Dissertations / Theses on the topic 'Education, Nursing Australia'

The purpose of this study was to present issues and the paradoxes surrounding advanced nurse specialisation (ANS) and education, This study was conducted in two parts. Part A examined the prospective experiences of 13 registered nurses (RNs) who were advancing in an area of special is III ion: they were working in a specialist area of practice and studying in II course specific 10 their specialisation. Two rounds of interviews were completed over six-month intervals. Part B examined the data gathered from a focus group interview and follow-up feedback from 10 nurse executives as stakeholders. The intersubjective data from this group of nurses expanded on the political, economic, and social complexities surrounding the same phenomenon of interest.

Since the introduction of the Internet, there has been an increase in the adoption of this technology for educational purposes. This development and widespread availability of Internet technologies, alterations in the needs of clinical practice and the characteristics of students, have all inspired changes in nursing education (Mallow & Gilje, 1999). In response, nursing education has embraced the opportunity this communication medium offers to the diverse groups of students in nursing. These students may be studying at a distance, or due to other constraints such as time or professional commitments, studying in flexible ways where students may or may not be in the classroom. In other instances, Internet technologies are being used with the aim of enriching learning in nursing. However, despite widespread development and implementation of these innovations, the effects on nursing education have not been extensively researched (Cheek, Gilham & Mills, 1998; Gillham, 2002; Mallow & Gilje, 1999) and little is known about how the Internet contributes to teaching and learning, what learning outcomes are, or what support is required by teachers and students (Billings, 2000). At this time of rapid development of Internet-based and Internet-supported courses in the Australian nursing education system, there is a need to ensure such courses are educationally effective, clinically relevant, and that resources are appropriately assigned. This exploratory study aimed to contribute to effective discipline-specific use of internet learning environments through increased understanding of students’ and academics’ experiences of teaching practices and learning processes. There were two phases to this mixed-method study, a survey of course coordinators, and secondly, interviews with eleven students and sixteen academics. The survey of diverse schools of nursing across Australia provided foundational information about the ways the Internet was integrated into nursing education, and the preparation and supports that were offered to students for Internet-based or Internet-supported learning. Guided by a constructivist theoretical framework, and analysed thematically, the key findings of this study were drawn from the academics’ and students’ experiences in a variety of nursing courses in universities located across Australia. The Internet was employed in these courses in a variety of ways. At the time of data collection for both the survey and the interviews, more courses were Internet-supported than Internet-based. A variety of Internet information and communication features were used in courses. The survey findings provided both a context for the interview findings, and a degree of confirmation of these findings. The context reported was diverse, consistent with an emergent educational environment that has few precedents to guide its implementation. The academics’ experiences revealed that teaching in online environments was vastly different to face-to-face teaching and required different practices of teaching and learning that took into consideration the separation of teachers from learners, and learners from each other. While often enthusiastic about the new environment, many teachers needed specific preparation, support, and adequate resources to teach in this new environment. Similarly, students experienced a dislocation from the learning environments to which they were accustomed. Significant shifts were apparent in the students’ constructions of both individual and collaborative learning that were contingent upon the separation of teachers and learners, and the necessity of communicating in a written medium. Both teachers and learners revealed how, consequent upon their dislocation, they were relocating to a new interpretation of time, place and relationships in Internet learning environments, and were reconstructing teaching and learning. The reconstructions of learning included ways of relating that built learning communities predicated on a shift in focus from teaching to learning. These included both a shift in individual student’s learning, and a constructed understanding that arose variously from shaping a fundamental comprehension or challenging thinking, to expand comprehension in the group. Through new understandings and practices, the participants were beginning to construct a place for students and teachers to realise the possibilities for enriched learning that online communities can provide. The findings of this study are discussed in terms of the possibilities for teaching and learning in nursing education, and recommendations are made.

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.

