Dissertations / Theses on the topic 'Community health nursing Standards Australia'

This descriptive• study discusses the development of community mental health (CMH) in Western Australia (WA) and describes the current practising population of CMH nurses. The study explores literature pertaining to the emergence of the CMH movement and the deinstitutionalisation of the mentally ill. A conceptual framework was developed by adapting Lewin's change theory. CMH nurses practising in WA (n= 130), were invited to participate in the study and were asked to complete a survey questionnaire. This resulted in a 66% response rate (n = 86). Quantitative data was analysed using the Statistical Package for the Social Sciences (SPSS). Open ended questions were analysed using Colaizzis steps. The study found that mental illness has been treated according to contemporary beliefs. In the 1950s multiple forces within society led to the movement away from institutionalisation of the mentally Ill toward deinstitutionalisation. The first community clinic was established in 1956 to manage the deficit between the ever expanding population needing mental health care and the paucity of available hospital beds. The need for follow up of clients in the community resulted in the development of CMH nursing. The study also provides a profile of the current practicing population of CMH Nurses in WA, demographic details, qualifications, the work environment, educational needs, work role and job satisfaction have been described. Recommendations have been developed from the findings and are directed towards, the dissemination of information, the need for role identification/development, staff development needs, future education needs, industrial issues, clinical practice issues and areas for further nursing research

Rural palliative care nurses (RPCNs) in Western Australia (WA) are a small population, who have embraced the specialist palliative care role since the first palliative care service in rural WA began in 1990. However, there are some challenges involved with being a specialist nurse in a generalist health care setting. fu particular, there is a suggestion in the literature that RPCNs may be professionally isolated, may be prone to burnout, and may therefore experience decreased job satisfaction and may consider leaving the palliative care field.

The aim of this study was to determine the ability and proficiency of the newly qualified professional nurses in utilising psychiatric nursing skills at Chris Hani District Psychiatric Health Care Services in the Eastern Cape, South Africa. The research method was a qualitative, phenomenological approach. A purposive sample of newly qualified professional nurses and supervisors participated in the study. The data were collected through interviews and focus group discussions, using semi – structured interview guides. Interviews responses were recorded on the interview guide. Data were analysed using the computer software Atlas ti and manually. Positive and negative themes were identified. Ethical considerations were ensured by means of privacy, anonymity and confidentiality. Ethical clearance was obtained from the University of Fort Hare and permission from the Provincial Department of Health and Chris Hani District Health and Mental Health Institution at Queenstown was sought. The findings revealed that newly qualified professional nurses performed well, according to the perception of their supervisors. Newly qualified professional nurses were faced with challenges such as shortage of resources, mental illness not considered as a priority and lack of skills development. The study also revealed that newly qualified professional nurses focussed on the curative aspect of ailments, rather than preventive care. However community health workers (CHW) focussed on the preventive aspect of care. Limitations and recommendations based on the findings of the study are presented.

This thesis comprises two interrelated sections. The first section is a substantial piece of creative writing, which l have cailed 'Other People's Country: A Memoir, in the genre of travel memoir, and an essay. The memoir borrows techniques from fiction, drama and poetry to tell a story of a middle-aged, middle-class city nurse, who travels to a remote settlement at the edge of the Western Desert of Western Australia to provide health care for a fluctuating population of around 400 people, for whom English is a third or fourth language. Writing that includes stories about vulnerable people from another culture, whose lives have touched those of the writer, demands sensitivity to differences, as well as an ethical approach. Writing about Aboriginal people also demands an awareness of what is appropriate when writing about cultural material. To achieve the voice of a trustworthy narrator is a challenge that faces all writers of narrative non-fiction, including memoir. The truth is subjective; perception is unreliable; memory can be distorted; error slips in unwittingly; deliberate falsification is possible. In spite of all this, a writer of memoir makes a contract with the reader that the story is significant, and that it is the writer's truth, told as honestly as possible. The pivotal concern of this thesis is the question, 'What are some of the important considerations for a memoirist who is attempting to develop the voice of an ethical and trustworthy narrator writing about experiences encountered when living and working within an unfamiliar culture? The second part of the thesis is an essay which develops a theoretical framework in response to some of the major dilemmas I encountered in this undertaking. It embraces memory, aspects of Aboriginal vulnerability, and ethics through which to explore the concepts of truth and honesty in memoir-writing.

