depth interviews with unregulated workers, Enrolled Nurses and Division 1 Registered Nurses in
The RACF sector as well as individuals involved in assessing the quality of care. Field observations of continence care interactions between RACF staff and residents An analysis of resident records and accreditation reports
Early Findings:Early open coding analyses from five interviews reveals that staff focus on the use of pads to contain and conceal incontinence to ensure residents are ‘nice and clean and dignified’. Staff believe incontinence is either a behavioural response or an inevitable consequence of age and cognitive impairment. As such, incontinence is anticipated. Pads are promoted as a strategy to promote residents’ dignity.
Future Plans:These early findings will be enhanced with additional data to provide a grounded theory that describes and explains how continence care is provided in RACF.
References:1. Pearson, J., P. Finucane, et al. (2002). Incidence of incontinence as a factor in admission to aged care
homes. Report prepared for the Australian Government Department of Health and Ageing.2. Australian Institute for Health and Welfare (2006). Australian incontinence data analysis and
development. Canberra, AIHW. cat. no. DIS 44
Living in residential aged care: a process of continuous adjustment
Barbara McKenzie-Green Australian Catholic University
Biography:Barbara McKenzie-Green has worked with older people in the acute, long term and community care settings in Australia and New Zealand. Her teaching and research is situated within the gerontological specialty and has included grounded theory studies on the work of RNs, charge nurses and staff in Residential Aged Care. She is currently writing her PhD study which was commenced when working at ACU as research project officer with Professor Barbara Bowers, the inaugural Chair in Aged Care.
AbstractLiving in Residential Aged Care: A process of continuous adjustment
There is limited research which explicates the strategies residents use to manage their lives in residential aged care (RAC). The objective of this PhD study using grounded theory methodology was to learn how residents manage life in RAC. The study was conducted in two Australian not for profit RACs. Data collection included 24 days of participant observation and interviews with 23 residents and 19 staff. Theoretically underpinned by Symbolic Interactionism, data collection and analysis were concurrent, with theoretical sampling guiding the ongoing data collection. Findings reveal residents engage in three processes as they adapt to aged care: presenting an acceptable self, living a communal life and preserving the self. Depending on the resident’s priority at a particular time, one or more of these processes may be backgrounded or foregrounded. Additionally, residents’ lives in any, or all of the three processes, can be shaped by staff or by internal and external environmental conditions. The three processes, together with the conditions which shape them, demonstrate that residents are in a process of continuous adjustment. This study explains the effort that residents put into living in RAC and could serve to assist staff, management and policy makers to examine the ways in which residents are supported to live their lives as effectively as possible. Limitations to this study are that the majority of resident participants were assessed as having low care needs. Future research plans are to focus on how high care residents can influence their life in residential aged care.
Empathic engagement in the provision of nursing care to the person living with advanced dementia in residential care
Joanne Grainger Australian Catholic College Biography:Ms Jo Grainger is a registered nurse with 20 years of clinical experience. Jo's postgraduate qualifications include a Grad Dip in Critical Care and a Master in Bioethics. Other nursing positions held include management and education at St Vincent's Private Hospital, The Alfred, and Notre Dame University (Sydney Campus). Jo holds a permanent appointment in the School of Nursing and Midwifery at the Australian Catholic University (Victoria) and lectures predominately in the area of ethics and spirituality in health care. In 2009, she commenced her PhD in the area of empathic engagement in the provision of nursing care to the person living with advanced dementia in residential care.
AbstractEmpathic engagement in the provision of nursing care to the person living with advanced dementia in
residential care
The term ‘dementia’ is complex, in that it describes the symptoms of a large group of illnesses which cause a progressive decline in a person’s mental functioning. The number of persons living with dementia is expected to increase by 327% between 2000 and 2050, with more than half of persons with moderate to severe dementia living in residential care facilities (Alzheimer’s Australia, 2009).
Research into the care of the person with advanced dementia has until recent years been undertaken predominately from a biomedical perspective. In 1997, UK psychologist Tom Kitwood presented an alternative way of ‘knowing’ dementia beyond a biomedical approach. Kitwood (1997) presented that it is through empathic engagement of the person with dementia that care is truly ‘person centred’ as opposed to disease orientated. A person who has highly empathic skills is able to retain his or her own feeling states, while also being aware of the feeling state of the other. However in the care of the person with advanced dementia, this may be quite problematic as it may mean that the carer has to draw on their own feelings to fully reconstruct another’s frame of reference.
