Dissertations / Theses on the topic 'Care of Victoria'
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1
Brundell, Kathryn Felicity. "Maternity care in rural Victoria: Midwives' perspectives." Thesis, Australian Catholic University, 2015. https://acuresearchbank.acu.edu.au/download/86d0d9b9b67fb204d15a134d98ff32193e99938b46baebfb665a6e6f4947d1b5/2369167/Brundell_2015_Maternity_care_in_rural_Victoria.pdf.
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This modified Grounded Theory study explored the experiences of midwives working in a rural Victorian setting during a period of maternity service redesign. Changes to the local maternity service under study were block funded by the Rural Maternity Initiative, Victoria, Australia (Edwards & Gale, 2007). The Rural Maternity Initiative, along with the release of the maternity service review report (Commonwealth of Australia, 2009), incorporated women’s requests for continuity of care provision, demedicalised care, choice in care, and accessibility of services across the pregnancy, birth and postnatal period. Midwifery workforce shortages and maternity unit closures in rural Australia have been identified by the government, maternity service users and other stakeholders as factors reducing options, and increasing travel requirements, and social and emotional costs for women (Hoang, Le, & Ogden, 2014). Australian state and territory governments encouraged the redesign of maternity services with continuity models of care, more often caseload care or team midwifery, in an effort to combat workforce deficits and rural inequities (Commonwealth of Australia, 2009). A review of literature was undertaken to frame key points associated with Australian health and maternity provision, recent policy developments, health workforce strategies, models of continuity care and rural maternity care accessibility. Significant gaps were noted, relating to the experience of the maternity service restructure in the rural setting, and the relationship between the health services undergoing maternity redesign and local communities. A modified Grounded Theory methodological approach was undertaken, using symbolic interactionalism as the theoretical perspective to frame the study. The work of seminal theorists Glaser and Strauss (1967) informed the design methods employed, particularly that of constant comparative analysis, coding and memoing. A modified approach was taken, however, influenced by constructivist concepts. Charmaz asserts that rather than ‘discovering’ theory, data is socially constructed by study participants with reference to their individual circumstances (Charmaz, 2006). Developmental work by Blumer (1986) significantly influenced the theoretical perspective of this study, as an inquiry based on the lived experiences of a small group of midwives who were affected by maternity service redesign in one locality. In line with symbolic interactionism, this study seeks to understand the meaning these midwives placed on changes and the social interactions they attributed to their work environment. The research setting was a small, rural maternity service, with a select sample population of fifteen. Participants were theoretically sampled and semi-structured interviews were the primary method of data collection. Constant comparative analysis was employed throughout the study, during which time the researcher became increasingly and thoroughly immersed in the data. Coding and categorisation was completed using OneNote Microsoft software to demonstrate thematic saturation and emerging theoretical concepts. It was during this rigorous analysis of data that a deep appreciation and understanding of Grounded Theory methodology was achieved. Constant comparative analysis enabled repeated interaction with data, comparative assessment of literature in conjunction with further data collection, and self-examination by the researcher. Themes that emerged from the midwives’ experiences of maternity service redesign in the rural Victorian context reflected known elements such as midwifery retention rates and burnout (Mollart, Skinner, Newing, & Foureur, 2013), and change planning, change leadership and interprofessional relationships associated with sustaining continuity models of maternity care (Monk, Tracy, Foureur, & Barclay, 2013). Two key themes related specifically to the rural context were communication of maternity service change, and change preparedness inclusive of women, families and interwoven rural communities.
2
Stuart, Rhonda Lee 1963. "Nosocomial tuberculous infection : assessing the risk among health care workers." Monash University, Dept. of Epidemiology and Preventive Medicine, 2000. http://arrow.monash.edu.au/hdl/1959.1/9004.
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Chau, Ka-kin Helen. "An oasis for children nursery and daycare centre in Victoria Park /." Click to view the E-thesis via HKUTO, 1999. http://sunzi.lib.hku.hk/hkuto/record/B31984459.
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Thesis (M.Arch.)--University of Hong Kong, 1999.Includes special report study entitled : Child's cognition of space. Content page of Thesis report missing. Includes bibliographical references. Also available in print.
4
Piterman, Hannah, and Hannah Piterman@med monash edu au. "Tensions around introducing co-ordinated care a case study of co-ordinated care trial." Swinburne University of Technology, 2000. http://adt.lib.swin.edu.au./public/adt-VSWT20050418.092951.
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The aim of the research was to analyse the organisational dynamics surrounding a health care reform implementation process associated with the introduction of coordinated care, which is an Australian Government initiative to introduce structural changes to the funding and delivery of health-care in response to rising health care costs. A longitudinal case study of an implementation team was studied. This included the perceptions and experiences of individuals and institutions within hospitals, the general practice community and Divisions of General Practice. Furthermore, the case study explored organisational structures, decision-making processes and management systems of the Project and included an examination of the difficulties and conflicts that ensued. The broader context of health care reform was also considered.
The study found that an effective change management strategy requires clarity around the definition of primary task in health care delivery, particularly when the task is complex and the environment uncertain. This requires a management and support structure able to accommodate the tensions that exists between providing care and managing cost, in a changing and complex system. The case study indicated that where tensions were not managed the functions of providing care and managing costs became disconnected, undermining the integrity of the task and impacting on the effective facilitation of the change process and hence, the capacity of stakeholders to embrace the model of co-ordinated care. Moreover, the micro dynamics of the project team seemed to parallel the macro dynamics of the broader system where economic and health care provision imperatives clash. Through its close analysis of change dynamics, the study provides suggestions for the improved engagement of stakeholders in health care change.
5
Chau, Ka-kin Helen, and 周家建. "An oasis for children: nursery and daycare centre in Victoria Park." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B31984459.
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Lea, Dorothy University of Ballarat. "Spiritual awareness of professional nurses in the western region of Victoria: Investigation of a significant component of holistic heath care." University of Ballarat, 2005. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/12789.