In Australia, specialist education in paediatrics is not a requirement for nurses caring for hospitalised children. Thus, nurses can work in paediatrics without any prior knowledge of the unique needs of children such as developmental stages or separation anxiety. As a consequence, there are some clinicians and authors who advocate that when children require health care, they should be cared for by nurses who are educated in, and understand the specific physical, psychological and social needs of children. Despite this, the evidence is lacking as to whether specialist nurse education affects the quality of care in paediatrics. This study investigates whether the quality of care that children and their families receive is different to when they are nursed by specialist paediatric nurses (SPNs) compared to nonspecialist paediatric Registered Nurses (NSPNs). SPNs are Registered Nurses who have undertaken specific or further education in paediatrics and NSPNS are Registered Nurses who have no specific or further education in paediatrics. This research was prompted by national policy changes in Registered Nurse (RN) education which shifted the focus from hospital-based training to the tertiary sector. There has not been a review of paediatric nurse education in Australia since these changes in 1994. Quality measures have been developed for the admission procedure as it is the most common clinical procedure performed in hospital on children. The quality measures were defined by the literature and a Delphi Panel of international paediatric nursing experts. The five stage methodology incorporated: (i) a desk analysis of the literature and policies regarding paediatric nursing and education to identify quality measures (QMs); (ii) development of QMs for the most common hospital procedure for children, the admission procedure; (iii) the development of a consensus definition of QMs using the Delphi method; (iv) observation of RNs using video during the admission of children to the hospital to test the proposed QMs and measure whether SPNs behaved differently to NSPNs; and (v) a follow-up on-line survey of all of the observed RNs regarding their perceptions of other factors influencing their practice. This research found that overall, SPNs meet the quality measures during the admission procedure significantly more often than NSPNs (p=0.009). When the QMs were analysed individually, the analysis showed a significant relationship between education and some of the QMs, but not in others where the relationship was not statistically different. This leads to the assumption that there are other factors than the level of specialist education which affect the quality of care such as prompts on admission forms and/ or the RNs‘ personal experiences. However, in the on-line survey of the sample, the RNs reported that tailored education has played a major role in their care delivery to children and their families. The findings of this research indicate that in Australia, the ‗comprehensive‘ nursing model, which leads to the qualification of RN, may not be the best model for delivering the highest quality of care to children and their families.

During the past decade, nurses in the clinical setting have began making a paradigm shift from Quality Assurance to Total Quality Management, or as it is commonly referred to within health care facililties, Continuous Quality Improvement.In contrast, scant attention has been paid to quality management practices in nursing in the higher education sector. This study provides an applied example of where it investigates quality management practices in the context of organisational culture and human resource management with the aim of developing a quality culture model for a school of nursing in higher education.The research study that was conducted produced several major findings from the views of nurse academics who participated in it. Several issues associated with nurse academics' opinions of quality management practices utilised in schools of nursing have been unravelled.The fundamental issue is that procedures and policies formulated for nurses in the hospital setting do not serve the needs of nursing education.The most crucial factor to be considered in policy developments and future research is that it needs to be contextualised in the culture of nursing in higher education.It has become imperative that a transparent quality culture reflects contemporary nursing in Australia and the proposed model in this thesis provides nurses with an opportunity to shape a quality system for the nursing profession.
Doctor of Philosophy (PhD)

The purpose of this portfolio was to establish what educational strategies would enhance the professional education for the nurse of the future. Through an examination of various contemporary educational theorists' work. a conceptual framework was developed using the concepts of Hargreaves (2003) as an overarching model to establish the current positioning of nursing and nursing education in the knowledge society. The preparation ofa nurse who can function effectively and efficiently within a rapidly changing health workplace relies heavily on educational preparation that includes the development of knowledge, skills and attitudes appropriate for the role. This portfolio has examined critical aspects of nursing and nurse education in relation to the development of these necessary areas for future nurse professionals.