This study investigated current use of American Association of Colleges of Nursing guidelines in preparing the baccalaureate nurse graduate to practice nursing in the community health sector of the healthcare delivery system and use of community based healthcare delivery sites by baccalaureate programs located in non-urbanized and urbanized areas. The extent of guidelines adoption, plans by colleges not currently using them to do so in the future, and impact of accreditation visits on the adoption of the guidelines were also explored. A qualitative survey design was used to describe the use of AACN guidelines in the development of baccalaureate nursing education.

La prestation coordonnée de soins de santé primaires (SSP) a été éprouvée comme améliorant la qualité et l’accès des soins prodigués aux Canadiens. Plusieurs études ont notamment confirmé les avantages des infirmières praticiennes (IP) et des modèles interprofessionnels en SSP pour le système de santé. Les écrits suggèrent toutefois que l’intégration des IP en SSP est jalonnée de tensions et restructurations en raison d’une confusion supposée de leur rôle. À ce jour, les recherches ont principalement ciblé les barrières et facilitateurs de l’intégration du rôle des IP. Une analyse critique des dynamiques socioprofessionnelles et politiques de l’intégration des IP n’a toutefois pas encore été réalisée. Une ethnographie critique combinant la Théorie de l’acteur-réseau et les concepts foucaldiens de discours, savoir et pouvoir a permis l’examen des interactions sémiotiques caractérisant certains milieux de SSP. Différents modèles interprofessionnels de SSP (2 centres de santé communautaire, 2 équipes de santé familiale et 2 cliniques dirigées par les IP) ont été investis. Les données issues d’entrevues semi-dirigées avec des IP (n=23), d’observations directes de milieux et de rencontres interprofessionnelles, et d’analyse documentaire ont été soumises à une analyse thématique puis une analyse critique de discours. Les résultats montrent que la valeur morale des IP, les finalités organisationnelles des milieux de SSP, les normes de pratique, la collaboration interprofessionnelle et la prise en charge des patients disposent les IP à la négociation de leur rôle et à certains enjeux socioprofessionnels et politiques qui génèrent plusieurs contrecoups: pluralisme de leurs rôles professionnels, dissonance identitaire, sentiments d’incompétence et d’incertitude, glissements discursifs dans leurs propres discours, et divers états émotionnels et souffrances. Ces contrecoups commandent diverses stratégies d’adaptation et de résistance permettant aux IP de gérer ces tensions. Plusieurs entités non-humaines (inscription des clientèles, discours de soutien aux médecins et espaces physiques) émergent comme acteurs agissant sur l’intégration et la négociation du rôle des IP en SSP. Cette étude permet de décrire le processus de traduction du rôle de l’IP en SSP qui problématise certains discours tenus pour acquis en SSP. Elle permet également de proposer une nouvelle définition de l’intégration du rôle des IP en SSP.