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A desire to more fully understand the impact of altered states of spiritual health on the general health of patients has been a focus of recent research activity. Studies have explored the meaning of spirituality held by patients and nurses, the spiritual needs of patients, and methods of providing spiritual care in nursing. However, few studies have investigated nurses’ own spiritual health and the significance this may have on the provision of holistic nursing care. The aim of this study, therefore, was to inform nursing regarding the spiritual health of nurses and the influence that nurses’ own spiritual health has on their ability to provide holistic nursing care to their patients. The study was conducted in two phases using both quantitative and qualitative methodologies. Phase one consisted of a survey of Division 1 nurses currently employed in the Grampians region of Victoria to describe key dimensions of their spiritual health. This survey provided biographical data and, through the use of the “Shalom Measure of Spiritual Health”, discovered the ideal of spiritual health held by nurses as well as the nurses’ perception of patient needs pertaining to the achievement of spiritual health. Phase two utilised Naturalistic Inquiry to further explore the meaning of spirituality and spiritual health held by nurses, and the methods of achieving these for nurses and patients. The findings revealed that although nurses perceive the spiritual dimension of patient care to be important, they feel ill-equipped to provide this aspect of care. In addition, the major support for nurses, who themselves experience spiritual distress whilst at work, comes from colleagues. Further, prevailing health care systems in place do not always lend themselves to holistic approaches to care. This study identifies the need for nurse education to redress the clearly inadequate preparation nurses are given for this aspect of their role. Health care policy-makers and administrators also have a responsibility to consider all dimensions of care when designing and implementing health care guidelines and systems.Master of Nursing
7
Lea, Dorothy. "Spiritual awareness of professional nurses in the western region of Victoria: Investigation of a significant component of holistic heath care." University of Ballarat, 2005. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/14624.
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A desire to more fully understand the impact of altered states of spiritual health on the general health of patients has been a focus of recent research activity. Studies have explored the meaning of spirituality held by patients and nurses, the spiritual needs of patients, and methods of providing spiritual care in nursing. However, few studies have investigated nurses’ own spiritual health and the significance this may have on the provision of holistic nursing care. The aim of this study, therefore, was to inform nursing regarding the spiritual health of nurses and the influence that nurses’ own spiritual health has on their ability to provide holistic nursing care to their patients. The study was conducted in two phases using both quantitative and qualitative methodologies. Phase one consisted of a survey of Division 1 nurses currently employed in the Grampians region of Victoria to describe key dimensions of their spiritual health. This survey provided biographical data and, through the use of the “Shalom Measure of Spiritual Health”, discovered the ideal of spiritual health held by nurses as well as the nurses’ perception of patient needs pertaining to the achievement of spiritual health. Phase two utilised Naturalistic Inquiry to further explore the meaning of spirituality and spiritual health held by nurses, and the methods of achieving these for nurses and patients. The findings revealed that although nurses perceive the spiritual dimension of patient care to be important, they feel ill-equipped to provide this aspect of care. In addition, the major support for nurses, who themselves experience spiritual distress whilst at work, comes from colleagues. Further, prevailing health care systems in place do not always lend themselves to holistic approaches to care. This study identifies the need for nurse education to redress the clearly inadequate preparation nurses are given for this aspect of their role. Health care policy-makers and administrators also have a responsibility to consider all dimensions of care when designing and implementing health care guidelines and systems.Master of Nursing
8
Ncube, Glen. "The making of rural health care in colonial Zimbabwe : a history of the Ndanga Medical Unit, Fort Victoria, 1930-1960s." Doctoral thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/11490.
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Includes abstract.Includes bibliographical references.
This thesis adopts a social history of medicine approach to explore the contradictions surrounding a specific attempt to develop a rural healthcare system in south-eastern colonial Zimbabwe (Southern Rhodesia) from the 1930s to the 1960s. Influenced by a combination of healthcare discourses and models, in 1930, the colony’s new medical director formulated the first comprehensive rural healthcare delivery plan, premised on the idea of ‘medical units’ or outlying dispensaries networked around rural hospitals. The main argument of the thesis is that the Ndanga Medical Unit, as this pioneer medical unit was known, was a variant of a typical colonial project characterised by tensions between innovative endeavours to control disease on the one hand, and the need to fulfil broader colonial ambitions on the other.
9
Clissold, Carolyn M. "How discourses stifle the Primary Health Care Strategy's intent to reduce health inequalities : a thesis submitted to the Victoria University of Wellington in partial fulfilment of the requirements for the degree of Master of Arts (Applied) in Nursing /." ResearchArchive@Victoria, 2006. http://hdl.handle.net/10063/185.
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Trenberth, Deborah Ann. "New Zealand families' beliefs about what constitutes successful management of unsupervised childcare : a qualitative descriptive study : a thesis submitted to the Victoria University of Wellington in partial fulfilment of the requirements for the degree of Master of Arts (Applied) in Nursing /." ResearchArchive@Victoria e-Thesis, 2008. http://hdl.handle.net/10063/640.
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Gardner, John. "The ordering of medical things : medical practices and complexity : a thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Master of Arts in Sociology /." ResearchArchive@Victoria e-thesis, 2009. http://hdl.handle.net/10063/1178.
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Ryder-Lewis, Michelle. "Reliability study of the sedation-agitation scale in an intensive care unit : a thesis submitted in partial fulfilment to the Victoria University of Wellington in fulfilment of the requirements for the degree of Master of Arts (Applied) Nursing /." ResearchArchive@Victoria e-Thesis, 2004. http://hdl.handle.net/10063/59.
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Gibbs, Lisa, and mikewood@deakin edu au. "'When the whole bloke thing starts to crumble... Men's access to chronic illness (arthritis) self management programs." Deakin University. School of Health and Social Development, 2003. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20051110.130916.