This study aims to explore what is empathic engagement in nursing care provision generally, and identify particular limitations, challenges and possibilities of such empathic engagement in caring for the person living with advanced dementia in residential aged care. For the meta-theoretical design of my study I have chosen a social constructionist research design within a critical inquiry theoretical framework and ethnographical methodology.
Alzheimer’s Australia. (2005). Dementia estimates and projections: Australian States and Territories. Retrieved from http://www.alzheimers.org.au/upload/EstimatesProjectionsNational.pdf Kitwood, T. (1997). Dementia reconsidered: the person comes first. Buckingham: Open University Press
Treatment planning and outcome measurement in mental health made easy
Brett McKinnon Monash University
AbstractTreatment planning and outcome measurement in mental health made easy
The Victorian Mental Health Act (1986) governs the care afforded to the mentally ill. In 2004 this Act was amended to include section 19A that stipulates that every patient receiving public mental health care shall have a plan pertaining to such care developed for them, with them and where applicable have the wishes of carers and significant others acknowledged as part of the planned care. The essence of section 19A is to foster strong working relationships between clinical staff and their patients.
Nearly 6 years since the inception of Section 19A services are still having difficulties achieving consistency in the development and delivery of such plans. In addition Outcome measures are a Commonwealth initiative that serves as a tool to evaluate planned care and consumer perception. The outcome measures suite of measurement tools consist of HoNOS, Basis –32 and Life Skills Profile (LSP) and serve as a valuable entity to allow services to examine their success.
This research aims to examine the current difficulties in treatment planning and determine whether a computer based program that has been developed by the candidate, makes a difference in terms of the desirable outcomes of treatment planning and Outcome measurement.
Specifically, the research aims to 1. Investigate treatment planning and outcome measurement as mandatory requirements in the care afforded to public system mental health patients. 2. Examine the current issues experienced in the treatment planning process by public mental health clinicians at five health services across the state. 3. Pilot a computer program that was developed by the research team and evaluate its effectiveness after a 6-month trial.
MIDWIFERY
Midwives and complementary and alternative medicine: a grounded theory study
Helen Hall Monash University
Biography:Helen is a qualified midwife, nurse and naturopath. She has worked in both the community and hospital settings in a variety of roles. She has been employed by Monash University since 2006 and is involved in teaching and course coordination of the Bachelor of Midwifery degree. Helen is currently undertaking a PhD exploring midwives’ response to the use of complementary and alternative medicine by pregnant women. Helen’s primary interests include midwifery models of care, cultural aspects of midwifery care, Indigenous women’s health and complementary and alternative medicine.
AbstractMidwives and Complementary and Alternative Medicine; a grounded theory study.
Complementary and Alternative Medicine (CAM) describes a group of therapies which are not generally considered to be part of conventional medicine. The use of CAM has become increasingly popular in the maternity setting in recent years. Research suggests there is widespread use of CAM during pregnancy and the majority of pregnant women believe these therapies to be safe. Expectant women frequently rely on advice from family and friends when deciding to consume CAM and many self prescribe. Midwives are involved with the care and decision making of childbearing women and will be increasingly required to assess the risks and benefits of CAM. The evidence suggests that they are eager supporters of complementary medicine. However, currently there are limited opportunities to become educated about the use of CAM in maternity care and few specific guidelines to assist midwives make informed decisions; this has implications for the integrity of the profession, and the wellbeing of the families midwives care for. This study aims to assist the midwifery profession and the health industry to better understand the challenges and processes involved in the use of CAM in the maternity setting, and to contribute towards a body of knowledge that results in better educational and practice guidelines. A grounded theory approach will be used. Participants will be practicing midwives working in a variety of maternity settings providing both antenatal and postnatal care. Data will be collected from relevant documentation (e.g. hospital guidelines/policies) in-depth interviews, and observation of a subset of participants in the clinical setting.