D.Cur.
Nursing is a clinical discipline, strongly anchored in clinical practice. In order to learn the art and science of Nursing, it should be kept in mind that nursing is a complex and intrinsic process that entails skills that are highly cognitive. Community Nursing is one of the clinical disciplines in which clinical guidance takes place. Guidance in Community Nursing takes place on district health level and is based on the primary health care approach. With clinical guidance from a community nurse in the community nursing practice, students are given the opportunity to apply in clinical practice what they have learned in theory. Students learn in the clinical practice by working alongside a competent, experienced and registered community nurse. They are guided to realise their full potential, to develop self-confidence in psychomotor skills, as well as the good values which are an inherent part of nursing. Due to the fact that the clinical learning environment is dynamic, it is necessary to ensure value-sensitive clinical guidance in the community nursing practice. This implies that the values of all role players involved in clinical guidance, namely the students and nurses (the patients during clinical guidance) should be handled with the necessary sensitivity. The goal of the study was to explore and describe to what extent value-sensitive clinical guidance in Community Nursing takes place. As a result of the findings a concept analysis of the categories identified was done and standards for value-sensitive clinical guidance in Community Nursing were developed and refined. For the purposes of this study an explorative, descriptive and contextual design was used. Interactions taking place between the nurses and students during clinical guidance were explored for value-`sensitivity by means of video-recordings, participative observation, diaries, focus-group and semi-structured interviews. The data collected were analysed and coded by the researcher and the external coder. As a result of the findings in this research a concept analysis was done of the different categories (identified in phase 1). The findings were compared with the literature in the concept analysis and similarities and differences were highlighted. As a result of the concept analysis standards for value sensitive clinical guidance in Community Nursing were developed, described and refined after it was presented to experts from academic training institutions and the community nursing practice. The four main categories identified were communication, attitudes, respect and clinical opportunities during clinical guidance. Due to the fact that professional socialisation mainly takes place in the clinical practice clinical guidance should be well-planned. Nurses acting as clinical guides should always keep in mind that they are acting as role models who are in possession of sufficient theoretical and clinical knowledge, and that they must maintain high nursing care standards. Nurses must approach the clinical guiding situation with an open and accommodating attitude. Students should be respected as human beings in order to establish open communication channels whereby clinical learning in students could be facilitated. Therefore a supportive, non-threatening clinical practice should be established, so that students will take the liberty to ask questions and will have the confidence to participate in clinical nursing actions under the direct supervision of nurses. The standards for value-sensitive clinical guidance in community nursing are aimed at all role players involved with clinical guidance. These role players include the service providers (the nurses, clinical co-coordinators and managers), as well as the academic training institutions (lecturers and students).

By 2014 the NHS is expected to make �21 billion in efficiency savings and increase productivity by 6% per annum, while maintaining or improving the quality of care. Given that the cost of the 1.7 million strong workforce represents 60% of the NHS budget, changes are likely. This context of innovation and cost-effectiveness has resulted in an ever greater emphasis to fully engage and support community nursing.

The social phenomenon of stress and workplace burnout has spanned over five decades. Despite a plethora of literature that exists, there still remain problematic issues that neither scientific investigation or government legislation have been able to resolve. The literature examined throughout this research is extensive and does reflect this 50-year period. It demonstrates that studies into this phenomenon have attempted to define stress, identify causal factors of workplace stress, workplace burnout and environmental congruence; and discusses strategies (focused on both the individual and organizational levels) that have been implemented to effect beneficial outcomes for individuals affected by any one of these. As this thesis continues, the more recent literature gives a greater recognition to violence in the workplace and legislative enactments as preventative measures to reduce the heavy burden of costs, both physical and financial, to organizations. This extensive literature review indicates no answer to the problem has been identified to date and that this phenomenon remains, giving a clear indication that further scientific investigation is required to find a solution to what was described as the most serious health issue of the 20th century. Based on the literature examined this health issue has now gone well beyond the 20th century, giving relevance to the research study described in this thesis. The investigation is validated as vital and should be used as a basis for further research. This study undertook a collaborative social process, action research, empowering participants to identify and change stressful factors identified within their practice indicative to rural remote community mental health teams. A critical social theory arose out of the problems within the context of the research setting, based on the ideal that the significant issues for this group of individuals within this organization could be solved through the action research process. The group ‘existed’ within the issues indicative to this rural remote area, however these issues were outside their control. Through the implementation of the action research process courses of actions were undertaken that provided enlightenment in self-knowledge with dialogue heightening collective empowerment to effect change within their practice. The action research process, being a holistic process, facilitated this change in practice, developed and refined theory as it proceeded in a cyclic fashion within this local setting. It concerned actual not abstract practices in the social world in which these participants practice. This methodology facilitated examining the significant stressors identified by the Community Mental Health Support Team (CMHST) that caused distress, allowing them to implement changes in their practice. The forum provided an avenue that could reduce stressors significantly and prevent ongoing occupational stress that contributes to workplace burnout. It offered an opportunity to work with a group of participants in a nonhierarchical and non-exploitative manner and enabled members of this group to identify their roles as effective practitioners, empowering them to effect the changes they deemed as essential criteria to reduce the stress they were experiencing indicative to their remoteness. Critical reviewing throughout the data collection attempted to understand and redefine these significant issues. It aimed to acknowledge the way things were relative to how things could be improved from organizational, personal and wider community perspectives. Simple principles and guidelines of action research were followed potentiating acceptance as a rigorous research approach from a positivist perspective whilst retaining the attributes that characterise action research. There are solutions to the dilemma of the employee overcoming the debilitating effects of stress leading to workplace burnout. This includes the cooperation of managers, policy makers, academic researchers and government officials working collaboratively to reduce the impact of occupational stress. Through this collaborative process, changes can be effected to ensure the health of the nation improves and that relevant recognition is given to the fact that there is a significant threat to a healthy workforce. Examining the nursing profession from a social perspective provides alternatives to medicalising workplace injuries and illnesses.
Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