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This thesis explores the issue of men's access to chronic illness self management programs from a social constructionist perspective. A combination of research methodologies was used; a quantitative analysis to confirm gender differences in levels and patterns of service use; a qualitative analysis to gain an increased understanding of the factors affecting men's access; and a trial to test the application of the research findings. The clients and services of Arthritis Victoria were chosen as the setting for this research.
The quantitative analyses were conducted on contingency tables and odds ratios and confirmed that men were under-represented as service users. The analyses also identified gender differences in patterns of service use. The qualitative analysis was based on a series of in-depth, semi-structured interviews. It was undertaken from a grounded theory approach to allow for the development of theoretical explanations grounded in the data. It was found that men's decisions to access chronic illness self management programs were strongly influenced by dominant social constructions of masculinity which constrained help-seeking and health management behaviour. However, the restrictive influence of hegemonic masculinity was progressively undermined by the increasing severity of the chronic condition until a crisis point was reached in terms of the severity of the condition or its impact on lifestyle. This resulted in a reformulation or rejection of hegemonic masculinity. The described conceptual framework was consistent for men from diverse social groupings, although it appeared less prominent in both younger and older men, suggesting that dominant social constructions of masculinity have the greatest influence on health decisions during the middle stage of adulthood when work and family obligations are greatest.
The thesis findings informed the development of some guiding principles for reviewing the structure and delivery of chronic illness self management services for men. The guiding principles will have direct application in the planning of Arthritis Victoria programs, and implications for other chronic illness self management programs in Australia, and also in Western countries with a similar health and sociocultural setting to Australia.
14
Jarden, Rebecca Jane. "Gastric residual volumes in the adult intensive care patient : a systematic review : a thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Master of Nursing (Clinical) /." ResearchArchive@Victoria e-Thesis, 2009. http://hdl.handle.net/10063/1188.
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Cordery, Carolyn Joy. "Dimensions of accountability : voices from New Zealand primary health organisations : a thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Doctor of Philosophy in Accounting /." ResearchArchive@Victoria e-Thesis, 2008. http://hdl.handle.net/10063/583.
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Buckley, Patricia Louise, and pbuckley@swin edu au. "'A sense of place' : the role of the building in the organisation culture of nursing homes." Swinburne University of Technology, 2000. http://adt.lib.swin.edu.au./public/adt-VSWT20060317.114711.
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This study attempted to identifj and explore the role the building plays in the
organisation culture of nursing homes. To do this a research plan was formulated in
which the central plank was a case-study of a seventy-five bed high care nursing home.
As part of the case-study, interviews were conducted at the nursing home with ten
members of staff, two residents and a daughter of a resident. The study was also
informed by interviews with two architects, who specialise in the design of nursing
homes and aged care facilities. A theoretical model entitled the 'Conceptual
Framework' was developed prior to the case-study. It was tested by applying it to
findings related to the physical context and the organisation culture of the case-study
venue. The hypothesis that the building does influence the culture of the nursing home
environment was explored by studying the manner in which the building influenced the
lives of those who work in the nursing home and those who live there. This challenge
was met with the use of theoretical contributions from organisation theory and psychodynamics,
which together provided a vehicle for analysis of the culture and the
building's role in it.
17
Chalkley, Paul F. "‘Crying for home: Who really cares?’ A critical analysis of care giving in the context of Victorian residential care." Thesis, Australian Catholic University, 2018. https://acuresearchbank.acu.edu.au/download/f35e05d418bface1677d5bc4f0601cfc1788c863b6bb47202200b96e0dd408fb/951505/CHALKLEY_2018_Crying_for_home_who_really_cares.pdf.
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Residential care provides for approximately 500 children and young people in Victoria each year, yet the dynamics of providing care within this system have received little scholarly attention, at least in part because it forms a much smaller part of the system than home-based care – in 2014 there were 5,900 children and young people in foster care and kinship care in Victoria. It has long been recognised that, despite being highly traumatised and vulnerable, young people placed in the care of the state are often exposed to further distress, instability and torment because of the nature of the out-of-home care system, and the available literature confirms that this is certainly true in residential care. Central to the care these young people receive, and their experience of being ‘in care’, are the agents through which the care is delivered: residential care workers. This thesis fills a gap in knowledge by examining the perspectives and practice of residential care workers, asking how they understand their ability to support good outcomes for children and young people within the restrictions of residential care settings which are far from perfect.
This thesis presents the findings of a qualitative study of interviews with twelve residential care workers that was guided by the principles of grounded theory. Led by the themes which emerged from these interviews, this project examines the pillars of good practice as residential care workers themselves understand them – both those which they can directly articulate, and those which are part of their tacit knowledge.
The findings point to three key areas. Using the framework of ‘care’ as provided by Tronto, the three areas that emerged were (i) caring about, (ii) taking care of and (iii) care giving. At the heart of these areas are the concepts of being rooted in genuine relationships, trauma informed practice and connection to the community. These findings point to guiding principles that residential care workers see as helping them to be effective in not only doing their job, but also in providing authentic and personal care to the young people.
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Kain, Victoria J. "Developing palliative care models in neonatal nursing : an investigation of barriers and parameters for practice." Thesis, Queensland University of Technology, 2008. https://eprints.qut.edu.au/17012/1/Victoria_J._Kain_Thesis.pdf.
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The neonatal intensive care unit (NICU) is frequently occupied by newborns who are marginally viable, or critically unwell, and could be considered terminally ill. It is a busy, highly technical environment with an arsenal of life-saving medical equipment at its disposal, and advances in technology used in this field stretch the boundaries of viability. Despite technological advances, increases in the margins of viability and highly skilled healthcare delivery, some newborns will still die in the NICU. In recent years, palliative care for the neonatal population has become increasingly topical and part of the lexicon of contemporary neonatal practice. Evidence-based protocols are available to inform this model of care, yet in reality, provision of palliative care to newborns is ad hoc. The reasons why implementing a palliative model of care have been problematic are unclear. The purpose of this study was to identify the barriers and facilitators to palliative care practice in neonatal nursing, and to develop policy recommendations to improve this area of practice. This exploratory research was conducted to answer two research questions: 1) What are the barriers and facilitators to palliative care practice in neonatal nursing? 2) How can the identified issues be addressed to inform policy and clinical guidelines in the practice environment?