Using a mixed methodology to investigate the clinical obstetric profile encountered by Victorian emergency paramedics
Gayle McLelland Monash University
AbstractUsing a mixed methodology to investigate the clinical obstetric profile encountered by
Victorian Emergency paramedics
Whilst it is widely accepted that paramedics are the emergency care provider for out of hospital pregnant and labouring, very little is known about their management of obstetric cases. Very little literature that was found regarding out of hospital obstetric cases encountered by paramedics after a thorough review of national and international literature. Of the literature that was located, the majority focused on unplanned births before arrival (BBA) to hospital. It was revealed that compared to in hospital and planned home birth, maternal and neonatal outcomes from unplanned BBAs are significantly worse. The outcomes for mother and baby do not seem significantly different regardless of whether or not paramedics attend. This may be in part because documentation at these events has been noted as being poor. The small amount of content in most paramedic undergraduate curriculum may contribute to the lack confidence experienced by paramedics caring for a mother giving birth and the newborn baby. Un planned BBAs are only a minor part of the obstetric workload encountered by paramedics.
This study aims to use a pragmatic mixed methodology to investigate the clinical obstetric profile encountered by Victorian Emergency Paramedics. Using an explanatory framework, the first part of the study is a retrospective quantitative study using Ambulance Victoria’s database. The second part will be a qualitative study driven by results revealed by the initial study.
Applying a contemporary grounded theory method to explore Bachelor of Midwifery students’ experiences of achieving competencies
Sharon Licqurish Australian Catholic University
Section I.01 Biography:Sharon Licqurish is a midwifery lecturer and PhD candidate at Australian Catholic University and an independent midwife. Her PhD thesis explores midwifery students’ experiences of achieving competencies. She is also part of a team exploring the impact of birth space on women’s experience of childbirth and is co-author of two papers, one published and one recently accepted by Midwifery, an A* rated journal. She also has one paper under review by Nurse Researcher, an A rated journal.
Section I.02 AbstractApplying a contemporary grounded theory method to explore Bachelor of Midwifery Students’ Experiences
of Achieving Competencies
In this study, a contemporary grounded theory methodology was used to answer the research question; how and when do Bachelor of Midwifery students achieve competency for beginning practice? The methodology was informed by Adele Clarke's (2008) conceptualisation of grounded theory, situational analysis. Situational analysis uses traditional grounded theory methods of data collection and analysis but also draws on postmodernist/poststructuralist theoretical perspectives, particularly those of Michel Foucault, in order to identify the impact of discourses on individuals and situations. Situational maps are used to highlight the actors, both human and non-human, as well as discourses and positions taken within the data. This presentation will discuss the way in which the methodology was explored and applied during data collection and analysis, as well as present preliminary findings from the study.
Discourses influencing policy direction of the reform of maternity services in Australia
Meredith McIntyre Monash University
Biography:Meredith is committed to the professional advancement of Midwifery in Australia in the interests of improving the experience of women having babies. Research interests include; maternity services policy, measurement of clinical competence in midwifery education and women’s early parenting experience. Meredith is the past President and Vice-President of the Australian College of Midwives (Vic branch) and actively involved in the Victorian Midwives Academic group (MIDAC). Meredith is a PhD candidate in the area of maternity service policy.
AbstractDiscourses influencing policy direction of the reform of maternity services in Australia
After a decade of inquiries, commissions and reviews advocating the need for reform Australian maternity services are set to embark on a major program of change with the introduction of primary maternity care, a major shift in national policy direction. Government response to the need for reform has been cautious due to concerns that quality and safety standards might be jeopardised. These concerns have been reinforced by the dominant medical discourse; ‘childbirth is inherently risky’. This paper reports on the discourses that have influenced the direction of government’s reform agenda despite strong medical opposition.
A critical discourse analysis approach was used in this study because of its ability to highlight issues of power, an important element in the key stakeholder struggle to influence policy. Most recent maternity services policy documents from each state, territory and national government from 2004 - 2010 and national key stakeholder organisation submissions to the maternity services review 2008 were included in the study. A three-step analytic framework described by Fairclough (2003) informed the critical analysis of text including the following step by step processes; becoming familiar with the text, identifying themes and examining relationships between discourses, identifying discursive strategies used to sustain the discourse and examining the effects of the discourse.
(a)Analysis revealed three dominant discourses including: ‘Australia is one of the safest place to give birth or to be born, but not for everyone’; ‘maternity care is about mothers and babies’ and ‘government must ensure provision of safe and sustainable maternity services’.