Aim: To determine if the current rural graduate programs in Western Australia adequately support new graduate nurses transitioning into rural and remote practice. Background: Graduate nurse transition to employment is a time of significant change and challenges often results in periods of transition shock. These challenges are magnified in rural areas when graduates have limited rural nursing experience and move to commence their career. Supportive graduate nursing programs are essential for enabling nursing transition to practice and assist in reducing attrition rates. Graduate programs were developed to smooth the transition for university trained bachelor’s degree registered nurses into the workforce. Design: A parallel convergent mixed method design which was informed by Duchscher’s Stages of Transition Theory, the conceptual framework chosen to guide the study. Method: Through a purposive sample of graduate and senior nurse participants were invited from rural and remote Western Australia during 2015 to mid-2016. The quantitative tool was applied three times to new graduate registered nurses of which a total of 34 completed the survey. The survey was applied once to senior nurses, 40 of whom completed the survey. Semi structured interviews were conducted for both cohorts at three separate time intervals. Ten new graduate registered nurses and 15 senior nurses were interviewed throughout the 12-month timeframe. Braun and Clarke thematic analysis was applied to analyse the qualitative data. Descriptive statistics and content analysis were used to analyse the surveys. Results: In the first three months new graduates cycled through both transition shock and honeymoon periods resulting in a high level of satisfaction overall, however less satisfaction with the preceptorship. The level of satisfaction dropped significantly at seven months resulting in transition crisis before the adjustment period began. The transition occurred in a linear manner over three distinct timeframes. Limited resources were highlighted as an obstacle to providing adequate support in the rural graduate programs. Conclusion: Graduate programs need to be structured but flexible to allow for individual differences in graduates and clinical situations. The honeymoon stage coexisted with transition shock which may hide the need for adequate support to continue. Inadequate and/or a lack of preceptorship was evident throughout the Western Australian rural graduate programs. Relevance to clinical practice: Graduate programs need to be structured but flexible to allow for individual differences in graduates and clinical situations. New graduate nurses would benefit from a break midway through their transition year to assist and overcome the transition crisis stage. Development of the preceptor role through education is required to deliver adequate support to graduate nurses and decrease transition shock. Emphasis on the transition journey is required in undergraduate final semesters to help better prepare new graduates to manage the change from students to registered nurse.

Aim This study aimed to determine the impact of the implementation of a ward based Nurse Clinical Educator (NCE) role on students and staff at one health service whilst students were on clinical practicum at a Western Australian regional health care facility. Question The research question was: “What impact does the NCE support intervention have on students and clinical staff during clinical practicum?” Background Clinical experience for undergraduate student nurses (students) undertaking their bachelor’s degree is of utmost importance for gaining both competence and registration. Students encounter difficulties in obtaining opportunities to practice their skills and develop competence when on clinical practicum; and preceptors are often overwhelmed by their responsibility to supervise students, as well as provide holistic patient care. The literature identifies a need for a role which is directly responsible for student learning, which would maximise learning opportunities for students, as well as support preceptors. This role could maintain synergistic relationships and communication between the university and clinical facilities. Although there is literature reporting on the evaluation of either students’ or preceptors’ experience in the clinical setting, there have been only a few studies where both students’ and preceptors’ experiences were evaluated in the same study; or the effectiveness of a support model was implemented into the clinical setting and evaluated. Research focused on the implementation of a partnership intervention support model, would add to the limited body of knowledge on the efficacy of clinical support interventions. Methods This study utilises a convergent parallel mixed methods design, as it was deemed to provide a better triangulation of data obtained. Quantitative and qualitative data were collected in surveys before and after the NCE intervention, whilst students were on clinical practicum. Surveys collected data using both Likert-scale and open text responses. Analysis was performed using descriptive statistics and content analysis to interpret the findings. Participants Participants in this study were undergraduate nursing students and clinical staff who participated in clinical practicum during the implementation of a ward-based NCE support role in a Western Australian regional health care facility. Findings This study found the main impact of the NCE role was upon stress and time. Stress was reduced for both students who had access to increased support networks, and for preceptors who could obtain assistance with students when workloads were heavy. There was an increase in teaching time available for skill development for the students, which in turn led to increased competence of students, less time taken by student to undertake skills, and increased student confidence. There was an increase in available time for the preceptors for their workloads on the wards, and more time for preceptors to assist students, without being hampered by students taking a long time with skills.