Phase one of this investigation developed, pilot tested, and administered an instrument to identify the barriers and facilitators to practice. Data analysis identified three subscales that indicated facilitators and barriers to palliative care practice. The second phase of this study used a translational research approach, utilizing interpretive methods to explore and contextualise the population study findings to inform policy development to improve palliative care practice in neonatal nursing. This research has identified that the facilitators that do exist for palliative care practice are subject to caveats that impinge markedly upon these facilitators. Furthermore, the barriers that were identified pose threats to the integration of a palliative model of care into Australian neonatal nursing practice. Thus, the overall results from this research have lead to a composite understanding of the barriers and facilitators to palliative care practice in Australian neonatal nursing, which may account for the gap between support of palliative care for marginally viable and critically ill newborns, and the application of this model of care in clinical practice. Translating the survey findings into policy directives that are applicable to the clinical environment has resulted in the development of recommendations that are aimed at improving palliative care practice in the NICU.
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Gibson, Oliver. "Health, environment and the institutional care of children in late Victorian London." Thesis, Queen Mary, University of London, 2017. http://qmro.qmul.ac.uk/xmlui/handle/123456789/25821.
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Using the example of the London-based children's organisation Barnardo's, this thesis examines the influence of contemporary ideas regarding the relationship between environment, health and disease on the organisation and everyday institutional practices of the charity. While autobiographical accounts and historical investigations have written on the 'man himself' as well as the discursive and representational strategies used by Barnardo's to justify child removal, the importance of environmental discourses to the institution remain underexplored. The thesis addresses this lacuna through a detailed analysis of archival materials relating to Barnardo's (committee minutes, pamphlets, reports, Dr Barnardo's personal notebooks) as well as through a textual analysis of Night & Day, the main outlet for publicising the work of the charity and stimulating support for it. The thesis covers the period from 1866, when Barnardo's was founded, to the death of Dr Barnardo in 1905. This is a period when the environmental idea was arguably at its strongest, with a host of social ills (from criminality and prostitution, to human health and vitality and later in the period racial degeneration) linked to the influence of the environment. Like many other social reformers and philanthropists, Dr Barnardo was a firm believer in environmental explanations for such social ills, as well as a committed evangelical Christian, and promoted the rapid removal of young people (not all were orphaned but the vast majority were destitute) from urban and familial environments believed to do harm to their physical, moral and spiritual health. Where the first part of the thesis covers the importance of environment to the Barnardo's justification for his child removal practices, the remainder of it considers the response of the institution to environmental ideas. In addition to examining the influence of environment on institutional design and on the everyday practices of the 'inmates', for example the promotion of light and air in the girl's home at Barkingside, emphasis is also placed on ideas of mobility and movement. Here the thesis explores the paradoxical relationship between the organisation's 'anti-institutional' projection and the institutional realities of constructing and policing 'out of home' care practices (trips to the country- and seaside, boarding-out, emigration). This thesis contributes to extant accounts of Dr Barnardo's; however, its primary contribution lies in its nuanced examination of the role of environmental ideas on shaping institutional design and on its influence on the everyday practices of Barnardo's young inmates.
20
Mansour, Gerard. "Child care in the retail industry in Victoria." Thesis, 1994. https://vuir.vu.edu.au/17934/.
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The aim of this research is to investigate the child care experiences and attitudes of those who work
within the retail industry in Victoria and it concentrates on the needs of parents with children aged
under 13 years old.
A number of issues are presented as part of the background information for this research: a summary of the historical developments in relation to the provision of child care for
working parents; the substantial growth in the participation of women in the workforce, including those
with dependant children, as well as the reasons why they work; the nature of the retail industry and the structure of employment in Victoria; the various types of child care arrangements which are used by working parents.
The methodology adopted to investigate the child care needs of retail workers in Victoria involved
several phases: interviews, group discussion, a questionnaire and phone polls. The practical field
research occurred in two separate phases, firstly interviews were conducted with retail workers and
the second phase was a survey of 893 workers in the retail industry in Victoria.
21
Lopez, Susan. "Indigenous self-determination and early childhood education and care in Victoria." 2008. http://repository.unimelb.edu.au/10187/8551.
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This thesis explores how Victoria’s early childhood community negotiates colonial constructions of Aboriginality around dualisms such as Indigenous/non Indigenous and intersecting constructions of the child as ignorant or innocent of race and power both in concert and conflict with the non Indigenous early childhood community. It found a need for a reconceptualisation of Aboriginality around complexity and multiplicity as well as continuity and uniformity. Such a reconceptualisation can better address those issues of race, culture, identity and racism that see Indigenous communities marginalised within non Indigenous early childhood programs.These negotiations around the colonial and the implications for Indigenous inclusion within the early childhood field are framed within post colonial theory which unites and connects major themes across tensions and contradictions. These themes act as a basis for each data chapter.
22
Sutton, David F. "An analysis of paediatric palliative care in the state of Victoria." Thesis, 2005. https://vuir.vu.edu.au/17919/.
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The concept of palliative care as an holistic approach to the management of patients
with incurable conditions has its roots in the hospice movement. It has since grown
into an established field of practice for health professionals of all disciplines and has
been recognised as a medical specialty since 1987. Palliative care remains relatively
underdeveloped in the paediatric setting for a number of reasons. Firstly, death in
childhood is now relatively rare due to the advent of antibiotics, immunisation and
advances in the treatment of malignancies. This means that any health professional's
individual exposure to palliative care issues is limited, making the development and
maintenance of skills difficult. Secondly, the traditional model of palliative care, as a
path to be taken when all curative options have been explored, does not adequately
serve children and adolescents where the transition to palliative care may be less clear
due to a broader range of diagnoses and patterns of disease progression. Children also
present added dimensions to palliative care including developmental, ethical and
physiological considerations. The involvement of parents as care givers and decision
makers further increases the complexity of providing palliative care.