PALLATIVE CARE
The palliative approach within the acute hospital setting
Christina Searle Australian Catholic University
Bibliography:Christina works at Austin Health as a Clinical Support Nurse for the graduate program on the Oncology/Haematology, Renal and Endoscopy Units. In 2006, she completed her Masters in Nursing Science with a qualitative study known as interpretive description, exploring the nurses’ perspective on pressure care management in patients at the end of their life. The study resulted in conference presentations, the Austin Health research award for a poster presentation and two articles published in 2008
AbstractThe Palliative Approach within the Acute Hospital Setting
Traditionally palliative care has been seen as relevant only to those approaching the terminal phase of their life. More recently this concept has been broadened to recognize that the palliative approach, that takes a holistic view to enhance the quality of life of those diagnosed with a life-limiting or life-threatening illness, can be of value far earlier in the course of an illness. Palliative care in contemporary times has been seen to offer people alternatives to exclusively curative interventions, and to act as an adjunct to such interventions. Acute oncology inpatient units are primarily populated by those with a life-limiting or life-threatening illness, and would arguably benefit from an incorporation of the principles of palliative care. However, generally the two areas of oncology and palliative care operate distinctly from each other. Acute oncology has cure as its focus, with palliative care only being considered when ‘cure’ is no longer seen as a clinical or medical possibility. An incorporation of the palliative approach within the acute oncology setting could potentially reduce this ‘split’ and provide treatment and care options for individuals earlier in the course of their illness. From clinical observations, nurses caring for patients in the acute hospital setting experience concerns about providing care during the patient’s transition from acute care management to palliative care. The aim of this study is to explore how care within an acute oncology inpatient unit could be constructed to incorporate a palliative approach. In this process patients are actively involved in the planning of their care, taking into account their needs for comfort and dignity, especially when they are no longer able to express their wishes and discomfort. This would include the patient’s wishes with respect to the role of their family members in their care. As this project is in the early stages of development, the paper will present an overview of relevant literature identified to date and an outline of the proposed methodology, which is anticipated to be ethnographic in orientation.
Caring for families of the terminally ill in Malaysia: a grounded theory from palliative care nurses’ perspective
Pathma Namasivayam Monash University
AbstractCaring for families of the terminally ill in Malaysia: a grounded theory from palliative care nurses’ perspective
Research problem:Caring for families of terminally ill patients is considered an important aspect of nursing because of the central role they play in care. Caring for families can be a challenge for nurses, in addition to providing care for the terminally ill person. However, there is a lack of research that has examined how nurses care for families of the terminally ill in Malaysian settings.
Research purpose:The purpose of this study was to explore how palliative care nurses in Malaysia felt about caring for families of the terminally ill.
Method:A grounded theory approach was used to provide insight into the issues being studied, to enhance understanding and provide a meaningful guide to action. Approximately 22 palliative care nurses working at five palliative care organisations in Malaysia who had experience caring for families of the terminally ill were selected using theoretical sampling method.
Results:The metaphor of Indian music was used to illustrate the results of the research. As the symbiotic relationship of the Indian musician with his/her audience can be considered to be similar to the nurse family relationship, therefore this was used to explain the results of the study. Furthermore, the theory of Indian music, in which the technique of improvisation was used, was found to be similar to the strategies that nurses used to resolve their main problem. The use of the metaphor of Indian music in relation to the results of the study will be described in this presentation.
Conclusion:Investigating this area of practice will help nurses understand their practice and enhance their knowledge of the behaviours of family members of palliative care patients and enable them to work in partnership with families.
End of life care in the acute hospital setting
Melissa Bloomer Monash University
Biography:Melissa has a background in diabetes education, intensive care nursing and nurse education. Melissa’s primary research interests relate to end of life care in critical care environments. Melissa’s previous research projects have focused on end of life clinical management in the ICU, and also clinician-family communication regarding death and end of life care, and how this relates to the decision making and patient care.
AbstractEnd of Life care in the acute hospital setting
Background:The Intensive Care unit is where the sickest of patients receive the most technologically sophisticated care, and many do not survive. End of Life (EOL) care is clearly defined and outlined in palliative care services but its place or existence in acute health services is not so clear.