This study investigates the preparedness of novice (student) paramedics for the mental health challenges of the paramedic profession and identifies the coping strategies used by veteran paramedics to successfully meet these challenges. The lived experience of veteran paramedics is utilised to provide this important assistance. Initially, two surveys were developed and administered to 16 course coordinators and 302 students of the 16 accredited undergraduate degree paramedicine courses across Australia and New Zealand, to identify the perceived need (for preparation) within the curriculum. In addition, the anticipations, confidence and fears of novice (student) paramedics, course coordinators and veteran paramedics were also collected as a means to facilitate the preparedness through self-evaluation, reflection and discussion. Twenty semi-structured interviews with veteran paramedics, each with a minimum 15 years paramedic experience from across Australia and New Zealand, were conducted to gain an understanding of their experiences, mental health coping strategies and advice for novice (student) paramedics. Results from the interviews were validated by three focus groups comprised of six veteran paramedics each, representative of the geographic spread. All 16 course coordinators and 302 novice (student) paramedics responded to the surveys. Results suggest there is widespread recognition for the need to include preparation for the mental health challenges of the profession within accredited undergraduate paramedic courses with 100% of course coordinators and 97% of students recognising this need. The semi-structured interviews with veteran paramedics provided valuable insights into the experiences and strategies used to aid the survival of the veterans throughout their careers. Within the interviews 70% of participants expressed a sincere love for theparamedic role, and 70% identified black humour as the coping strategy most used by themselves and colleagues. In addition, extensive advice was given to novice (student) paramedics based on the veterans lived experiences. This advice focused comprised of three themes; support, health and the profession. The findings of the study indicate that the preparation of novice (student) paramedics for the mental health challenges of the paramedic profession throughout the undergraduate curriculum could be advantageous. By utilising the relatable data collected on the anticipation, confidence and fears of novices, course coordinators and veterans, the advice offered by the veteran paramedics can be included within undergraduate paramedic curricula and delivered by sharing the lived experiences of the veteran paramedics. These lived experiences are highly credible and an opportunity for veterans to contribute positively to the future of paramedicine. Guidelines for their inclusion to the paramedic curriculum have been prepared to facilitate the knowledge and commence the development of conscious coping strategies by novice (student) paramedics during their learning phase.

The purpose of this study was to examine some of the interrelationships between innovation in nursing education, professional attitudes and wastage from nursing. Five groups of students who participated in innovative nurse education courses in A.C.T. hospitals in the 1970's were surveyed by a self administered questionnaire which gathered biographical data as well as attitudinal information. Their responses were compared with those of students who had undertaken a traditional nursing course at an A.C.T. hospital in the same period. The findings of this study suggested that the instrument used may provide a better measure of satisfaction with nursing than of professional attitudes. One of the unexpected findings from the survey which suggested the need for further study was that many of those who had undertaken further nursing study indicating apparent commitment to continuing education in a chosen career would not encourage others to enter nursing. Another was that those who indicated greater career choice commitment may in fact be those who felt unable to obtain alternative employment. It was found that innovation in hospital based nurse education courses attracted different people and produced graduates with different attitudes to professional issues,who followed different career pathways compared to graduates of traditional nurse education courses. Innovative courses appear to have attracted older and better qualified entrants and to have increased the likelihood of graduates being promoted. Respondents from the innovative courses showed increased interest in continuing education and Professional Association activity than their control group colleagues. They were more frustated with the traditional role of the nurse as the selfless, dedicated worker and were less commited to their career choice, overall these findings perhaps indicated a level of dissatisfaction with nursing higher in the innovative course graduates than in the control group. These findings may support Brief's contention (1976) that expectations raised during the educational process, if not fulfilled, will lead to wastage. wastage from nursing was intimately linked with dissatisfaction with work conditions in nursing. Those who had permanently left nursing had more frequently left for work related reasons and undertaken non-nursing study than those who had left and returned or who had never left. Those who left for work related reasons were less likley to return and less likely to choose nursing again if given the chance than those who left for other reasons. Findings about the institutionalisation of innovation in nursing education were difficult to identify with certainty, since time lapse alone could explain many of the findings. Attitudes to the Professional Association were more favourabe in respondents from the later intakes into the innovative courses than from the earlier. Given the recent increases in industrial activity in nursing, this finding is consistent with time lapse. Later intakes also demonstrated greater commitment to continuing education than earlier. This too can probably be explained by the greater availability of such facilities in more recent times. In a period of shortages of nurses prepared to work in the health care facilities of Australia, and of changes in the educational preparation of nurses, the findings of this study relating to attitudes and wastage should be used as the basis for future workforce planning.