Research is lacking and the evidence on which to base practice is limited.
Nevertheless, there are theoretical constructs that can be utilised to build a framework
for research in this area. The works of Glaser and Strauss, Corr and Copp on theories
of death and dying coupled with earlier works by Freud, Erikson and Piaget on
theories of childhood development provide a suitable theoretical framework. Corr's
'task' based model described in 1992 allows us to view the process of providing
pediatric palliative care from many different perspectives, and thus provides for a rich
multi-dimensional model of pediatric palliative care to be constructed.
This study was done to analyse and investigate the knowledge, attitudes and needs of
both providers and recipients of palliative care in a major tertiary paediatric hospital,
the Royal Children's Hospital (RCH), Melbourne, Australia and, in addition, to
examine various models of delivery of paediatric palliative care in use around the
world, and to identify from the literature the constituents of care that make up 'best
practice' as regards paediatric palliative care. From this investigation it is hoped to
develop a model of care that will best serve the RCH and its patients.
23
Taylor, Kara. "In search of dignified maternity care: an exploration of childbearing women's experiences of midwifery care in Victoria, B.C." Thesis, 2009. http://hdl.handle.net/1828/1494.
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This thesis is based on follow-up research from a project undertaken by my supervisor, Cecilia Benoit and colleagues (2007) entitled Social Determinants of Postpartum Depression: A Mixed-Methods Longitudinal Study (henceforth referred to as the “postpartum and health project study” -- PPHS). The PPHS examined the prevalence of postpartum depression amongst a diverse sample of mothers in Victoria, British Columbia. The main findings illustrate that the greater a woman’s satisfaction with maternity care, the lesser her likelihood of postpartum depression. The group of participants with the least satisfaction was those who were transferred from midwifery care to obstetrical care. This group also had a lower mean income than other care provider groups, such as those who retained their midwives, pointing to the connection between socio-economic status and quality of care.
In search of dignified maternity care for all women, that is care that is respectful and autonomous, my research foregrounds the narratives of women who were transferred from a midwife to an obstetrician during their labour or birth (n=11). I examine the formal and informal support they receive, and interactions between health care practitioners and reasons for satisfaction or dissatisfaction with care. I also compare the experiences of women who were transferred from a midwife to an obstetrician with those who retained their midwife in the PPHS.
My findings indicate that both sample groups’ satisfaction of care and well-being was due to feeling they had autonomy over the birthing process, adequate information from health care providers about medical and technological procedures, and support. The participants’ who were transferred, however, were less likely than the group who retained their midwife to experience the above elements of care. Participants who were transferred said they felt invaded by unnecessary procedures and technology, which contributed to a decreased level of autonomy. However, both sub-samples were affected by a lack of multi-disciplinary teamwork in the hospital setting. This had more of a negative impact on participants who were transferred from a midwife to an obstetrician.
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Gilmour, Carole. "Renovating midwifery care : the complexity of organisational change for midwives in Victoria, Australia." 2009. http://hdl.handle.net/2100/1072.
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The importance of the role of the midwife in providing safe, quality care for women has until recently, been underrated in Victoria, Australia. Acknowledgement of the need for midwife-led models of care in state maternity service policies provided opportunities for midwives to become recognised within the healthcare system and the wider community. This professional doctorate aims to examine the ways in which the role of the midwife and her practice has been impacted on by organisational renovations of midwifery care. It identifies the complexity of the factors that affect the midwife’s ability or choice to work in midwife-led models of care. Furthermore this doctorate highlights the need for ongoing debate into midwifery in Australia. Concepts related to midwifery practice are examined as they form the foundations for the research and policy components of the portfolio. This includes an exploration of midwifery philosophy, the antecedents to autonomous practice and the experience midwives have of midwife-led care. An examination of the concepts of continuity of care and woman-centred care provides a platform upon which to review models of midwifery care. This review highlights the development of an ongoing relationship as a source of satisfaction for midwives and women. The second part of the doctorate reviews policies that guide the provision of maternity services in Victoria. Analysis of these policies using Kingdon’s multiple streams framework identifies the problems, the political actors and the policy developed, establishing the context for organisational change in maternity care. The antecedents for successful integration of organisational change are explored through a review of change theory and leadership. A case study approach utilised for the research component of the doctorate provides insights into organisational change that occurred at two maternity sites in Victoria. The findings of the study suggest there was a dichotomy between those midwives desiring autonomous practice and wanting to work in midwife-led care and those wishing to remain in one specialised area. Recommendations stemming from these findings include the need for sufficient education and support during change, a review of terminology used to describe midwifery models of care and research into the use of integrated maternity units. Complexity science is examined in order to bring the different strands of the doctorate together, providing an explanation for the different outcomes that occur despite the implementation of similar models. The connective leadership model was suggested as the means to provide leadership that is inclusive of providing direction, mentoring new leaders and providing support and opportunities for midwives to become empowered to practice autonomously. Attention to the complexity of organisational change is vital to ensure the future of midwifery.
25
Butler, Kate. "Negotiating Citizenship Practices: Expressions of citizenship in the lives of youth-in-care in Greater Victoria." Thesis, 2013. http://hdl.handle.net/1828/4571.