Aims: The aims of this project are to:1. Explore EOL care in acute settings2. Develop practice guidelines for EOL care3. Implement developed guidelines in 2 acute settings (ICU and General medical) and 2 regions (Rural
and Metro)4. Evaluate the implementation of the EOL guidelines
Proposed methods:A mixed methods approach will be taken and will include: A systematic review of the literature Survey of health care workers regarding their knowledge, attitudes and skills regarding EOL care in
acute settings Survey of family members of recipients of their experiences of EOL in acute settings Development of clinical guidelines using Joanna Briggs Templates and incorporating expert review Develop the implementation strategy and action Undertake a comparative analysis of the implementation of the guidelines across the 2 sites and
regions Evaluate the implementation through individual interviews with clinicians, family members and recipients
of care if appropriate
Findings:Data will be analysed using appropriate statistical processes for numerical data and thematic analysis for narrative data. Findings will be incorporated into revised practice guidelines and will also be disseminated through peer-reviewed journals, conference presentations and thesis.
How do practice development strategies enable the implementation of evidence-based palliative approach guidelines in residential aged care?
Joan Yalden Monash University
Brief biography:Joan Yalden is currently completing doctoral research. She has a background in clinical nursing in the UK and Australia and over the latter part of her career, in nurse education and research. Her previous studies investigated older people’s experience of ageing, the development and implementation of a modified Tai Chi exercise program to promote the health of the older person and screening tools for use by nurses in the management of acute stroke.
AbstractHow to practice development strategies enable the implementation of evidence-based palliative approach
guidelines in residential aged care?
Background: Over the past decade, considerable emphasis has been placed on policy and evidence-based guideline development in attempting to make good quality palliative care more accessible to people in residential aged care. How guidelines are translated into practice has received less attention. This paper focuses on the outcomes of an evaluation of practice development strategies used in the development of a palliative approach in a residential aged care facility in Victoria.
Aim: To discuss how key strategies enabled the aged care team to implement a palliative approach in residential aged care.
Method: The participatory, inclusive and collaborative principles of action research and practice development underpinned the study design. Data from multiple sources were used to evaluate the impact of strategies on the implementation of a palliative approach. Results: Clinical strategies were developed through projects facilitated through active learning, critical and creative activities in clinical and management groups and supporting education. They included the development and use of an integrated palliative approach pathway; teamwork and communication; development of a holistic model of end-of-life care. How these strategies enabled implementation and the utilisation of evidence-based guidelines will be discussed under broad themes that emerged from the analysis and in the context of transformational processes.
Conclusions: Implementation of a palliative approach is enabled by processes that create conditions to support transformation in practice and are sustainable in the culture and context of care.
CARING, QUALITY OF LIFE AND DECISION MAKING
Factors influencing the process of decision making for registered nurses (RNs) working in residential aged care facilities (RACFs) when a resident’s health status changes
Bridget Fussell Australian Catholic University
Biography:Bridget Laging is a lecturer in the School of Nursing and Midwifery at ACU. She has worked in emergency departments throughout Australia since arriving from New Zealand in 2001. She has a strong interest in the nursing management of older people and in 2008 she completed an Honours research entitled “New Graduate RNs experiences’ of working in aged care contexts: A case study.” Bridget commenced her PhD part-time in 2009.
AbstractFactors influencing the process of decision making for Registered Nurses (RNs) working in Residential Aged Care Facilities (RACFs) when a resident’s health status changes
Older people housed in Residential Aged Care Facilities (RACFs) are the sickest and frailest of people in Australia, with severe or profound disability (Flicker, 2002). Currently, 6% of people aged 65 years or over live in RACFs, with an average age of 83 years (ANHECA, 2004). A common misconception is that resident’s needs are solely about day-to- day practical care and not the management of complex and unstable clinical problems. The Australian aged care workforce has seen major changes, particularly casualisation and the substantial substitution of personal care attendants (PCAs) for qualified registered nurses (RN)s (Commonwealth of Australia, 2005). Consequently, the staff making clinical decisions when a resident’s health status changes may range from a Division One RN who knows the facility, its procedures and residents, to an agency staff member with or without nursing qualifications who is unfamiliar with the facility or resident. While it is known that there is a significant increase in the dependency of older persons living in RACFs and a considerable reduction in the presence of RNs working there, there is a limited understanding of the issues impacting on RACF staff’s clinical decision-making when a resident’s health status changes. Very little is known about the experiences and actions of RACF staff with regard to such clinical decision-making, despite the centrality of their role. Using a critical ethnographic method, this study aims to explore the factors impacting on the clinical decision making of staff working in RACFs when a resident’s health status changes. This presentation will focus on a review of relevant literature and provide an overview of the planned research methodology and design.