By the end of the 20th century, hospital-based nurse training was replaced by nursing university programs with a greater focus on theoretically informed practice. This move coincided with the appearance of the competency movement across industries. Nursing competencies were primarily associated with political interests of increasing the flexibility through the demonstration of generic skills that could effectively increased scopes of practice. This flexibility created a blurring between RNs/ENs that contributed to an environment where neither role had clearly defined disciplinary boundaries. Competencies provided financial rewards for the organisation while increasing the workload of ENs and limiting the functions of RNs.

This study set out to examine and describe the experiences of undergraduate students from different cultural backgrounds studying nursing across three Australian states. The researcher chose to use the grounded theory method to analyse data collected from 40 undergraduate student nurses and 32 nurse teachers. Other data resources included field observations of student nurses in clinical practice and classroom settings. All interviews were transcribed verbatim and along with field notes and memos were analysed using the constant comparative method synonymous with grounded theory. This study was set in a sociopolitical climate of disharmony in which the basic social problem of sociocultural discord: being different and not fitting in (SD) was identified and developed as the core category. The basic social psychological problem existed for culturally and linguistically diverse nursing students because they were in some way different to the majority of their White western counterparts. Differences existed in, for example, religion, dress, skin colour, beliefs, behaviours, and ways of communicating. Because these students were different they experienced discord. Discord was characterised as sociocultural because differences causing discord were rooted in either a cultural or social domain or both. Those students who experienced SD lived with feelings of social and professional isolation, discrimination, and low self esteem to name a few. For the students, experiences of sociocultural discord were largely unpredictable and occurred episodically. The fear of embarrassment, discrimination, or some other form of inequitable treatment prevented students participating actively in classes or on clinical practice.Students, however, were unable to determine when they were likely to experience inequitable treatment and for many when it had been identified it was too late; they were amidst the experience. Others were hesitant to interact with their Australian counterparts for fear of rejection. This study occurred during a particularly disharmonic climate which permeated all aspects of the students’ lives and had the propensity to impact upon individual levels of SD. As such this climate existed as the background in this study. One of the background issues identified as impacting upon students in this study was stereotyping. In this study stereotyping was often based upon perceived cultural, religious, and/or gender norms. The physical environments, that is, university campuses and clinical practice settings in which the students were required to participate, were also found to impact upon student participants and were therefore also considered as background. In these institutions there was an obvious lack of cultural role models and students’ behaviours were often misinterpreted. Whilst some students’ families were considered as immensely supportive others were identified as being the cause of much sociocultural discord. The politics of race and culture also acted to permeate the students’ existence and these issues were given wide media coverage at the time of this research. In an effort to deal with, or counter, episodes of sociocultural discord student participants engaged the process of seeking concord to get in the right track (SC). Some of these strategies worked to reduce SD whilst others did not. These strategies consisted of saving face, covert deception, and using the “yes syndrome”.Other strategies included clustering, trying to form friendships, and trying to interact with members of the dominant group. Many students struggled to suppress their feeling of SD by being quiet and/or ignoring differential treatment and avoiding interaction with others. Some adopted other strategies to strengthen their communication abilities in an effort to reduce discordant episodes. Many of these strategies were learnt from other students or supportive nurse teachers. Other support was attained from student counselling services and supportive family members. These were considered the influencing conditions. Unlike many grounded theories this study was unable to identify the end of the process, that is, successful outcomes. Irrespective that students implemented strategies to decrease their discord they continued to experience other discordant events throughout their undergraduate degree program. Whilst many of the findings in this research support the existing literature, this study can be considered as one of the first attempts to study student nurses from different cultural backgrounds and their experiences of nursing education in Australian universities.