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Expressions of youth citizenship are evident in young people’s actions, behaviours, and embodied experiences. Young people in late (post) modernity occupy a liminal position when it comes to citizenship. On the one hand, they are conceived of as rights-bearers with particular responsibilities to themselves and others; at the same time, they are presumed to belong to a family unit that will take care of their major interests. Young people with government care experience (henceforth referred to as “youth-in-care”) practice citizenship at an intersection of private and public in their lives as wards of the state. They are expected to belong to foster families of some sort, even though this kind of living situation is often temporary, fragmented, and unsettling. In an era of self-responsibility and rights claims, being unmoored from traditional family life illustrates some of the inherent tensions of practicing citizenship. While youth citizenship literature has proliferated in the last two decades, the focus has often been on rights and responsibilities, rather than the differences in citizenship practices amongst youth themselves. Expressions of citizenship by youth-in-care are contextualized by internal and external factors that shape these young people’s lives. Furthermore, the history, politics, cultural difficulties and social implications of child protection systems have received much attention from academics and policy-makers, but research on youth-in-care as citizens remains rare. This dissertation explores the gap in the literature by looking at the ways that citizenship is complex, multilayered, and fluid for this group of young people. A qualitative research design is used to examine how youth-in-care practice citizenship in their daily lives. Semi-structured interviews were conducted with participants between the ages of 14-24 in Greater Victoria, all of whom had been in government care at some point in their lives (n= 20). Transcripts were coded using an analytical hierarchy strategy. Findings indicate that the social group in question – youth-in-care – practiced citizenship in a multitude of ways, and that it was important to take situational or social context into consideration when examining how they expressed citizenship. Analysis of participants’ narratives revealed three types of citizenship practices, namely self-responsible citizenship, dissenting citizenship and reluctant citizenship. Expressions of citizenship were navigated through experiences of self-responsibility and rights, belonging and exclusion, and risk and resilience. Citizenship, therefore, is best understood through behaviour and actions, as well as enacted and embodied by participants themselves. For youth-in-care, citizenship practices matter in their relationships with others, the ways they experience belonging and exclusion, and the discourses of resiliency and vulnerability which emerge from their narratives. The dissertation concludes with a consideration of the implications of the findings for the literature on youth citizenship, focusing on the ways that youth citizenship is contextualized by experiences with family, peers, institutions, and the government care system.Graduate
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Colley, Alasan, and Alasan Colley. "Comparison of Patients’ and Health Care Providers’ Perceptions of the Quality of Diabetes Care for Patients with Type 2 Diabetes at the Royal Victoria Teaching Hospital." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/70902326662510782549.
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Phillips, Rachel E. "Health and the sex trade : an examination of the social determinants of health status and health care access among sex workers." 2003. http://hdl.handle.net/1828/424.
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Harrington, Marisa. "Examination of healthcare workers’ response to rotating shift work during the COVID-19 pandemic in Greater Victoria care sites." Thesis, 2021. http://hdl.handle.net/1828/13257.
Full textAbstract:
Nurses are already exposed to plenty of stressors while at work, one of which
being the unavoidable nature of rotating shift work scheduling which can have profound
physiological effects carrying heightened long-term health risks. Working on the
frontlines of the COVID-19 pandemic has introduced new stressors while further
exacerbating the effects of pre-existing ones in this already understudied group of
essential workers. The purpose of this research was to examine physiological markers of
stress and health in nurses during the COVID-19 pandemic. Nine subjects (mean age
32.11 ± 7.25 years) from two hospitals in the Greater Victoria region collected data over
an eight-day shift roster consisting of two 12-hour day shifts, two 12-hour night shifts,
and four days off in two separate collection periods; remote data collection was used to
adhere to COVID-19 safety guidelines. Salimetrics ELISA kits were used to conduct
analyses for salivary cortisol, melatonin, and interleukin-6 (IL-6) content. Frequency
domain heart rate variability (HRV) was collected with a Polar H10 Chest Strap and
Polar Ignite Activity Tracker. A salivary sample and 5-minute HRV recording were
obtained upon waking or shortly thereafter on each day; a second saliva sample was
obtained after work for the four working days. The Expanded Nursing Stress Scale
(ENSS) was completed at the end of the last night shift in each period. There were no
significant differences between IL-6 concentrations across the eight days within each period; the same was observed for cortisol. Additionally, no difference was apparent
between the morning and evening salivary cortisol concentrations, thus demonstrating a
blunting of the diurnal release pattern. Evening salivary cortisol concentrations remained
elevated near the level of morning samples and were consistently above reference values
for the population age group. Morning salivary melatonin concentrations significantly
differed by day (F(5, 25) = 6.626, p < 0.001) but not period; melatonin concentrations
were lowest following night shifts, showing a suppression in release due to participants
being exposed to light at night with shift work. No statistically significant differences
were apparent between any frequency domain HRV parameters in either Period 1 or
Period 2. Perceived occupational stress was heightened in comparison to previously
published pre-pandemic research using the ENSS. The results of this research reveal
alterations to the circadian nature of cortisol and melatonin alongside elevated perceived
occupational stress; these physiological and psychological effects can compound the risk
for adverse health outcomes. While it is difficult to discern the root cause of these
responses, it nevertheless reveals insight into the effects of nurses working during the
COVID-19 pandemic and raises concern for potentially related disease risk.Graduate
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O'Hara, Denise Anne. "Organisational challenges: the boundary spanning role of divisions of general practice in Victoria, 1993-2006." 2007. http://repository.unimelb.edu.au/10187/2206.
Full textAbstract:
This qualitative study investigates the evolving role of Divisions of General Practice (Divisions) in linking general practitioners (GPs) and general practice with the wider health sector in Australia. The work draws on boundary role theory within organisations, integration theories, empirical research on service integration involving general practice, and structural interests theory to develop the conceptual framework on which the research was based. The data for the research came from both documentary and interview sources that gave voice to Divisions in the state of Victoria, Australia. The documents used represented the core working documents of Divisions, and the semi-structured interviews involved 30 key informants, these being leaders in all Victorian Divisions.
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Touray, Musa, and Musa Touray. "the use of mobile electronic assessment form for Tuberculosis care and control at Royal Victoria teaching Hospital Banjul the Gambia." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/30878727082885025453.