The social phenomenon of stress and workplace burnout has spanned over five decades. Despite a plethora of literature that exists, there still remain problematic issues that neither scientific investigation or government legislation have been able to resolve. The literature examined throughout this research is extensive and does reflect this 50-year period. It demonstrates that studies into this phenomenon have attempted to define stress, identify causal factors of workplace stress, workplace burnout and environmental congruence; and discusses strategies (focused on both the individual and organizational levels) that have been implemented to effect beneficial outcomes for individuals affected by any one of these. As this thesis continues, the more recent literature gives a greater recognition to violence in the workplace and legislative enactments as preventative measures to reduce the heavy burden of costs, both physical and financial, to organizations. This extensive literature review indicates no answer to the problem has been identified to date and that this phenomenon remains, giving a clear indication that further scientific investigation is required to find a solution to what was described as the most serious health issue of the 20th century. Based on the literature examined this health issue has now gone well beyond the 20th century, giving relevance to the research study described in this thesis. The investigation is validated as vital and should be used as a basis for further research. This study undertook a collaborative social process, action research, empowering participants to identify and change stressful factors identified within their practice indicative to rural remote community mental health teams. A critical social theory arose out of the problems within the context of the research setting, based on the ideal that the significant issues for this group of individuals within this organization could be solved through the action research process. The group ‘existed’ within the issues indicative to this rural remote area, however these issues were outside their control. Through the implementation of the action research process courses of actions were undertaken that provided enlightenment in self-knowledge with dialogue heightening collective empowerment to effect change within their practice. The action research process, being a holistic process, facilitated this change in practice, developed and refined theory as it proceeded in a cyclic fashion within this local setting. It concerned actual not abstract practices in the social world in which these participants practice. This methodology facilitated examining the significant stressors identified by the Community Mental Health Support Team (CMHST) that caused distress, allowing them to implement changes in their practice. The forum provided an avenue that could reduce stressors significantly and prevent ongoing occupational stress that contributes to workplace burnout. It offered an opportunity to work with a group of participants in a nonhierarchical and non-exploitative manner and enabled members of this group to identify their roles as effective practitioners, empowering them to effect the changes they deemed as essential criteria to reduce the stress they were experiencing indicative to their remoteness. Critical reviewing throughout the data collection attempted to understand and redefine these significant issues. It aimed to acknowledge the way things were relative to how things could be improved from organizational, personal and wider community perspectives. Simple principles and guidelines of action research were followed potentiating acceptance as a rigorous research approach from a positivist perspective whilst retaining the attributes that characterise action research. There are solutions to the dilemma of the employee overcoming the debilitating effects of stress leading to workplace burnout. This includes the cooperation of managers, policy makers, academic researchers and government officials working collaboratively to reduce the impact of occupational stress. Through this collaborative process, changes can be effected to ensure the health of the nation improves and that relevant recognition is given to the fact that there is a significant threat to a healthy workforce. Examining the nursing profession from a social perspective provides alternatives to medicalising workplace injuries and illnesses.
Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