Quality of Life Assessment of Children Requiring Long-term Oral Anticoagulant Therapy
Sophie Jones University of Melbourne
Brief biography:Sophie has a degree in Nursing (Hons) and is currently completing her Masters of Philosophy (Nursing), investigating the quality of life for children who require long-term oral anticoagulation therapy. Sophie has previously completed research exploring the negotiation of care between parents and nurses in the paediatric setting. Sophie’s previous and current research are relevant to her clinical role as a cardiac clinical nurse specialist, where she has been involved in providing education to paediatric cardiac nurses locally and internationally.
AbstractQuality of Life Assessment of Children Requiring Long-term Oral Anticoagulant Therapy
Background: Multiple studies have investigated the success of home international normalised ratio (INR) monitoring of paediatric patients requiring oral anticoagulant therapy (OAT). Home monitoring of INRs is a means of mobilising care from the critical and acute care practice setting to the community. No study has evaluated what impact home INR monitoring has on a child and their family’s quality of life (QoL).
Aims and objectives:To assess baseline QoL in a cohort of paediatric patients requiring long-term OAT and their family and to reassess QoL following commencement of home INR monitoring.
Research methods: Children completed two child QoL questionnaires. One parent from each family completed three parent-proxy QoL questionnaires. Questionnaires were completed once before commencing a home INR monitoring program and again six to twelve months later. Participants also answered four open-ended questions when completing the QoL questionnaires for the second time.
Results: 55 parents and 35 children participated. Preliminary results from the baseline child QoL assessment indicate that 60% of children thought their parents were overprotective sometimes or always and 85.7% children thought their parents worried. Being involved in sports was affected by OAT for 71.4% of children. The majority of children felt safe most of the time that they would not develop a clot (71.5% of participants) or bleed (65.8% of participants).
Conclusions: Baseline QoL assessments indicate that whilst these children have experienced major health challenges and long hospitalisations, their approach to life is not significantly impacted by their OAT. These early results enhance evidence for clinicians to provide patient-centred care that promotes normal growth and development.
Acknowledgement: The Brockhoff Foundation supported this research study.
Malaysian nurses attitude toward e-learning?
Mei Chan Chong Monash University
Biography:The author is lecturer of University of Malaya; she is currently a PhD Candidate at Monash University, Australia. Her research work is related to continuing professional education and readiness towards e-learning among Malaysian Nurses. Her others interest in research are nursing education, problem based learning, gerontology, infant feeding and community health nursing.
AbstractMalaysian nurses attitude toward E-learning?
Back ground:The study undertaken is understanding the need for CPE among Malaysian nurses and their readiness towards e-learning which involve two phases of study. Phase one was aim to explore the Malaysian current CPE practice. Second phase was to examine the Malaysian nurses’ readiness on e-learning.
Objective: This presentation will focus on one objective which explains the assessment of the attitude of Malaysia nurses towards e-learning as a means to CPE.
Methodology: A cross-sectional survey was carried out on 300 nurses to determine the nurses’ attitude towards e-learning. Sample was randomly selected from the previous pool of participant from previous survey on CPE who has agreed to be involved in this study. Self explanatory questionnaires were used to collect data.
Results: All participants (N=300) had returned the completed questionnaire. The participants attitude towards e-learning were satisfactory with the mean score of 3.62, SD=0.42, (minimum score 1.93 and maximum score is 4.82). The attitude score was categories into three groups, poor(less than 84points), good (84 to 111 points) and excellence (more than 111 points). Majority of them (224, 74.7%) had good attitude follow by excellence (60, 20%) and only 16(5.3%) had poor attitude.
Conclusion:Since Malaysian nurses are favorable in engaging CPE via e-learning mode, the Malaysia Nursing Board may need to consider implementing e-learning .the public institute of higher learning should integrate more e-learning module in the nursing curriculum and faculty members need to collaborate with the nursing administrator in the clinical area to facilitate course using e-learning.
How do you “do” phenomenology? Unravelling the mystery of secret Phenomenologists’ business!