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碩士臺北醫學大學
醫學資訊研究所
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Background: Healthcare delivery with mobile technology is one of the key strategy and component in tackling chronic non-communicable diseases (CNDs) like tuberculosis. It is well-stated for the need of latest and reliable technology tools for assessment of these CNDs embodiments like Tuberculosis (TB). Primary measure of battling and early detection to control the spread of TB is vital, its associate and complications in Royal Victoria Teaching Hospital (RVTH) is assessed in this research study. In this study, a revise technology acceptance model is examined to determine healthcare system delivery to public in acceptance by healthcare professionals in RVTH. Method: A descriptive study using questionnaires and mobile device used by the nurses to electronically record TB suspected patients and their perception about the MEAFTC implementation in their work. Result: A total number of 64 participants, first age group between 24 ~ 29, which a total number of 11 male of (25.6%) and female 32 (74.4%) . A higher number of age group 30 ~ 34, showing a higher number of 17 female with an impact factor of 81.0% to declare the high age group of professionalism in training. This statistical analysis has a major impact in The Gambia at RVTH for younger age female nurses than male nurses. Conclusion: This research provides an insight study of Mobile-phone-based electronic health record system in The Gambia for TB patient assessment. Therefore, mobile base electronic assessment is of paramount importance and it will help facilitate the easy uploading of data to hospital’s patient database in real-time over the phone network or where mobile network connectivity may be unreliable, and completed electronic forms can be stored on the phone and then bulk upload when connectivity is available. Keywords: OpenMRS, SANA ,chronic non-communicable diseases, electronic health records, MEAFTC, mobile technology, tuberculosis.
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Elderkin, Tania. "Retention of graduates of critical care nursing courses undertaken in Victorian regional centres between 1995 and 1997." Thesis, 2002. https://vuir.vu.edu.au/33013/.
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Nursing recruitment and turnover is a significant issue for the health care system, as
high turnover rates can contribute significantly to negative outcomes in terms of cost
and quality of care. Both critical care and regional nursing have been highlighted as
areas of specific concern in the literature (Department of Human Services, 2001),
but no studies have focussed on the retention of regional, critical care nurses.
This research is an exploratory, descriptive study to. investigate the outcomes of
tertiary critical care nursing courses based in Victorian regional hospitals in terms of
employment and retention of graduates and the factors which influence this.
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Ryan, Kerry. "Palliative care for an ageing population: a rural based model? Or, “For whom the bell tolls”." Thesis, 2007. https://vuir.vu.edu.au/1482/.
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Statistics show that Australia has an ageing population which will experience radical changes over the next 50 years due to the progression into retirement of generations born in the ‘baby boom’ years (1945-1965). Statistics also show that the proportion of Australian people over 65 is increasing and, as the majority of deaths occur in this age group the demand for palliative care, or care of the dying, is also likely to increase. Many retiring baby boomers looking for a sea change, gravitate towards coastal and rural areas may well be contributing to Foskey’s (1998) notion of ‘Aged Care Ghettos’ where these areas may not have the desired infrastructure to deal with an increased demand for health services including palliative care services. An increasing focus on, and public interest in palliative care research will likely emerge in keeping with the changing needs of an ageing population. It will become particularly important that relevant research undertakings are initiated to establish a clearer understanding of the issues and problems surrounding palliative care. At the present time there exists a limited research base in relation to palliative care and related services in Australia. While there has been a concentration of palliative support services in urban settings this has not been the case in rural based settings. Palliative Care Australia (2000) reported that half of the people receiving palliative care in Victoria in 1997 died in rural and regional areas, which may be attributed to harsher living environments, poor access to health services, specialists, and health professionals, lower socio-economic status and employment levels, and exposure to occupational hazards. This thesis is concerned with examining palliative care services and related needs in a selected rural area within the Australian state of Victoria. The overall aim of this research was to investigate the availability of palliative care services, trends in ageing and to examine the relationship between the two. Methodology used in this research incorporated a sequential mixed methods approach of quantitative and then qualitative methodology to determine the relationship between the needs of an ageing population and rural palliative care service delivery in Australia. The data collection included demographic statistics from the Australian Bureau of Census and Statistics and Palliative Care Australia, and were used for descriptive purposes to inform and support this research. Other ordinal data were obtained using a questionnaire. These data were analysed in the context of the research. Qualitative data were obtained through interviews with focus groups. The Gippsland area provided an excellent area for this research and the findings of this research would appear to be consistent with the literature relating to access and equity issues faced in rural areas. Other rural areas may replicate the data gathering used in this research. A number of conclusions are able to be drawn from this research based on the review of literature and examination of the emerging issues, results and findings. Statistical projections into ageing indicate that the health of all Australians will have significant consequences for our society as we generally live longer and healthier lives. Health and ageing predictions and projections should prompt key stakeholders including baby boomers, the aged cohorts of the future, to plan and prepare, perhaps redefining ageing in the attempt. Findings further show that planning should include preparations for the expected rise of dementia related diseases and the implications of gender on health which will have ramifications for an ageing population, and in particular for women as carers in our society. As a result of this research recommendations are made for a model for the delivery of palliative care services in rural areas, which is specific to the needs of an ageing population. These recommendations are made in acknowledgement and with respect and consideration for the concerns of the rural community where feedback from focus group participants suggests that rather than another ‘model’, a hospice is what is needed to meet the current and future needs of rural communities. “Another ‘Model’ is the last thing we need, it’s not the how we are doing things, it’s the where – we desperately need a hospice down here” and, “It’s bricks and mortar we want down here, not more theories”. Evidence collected from this research also suggests that a ‘rural attitude’ to death and dying may prevail. In its simplest form, this attitude emerges in statements such as: ‘it’s the country you expect to get less’ and ‘we just look after our own when we can’. It is also apparent that while people in rural areas have the same medical and palliative care needs as those in metropolitan areas, this research shows that they are differentially disadvantaged when it comes to accessing palliative care services. This research has found that a negative relationship exists between ageing trends in a selected rural area of Australia chosen for this study and the availability of palliative care services.