Bibliography: leaves 252-270.
275 leaves ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Events of sadness from their daily routine are described by sixteen participants and retold as stories. Inspired by philosophical and methodological ideology situated firmly within the interpretive paradigm, an analysis of these stories is undertaken using an interpretive, hermeneutical lens.
Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 1999

M.Cur.
The establishment of the South African National Defence Force (SANDF) in 1994 was coupled with problems for all the members that were integrated into the new defence force. The perception exists that members of the former non-statutory forces are receiving preferential treatment to the members of the old South African Defence Force. These perceptions create a spirit of negativity amongst members of the former statutory forces. On the other hand members of the former non-statutory forces are frustrated because they feel that top management in the SANDF is resistant to change. The South African Medical Health Service (SAMHS) is an integral part of the SANDF, and therefore the changes that took place in the last five years have had a direct effect on the members of the service, inter alia, the nursing staff It seems as though nursing service managers in the South African Military Health Service are suffering from a lack of motivation. At the moment they are also unable to motivate their subordinates. The following research questions were posed: What are the perceptions of the nursing service managers in the SAMHS with regard to their own level of motivation? What problems do the nursing service managers in the SAMHS encounter with regard to the motivation of their subordinates? Which factors motivate nursing service managers in their work setup (SAMHS and SANDF)? Which factors demotivate nursing service managers in their work setup (SAMHS and SANDF)? Which strategy must be developed to enhance the motivation of the nursing service managers in the SAMHS?

Text in English
In South Africa, retention of newly qualified professional nurses in public health institutions upon completion of their year of compulsory remunerated community service remains a challenge that exacerbates the shortage of professional nurses in these institutions. The literature indicates that many newly qualified professional nurses leave the public health institutions due to lack of professional development support and heavy workloads while they are still finding their feet. A mixed-methods design of concurrent triangulation approach was used to answer the question: How are the newly qualified professional nurses supported in terms of induction and professional development during community service in South Africa? Triangulation was achieved by using both quantitative and qualitative methods. Induction/orientation documents from public health institutions were analysed using a checklist. A survey questionnaire with mixed quantitative closed items (1–43) and qualitative open-ended questions (43–46) was sent to newly qualified professional nurses who had recently completed community service. Focus groups held with operational nurse managers and individual interviews with coordinators of community service for nurses yielded rich qualitative data. Descriptive and inferential statistics were used to describe and synthesise data. The qualitative findings confirmed the quantitative findings. Findings were lack of professional development support in some public health institutions, informal, non-comprehensive support where given, shortage of experienced professional nurses, reluctance by some professional nurses and operational nurse managers to supervise newly qualified nurses, and increased workload due to the shortage of experienced professional nurses in the public health institutions. Inadequate clinical skills, poor discipline and lack of professionalism in the newly qualified professional nurses also played a part. Respondents suggested constructive recommendations for the induction and professional development support of the newly qualified professional nurses, and these were incorporated in the recommended guidelines for the induction and professional development support of newly qualified professional nurses during community service.
Health Studies
D. Litt. et Phil. (Health Studies)