This thesis is based on a model of critical feminist ethnography, designed to explore how practice nurses experience their daily work life in rural and regional general practice. Here, rural and regional practice includes small and large organisations based outside the metroploitan area that employ practice nurses, some in large regional centres and others in small regional communities. Ownership of the general practicioners, local government, regional health services, Aboriginal medical services, universities and private-for-profit businesses.

This study set out to examine and describe the experiences of undergraduate students from different cultural backgrounds studying nursing across three Australian states. The researcher chose to use the grounded theory method to analyse data collected from 40 undergraduate student nurses and 32 nurse teachers. Other data resources included field observations of student nurses in clinical practice and classroom settings. All interviews were transcribed verbatim and along with field notes and memos were analysed using the constant comparative method synonymous with grounded theory. This study was set in a sociopolitical climate of disharmony in which the basic social problem of sociocultural discord: being different and not fitting in (SD) was identified and developed as the core category. The basic social psychological problem existed for culturally and linguistically diverse nursing students because they were in some way different to the majority of their White western counterparts. Differences existed in, for example, religion, dress, skin colour, beliefs, behaviours, and ways of communicating. Because these students were different they experienced discord. Discord was characterised as sociocultural because differences causing discord were rooted in either a cultural or social domain or both. Those students who experienced SD lived with feelings of social and professional isolation, discrimination, and low self esteem to name a few. For the students, experiences of sociocultural discord were largely unpredictable and occurred episodically. The fear of embarrassment, discrimination, or some other form of inequitable treatment prevented students participating actively in classes or on clinical practice.
Students, however, were unable to determine when they were likely to experience inequitable treatment and for many when it had been identified it was too late; they were amidst the experience. Others were hesitant to interact with their Australian counterparts for fear of rejection. This study occurred during a particularly disharmonic climate which permeated all aspects of the students’ lives and had the propensity to impact upon individual levels of SD. As such this climate existed as the background in this study. One of the background issues identified as impacting upon students in this study was stereotyping. In this study stereotyping was often based upon perceived cultural, religious, and/or gender norms. The physical environments, that is, university campuses and clinical practice settings in which the students were required to participate, were also found to impact upon student participants and were therefore also considered as background. In these institutions there was an obvious lack of cultural role models and students’ behaviours were often misinterpreted. Whilst some students’ families were considered as immensely supportive others were identified as being the cause of much sociocultural discord. The politics of race and culture also acted to permeate the students’ existence and these issues were given wide media coverage at the time of this research. In an effort to deal with, or counter, episodes of sociocultural discord student participants engaged the process of seeking concord to get in the right track (SC). Some of these strategies worked to reduce SD whilst others did not. These strategies consisted of saving face, covert deception, and using the “yes syndrome”.
Other strategies included clustering, trying to form friendships, and trying to interact with members of the dominant group. Many students struggled to suppress their feeling of SD by being quiet and/or ignoring differential treatment and avoiding interaction with others. Some adopted other strategies to strengthen their communication abilities in an effort to reduce discordant episodes. Many of these strategies were learnt from other students or supportive nurse teachers. Other support was attained from student counselling services and supportive family members. These were considered the influencing conditions. Unlike many grounded theories this study was unable to identify the end of the process, that is, successful outcomes. Irrespective that students implemented strategies to decrease their discord they continued to experience other discordant events throughout their undergraduate degree program. Whilst many of the findings in this research support the existing literature, this study can be considered as one of the first attempts to study student nurses from different cultural backgrounds and their experiences of nursing education in Australian universities.