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Finn, Joanne. "The Rhetoric and Reality of Continuing Professional Development for Critical Care Nurses: A Critical Ethnographic Perspective." Thesis, 2018. https://vuir.vu.edu.au/38653/.
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Current research and evidence into Continuing Professional Development
(CPD) has mostly centred on effective delivery formats to engage consumers.
The perceptions and approaches that influence an individual engaging in CPD
have yet to be explored, particularly in nursing. This qualitative research
grounded in critical social constructionism and critical ethnography explores the
perceptions and influences for regional intensive care nurses from Victoria,
Australia as they engage in CPD. Participants from three field sites participated
in semi-structured interviews. Through interviews the major themes of fear and
vulnerability, isolation, professional inconsistencies and a myriad of concern for
the nursing profession were identified. Threaded throughout each theme was
the social influence of workplace upon nurses’ perceptions and their approaches
toward CPD and the sharing of acquired knowledge amongst colleagues.
The theoretical perspective of Pierre Bourdieu have been used to explore and
discuss the findings of the research through the positions of orthodoxy and
heterodoxy. These two positions allow the reality and the rhetoric of mandatory
CPD for Australian nurses to be revealed, as shared by the participants.
Orthodoxy and heterodoxy bring to light a disconnect between the regulatory
body of the Australian Nursing and Midwifery Board (NMBA), and the nurses it
registers. Nurses engage in CPD influenced by peers and often as a means of
protection or a strategic tool to acquire and hold capital and power. The NMBA
mandates CPD for knowledge growth and practice change. The findings reveal
that nurses’ and the NMBA appear to be playing a game creating a state of
illusio, with many nurses looking to mandatory CPD to maintain their
employability rather than, public protection. This research highlights the
symbolic power of CPD exposing the influences of social culture, habitus and
the field in which nurses’ practice.
Recommendations of this research suggest that the current model of CPD is
fundamentally flawed. Significant changes need to be undertaken to achieve the
goal of public protection through a contemporary and knowledgeable workforce.
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Rouse, Elizabeth Jane. "Effective family partnerships in early childhood education and care: an investigation of the nature of interactions between educators and parents." Thesis, 2014. https://vuir.vu.edu.au/25861/.
Full textAbstract:
Early childhood education and care in Australia is recognised as playing an important role in determining the long term educational benefits and outcomes for children across their life span. A key determinant of a quality early childhood program is the quality of relationships that educators develop with parents and families as equal partners in the education and care of young children.
In 2010 the State of Victoria, Australia, launched a framework for educators working in early childhood settings. This framework identified family centred practice (FCP) as the approach to be implemented by educators in their work with families. FCP has been widely used in early childhood intervention programs since the latter part of the 20th century; however, this approach had not previously been adopted in mainstream early childhood education and care contexts.
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Mugisha, Emmanuel. "Delivery and utilisation of voluntary HIV counselling and testing services among fishing communities in Uganda." Thesis, 2008. http://hdl.handle.net/10500/2954.
Full textAbstract:
The study explored, described and explained the current models of voluntary counselling and testing services delivery and analysed the extent to which a given VCT model had influenced uptake of VCT services in the fishing communities along the shores of Lake Victoria, in Wakiso District, with an aim of designing optimal VCT service delivery strategies. The study was therefore exploratory, descriptive and explanatory, and collected both qualitative and quantitative data in a three-phased approach. Phase I involved the Kasenyi fishing community respondents, while phases II and III involved VCT managers and VCT counsellors at the Entebbe and Kisubi Hospitals.
The findings indicated that VCT services are generally available onsite at health facilities, and in the field through mobile VCT outreach or home-based VCT services provided at clients’ homes. Both client-initiated and health provider-initiated VCT services are available and services are integrated with other health services. Despite the availability of VCT, only about half of the respondents in phase I had accessed VCT services although almost all indicated a willingness to undergo HIV testing in the near future. The main challenges to service delivery and utilisation included limited funding and staffing as well as limited awareness in target communities. The strategies drawn are based on the need to increase availability, accessibility, acceptability and utilisation of VCT services.Health Studies
D. Litt. et Phil. (Health Studies)
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Bristow, Glenys Julie. "What are the characteristics (types of knowledge) residential youth workers with high-risk young people bring to the field of residential work? “Identifying artistry in youth residential workers: fact or fiction?”." Thesis, 2018. https://vuir.vu.edu.au/38631/.
Full textAbstract:
This study investigates the characteristics of therapeutic residential care workers with high-risk young people. It takes as its focus the types of knowledge that those who are considered as exceptional residential workers bring with them to the field, and explores the notions of ‘artistry, knowing, intuition, essence and gut feelings’ in relation to the construction of the professional residential care role.
Fourteen residential youth workers with 10-plus years’ experience were interviewed to investigate notions of exceptional practice in relation to:
• their characteristics, ethics, values
• if the multiplicities of theories and artistry they demonstrated were largely due to life development and learning, experience, gut feelings, and/or intuition
• if formal education / training is the most effective way of informing conscious residential work practice.
Drawing on a bricolage of knowledge, theories and theorists across disciplines to scaffold and frame the reconstruction of ways of knowing, this multi-genre methodology creatively utilised narrative research. The metaphor of quilting was drawn upon to contextualise the rhizomatic nature of the research process through which a crystallised understanding of my critical ontological values, ethics and morals afforded emergence of the interconnected history of people’s lives within a developmental bioecological model.
Four knowledge categories emerged, resulting in a ‘percentages model’:
[i] historical/developmental life stages and impacts
[ii] educational and training and bioecological contexts of lived experience
[iii] social learning
[iv] confirming the existence and essential roles of ‘artistry’, spirituality, gut feelings and intuition.
These four stages are analysed to inform workforce promotion, recruitment/retention, training, mentoring, reduction of WorkCover and sickness costs and the possible subsequent loss of valued residential workers.