Tracey McConnell-Henry Monash University
Biography:Tracy is a postgraduate lecturer at Monash University. Concurrently she is employed as Senior Nurse in Organ and Tissue Donation at Central Gippsland Health Service. Her doctoral thesis is by full publication and is entitled “When it is someone you know”. Tracy’s other areas of interest and research include the use of simulation in nursing education, high acuity and resuscitation education, end of life issues and psycho-social care of patients and bereaved families.
AbstractHow do you “do” phenomenology? Unravelling the mystery of secret Phenomenologists’ business!
Phenomenology, as influenced by Heidegger has baffled many a scholar with it’s esoteric use of language. Furthermore the confusion is exacerbated by authors frequently glossing over the method or approach employed to analyse the generated data, offering only generic terms such a thematic analysis without defining or explaining these terms. As a budding researcher I became increasing frustrated and disillusioned by the lack of information provided by researchers about the approach they used. Additionally the lack of explanation offered in regards to methods of analysis continue to plague phenomenology, endangering the integrity of this methodology as a rigorous research paradigm.
This presentation will endeavour to fill this void as I tease out and describe the approach I used in my PhD study which explored what it is like for rural nurses and midwives to care for people they know. Not only will I explain the way in which Heidegger’s philosophy was used to frame the study, I will also show how philosophy can be transformed into a user friendly method suitable for contemporary nursing and midwifery research.
WORKFORCE AND ATTITUDES
Professional supervision as a model for untrained health care workers.
Vicki Yarker-Hitchcock Monash University
AbstractProfessional Supervision as a Model for Untrained Health Care workers
INTRODUCTION:Unregulated health care workers (UHCWs) are fact of life in aged care and home care situations worldwide. The issues that must be examined relate to their support, learning needs and assurance of quality service provision. Clinical supervision (CS) has been widely used to facilitate health care workers needs for reflective and quality practice. To date there is limited evidence of the use of CS with unregulated health care workers. This project seeks to engage UHCWs using action research methods to investigate the feasibility of various models CS in aged care and home-based care. For the purpose of this project the term “professional support” has been used to overcome some of the negative associations regarding the term “clinical supervision”. AIM:To determine feasible models of professional support that relate to individual and organizational needs. METHOD:This project utilizes action research cycles to uncover the workable models of professional support that recognize the organizational cultures and the personal characteristics that influence and underpin each model. Four groups, comprising both aged residential care and home-based care workers in either rural or urban settings are participating in the project. Each model will be implemented over 12 months and evaluated using a range of measures. ANTICIPATED OUTCOMES:Outcomes will reflect individual and organizational growth and improvement in quality measures as well as the identification of enablers and challenges within the workplace or the process. This presentation will outline the project and work to date.
ENs in Australia – Different role or just another name? Elisabeth Jacob Monash University
Brief biography:Elisabeth has a background in critical care and nursing education. She has been involved in several research projects focusing on clinical placements for nurses and IPE. Having worked as a nurse educator in industry, TAFE and tertiary sectors with both undergraduate registered nurses and enrolled nurses, she has an interest in the difference in educational philosophy and curriculum for the different levels of nurses and the resulting differences in scope of practice in Australia. Abstract:
AbstractENs in Australia – Different role or just another name
Background:Enrolled nurses (EN’s) were introduced in Australia in the 1960’s to work as assistants to registered nurses (RN’s) under their supervision. The scope of practice for EN’s has changed significantly since 2000. The need for the increase in scope of practice was due to economic constraints and workforce shortages of RN’s. In 2006, the NBV introduced the enhanced scope of practice scheme for nurses in Victoria. This in effect paved the way for EN’s to practice any skill in any field in which they have been trained, deemed competent and endorsed by their organisation, resulting in an increasing use of EN’s in many acute patient areas previously reserved for RN’s. A major consequence of these developments is the overlap and role confusion between the practice roles of RN’s and EN’s.
Research Aims:This research aims to identify the differences in educational preparation and role expectations for the different levels of nurses on graduation in Victoria. Research Method:The research will use a mixed method approach including a comprehensive literature review on the scope of practice of EN’s and RN’s, examination of curriculum and course documents of 6 Victorian educational institutions preparing RN’s and EN’s for practice, verification of result in interviews with educators, and interviews with hospital personnel to determine required graduate attributes. Surveys will also be conducted of RN’s and EN’s completing their basic training from the previously selected six educational institutions to determine their initial understanding and expectations of their respective roles and scope of practice.