Text in English
The aim of this study was to gain understanding of community service nurses’ experiences of health care services at Tshwane district public hospital. This qualitative study followed an Interpretative Phenomenological Analysis (IPA) approach to explore the community services nurses’ experiences of health care services at Tshwane district public hospital. Data were collected from 11 purposively selected community service nurses using a semi-structured interview format. Data was analysed using Interpretative Phenomenological Analysis framework for data analysis. Four super-ordinates emerged from data analysis: (1) Resources, (2) Work environmental relations, (3) Supervision and support and, (4) Impact of community service experiences. The study revealed that the health care services rendered at the hospital studied are substandard. Community service nurses reported several challenges experienced during their placement in the hospital under study. Lack of human and material resources, supervision and support contributed to hindrance of smooth acquisition of their clinical skills and experience. These challenges resulted in the psychological and emotional drain of the participants. There is a need for development of guidelines to ensure constant and adequate support to all the community service nurses placed at Ratanang Hospital.
Health Studies
M.A. (Nursing Science)

PURPOSE: The purpose of the study was to explore the perception of the R48 trained professional nurses with regard to implementation of the EPI in Tshwane District Gauteng Province. METHODOLOGY: A qualitative research design was followed. Data were collected through in-depth qualitative interviews from a purposive sample of eight (8) R48 trained professional nurses. Eight steps of Tech’s inductive, descriptive open coding technique was followed. FINDINGS: The study established that EPI programme is important in R48 training. The implementation of integrated approach was viewed as beneficial leading to the reduction of diseases. The successful implementation would be more beneficial if it is consistently coupled with support from programme managers and regular in-service on up-dates of new vaccines and technologies are introduced within the programme
Health Studies
M.A. (Nursing Science)

In this study the researcher attempted to determine the current role expectations of a clinic manager in a primary health care setting, to identify factors determining and influencing the role of a clinic manager, to determine what effect the current role expectations had on the management of primary health care services rendered at the clinic, to establish the developmental needs of clinic managers to enable them to adhere to their role expectations, and to identify and recommend measures to support clinic managers in the execution of their managerial role by addressing the identified deficiencies. The researcher selected a quantitative, exploratory, descriptive and contextual design. Clinic managers of fixed clinics in the Free State province were randomly selected to participate in the study and a questionnaire was utilised as data-collection instrument. The study found that the clinic manager's role is comprehensive and varies from telephonic booking patients to assessment of the quality of primary health care programmes. A number of non-managerial functions were identified, such as consultation of patients, management of medicine, dispensing of medicine and ordering of stock. It was also found that the respondents were not involved in a number of management functions such as financial and human resource management, and adherence to the implementation of standards. Factors that negatively influenced the clinic managers' management role included: * Lack of time due to the large number of patients they had to consult due to the shortage of staff. * Shortage of staff. * The execution of non-managerial tasks. Although it was found that the current role of the clinic manager was confusing as it entailed much more than just clinic management, it is foreseen that the role of the clinic manager could in future be clarified if the recommendations are implemented.
Health Studies
D. Litt. et Phil. (Health Studies)

Adolescent pregnancies are high risks obstetric occurrences. Antenatal care (ANC) provides opportunities to recognise and treat obstetric complications, enhancing the pregnancy outcomes for mothers and babies. This study investigated factors influencing pregnant adolescents' utilisation of ANC services in Bulawayo, using the Health Belief Model's major tenets. A quantitative descriptive design was used in four phases: 80 adolescents' ANC records were audited; structured interviews were conducted with 200 adolescents attending ANC and with 80 adolescents who had delivered their babies without attending ANC; and 52 midwives completed questionnaires portraying their perceptions on adolescents' utilisation of ANC services in Bulawayo. Documentation of ANC services provided to adolescents did not meet the expected standards. Poor or non utilisation of ANC services was influenced by socio demographic factors, individual perceptions of adolescents about antenatal care, perceived benefits of and perceived barriers to the utilisation of ANC. Most pregnant adolescents could not access these services because they could not pay the ANC and/or delivery fees charged at government clinics/hospitals. Midwives required more training in providing and recording adequate ANC services. Free ANC and delivery services could enhance adolescents' pregnancy outcomes in Zimbabawe. An information brochure on the importance of ANC attendance for adolescents has been compiled, based on the research results (see Annexure J).
Health Studies
D.Litt. et Phil. (Health Studies)