Impact of hospital organisational structure on patient outcomes and nurse job satisfaction in Saudi Arabia
Saleh Altallal Monash University
AbstractImpact of Hospital Organisational Structure on Patient Outcomes and Nurse Job Satisfaction in Saudi Arabia
Background: Organisational researchers have long sought to establish and identify the impact of organisational structure, particularly in hospitals regarding a number of important outcomes for patient and nurses (West, 2001). A literature review showed that the structure of the health care delivery system and the work environment have a significant impact on patient outcome and is a key factor in the level of workplace satisfaction for nurses. There is empirical evidence which suggests that hospitals demonstrating organisational attributes which enable nurses to fully utilise their knowledge and expertise, provide high quality of care (Havens, et al 1999).
In Saudi Arabia approximately 60% of health care services are provided by Ministry of Health (MOH) and the rest by other government sectors and private hospitals. Within MOH hospitals, there are currently two distinct management styles and from this arise two main organisational structures: autonomous structure (Decentralised) and bureaucratic structure (Centralised). However, despite the clear differences, the organisational structure and work environment of hospitals in Saudi Arabia has not been previously examined.
Aim:To examine the extent to which differences in patient outcomes, level of nurses’ job satisfaction and perception of the intensive care/critical care work environment might be associated with selected hospital organisational structures. The findings could provide a database to assist in the achievement of enhanced quality care outcomes.
Method: A descriptive comparative study utilising a mixed methods approach was used. The Index of Work Satisfaction (IWS) (Stamps, 1997) was used to describe and compare the level of critical care nurses’ satisfaction at seven hospitals represent two different hospital organisational structure. Critical care nurses’ perception of their practice environment was measured using Practice Environment Scale of the Nursing Work Index (Lake, 2004). A cross-sectional analysis of administrative data for three years from seven hospitals will be linked to hospitals organisational structure and critical units nursing characteristics. Patient outcomes of interest are mortality rate, medication errors, hospital acquired infection rate, and accidental extubation. Unit nurse staffing data were obtained during the study period by a Background/Structure Questionnaire developed by the student researcher and his supervisors and was completed by Nurse managers in each unit. Semi-structured interviews were also conducted with Nursing Directors and Unit Nurse Managers.
Results:A total of 268 nurses (67%) responded to the questionnaire. Some surprising differences were seen in term of respondents’ characteristics. Autonomous hospitals had higher RNs in workforce with significantly higher education preparation than bureaucratic hospitals. An analysis of the IWS showed that respondents working in autonomous hospitals were more satisfied (wages, task requirements, organisational policies, autonomy, interaction and professional status) than those working in bureaucratic hospitals.
Practice environment showed to play a fundamental role in the quality of work life in regard to staffing adequacy and levels, nursing leadership and support, availability of written nursing care plan, policies and procedures. Positive conditions for nursing practice environment were also found in autonomous hospitals than those working in other hospitals. Respondents working in autonomous hospitals have significantly more positive perception of staffing and resource adequacy than did respondents in other hospitals. These findings suggest that autonomous hospitals have adequate staffing (enough nursing personnel and RNs) and support services to provide highly patient care. They also have positive perception of orientation programme offered to newly employed nurses in their units. Furthermore, they rated their work environment more pleasant and safe than did respondents in other hospitals.
Analysis of administrative data and interviews are still in progress. Children’s attitudes towards their peers with asthma in primary schools
Mohammad Al-Motlaq Monash University
Brief biography:Mohammad Al-Motlaq is a PhD candidate and a research assistant in the School of Nursing and Midwifery at Monash University. His research interests are childhood chronic illness, paediatric health promotion, and developing instruments for nursing and public health research. Mohammad published and co-authored a number of papers and presented at many national and international conferences.
AbstractChildren’s attitudes towards their peers with asthma in primary schools
The attitudes peers hold toward a child with asthma can significantly impact their self confidence. It can be difficult for a child with asthma to spend their time in a class with peers who do not understand their situation and physical limitations. As part of a larger study to evaluate the efficacy of the Asthma Friendly Schools Program in Gippsland, Victoria, this paper sought to investigate the attitudes peers hold toward children with asthma and aimed to explore factors associated with their attitudes towards their peers with asthma. A total of 507 children without asthma completed an attitude towards children with asthma scale developed specifically for this study. Results suggested that participants held a positive attitude towards their peers with asthma.