This study presents a narrative inquiry of Chinese nursing students at Australian universities in order to examine these students’ motivations, learning experiences and future career planning. Australia seeks to attract international nursing students from China to maintain its economic advantage and alleviate its projected nursing shortage. In contrast, China desperately needs its best and brightest citizens who have trained abroad as nurses to return to China in order to cope with its current challenges in the healthcare system and nursing education. Little is known about the underlying factors that motivate Chinese nursing students to study in Australia, these students’ learning experiences at Australian universities, and whether or not these students will return to China after graduation. This study undertook a narrative inquiry using the three-dimensional space narrative structure approach, with an epistemological perspective drawing on constructivist and interpretivist theory. Through interviews, the authentic voices of six participants’ stories were collected to capture the entire emotional, social, intellectual and reflective processes of each student’s motivations, learning experiences and future career plans. The research findings from this study are presented as both narrative and thematic representations. By exploring and representing each theme and narrative that emerged from the field texts, meaning was unpacked to provide insights to the ‘reality’ as seen by the study participants. The findings revealed that the students’ key motivation to study in Australia was related to the possibility of permanent residency post-qualification. The decision to move was dynamic, with the participants describing cultural and social push and pull factors. Encouragement and support from peers and family were strong contributors to the motivation to study nursing and eventually work and live in Australia. Parents played an especially vital role in this decision-making process. In addition, the participants expressed a strong desire to maximise Australia’s opportunities and cultural experiences. The participants’ experience of studying in Australia was characterised by the need to learn a new language, feeling lost in a new education system vastly different to the one at home, the challenge of making new friends and socialising, and eventually successfully completing their study and attaining their goals. The experience of being an international student was not described as easy. It requires taking risks, courage, determination, motivation and persistence to succeed. Through their lived experiences and reflections of their learning journey in Australia, the six participants reconstructed their personal identity and worldviews, which ultimately helped them locate their place in Australia. The conclusion of the participants’ journey highlighted that their learning experiences have particular implications for international education, healthcare development, future educational connections and investment globally. The insight gained from this study can support the development of successful human capital investment strategies for all parties involved. In the field of international student education, nursing education is relatively understudied. This thesis presents insight into the reality of international student migration through the lens of individual actors in the process, the students themselves.

The purpose of this research was to discover the extent to which practising registered nurses in the ACT undertake physical assessment. It was also organized to discover the perceived reasons why, in appropriate instances, it was not undertaken and the extent to which certain variables may have influenced its practice or non-practice. It was directed also at discovering the extent to which the practising registered nurse would be prepared to undertake workshops on the subject, so that, if appropriate, a core of registered nurses could be provided to act as the role-models and to create the necessary learning environment in the ACT hospitals and agencies where most of the Canberra College's graduates would find employment. Since the first undergraduate course in nursing was introduced in the tertiary sector, nurse academics have placed significant emphasis on the teaching of the nursing process. It is within the first phase of this process, the assessment phase, that the physical assessment of the patient/client is conducted. Discussions with practising registered nurses and observations, led to some uncertainty as to the extent to which physical assessment was actually being used. A review of the literature showed that no investigation of the matter had been reported in the Australian literature. It was, therefore, proposed to make good this deficiency and to resolve any uncertainty about the extent of use of physical assessment in the ACT. This study was restricted to registered nurses in the ACT where all beginning nurses are educated at the CCAE with a curriculum which includes a comprehensive study of physical assessment. Even so, it is recognized that such studies will only reach a beginning level of competency. In order to ensure that the graduates of these courses extend their competency in physical assessment they need to be able to use these skills in every day nursing practice. This research, therefore, was conducted using a questionnaire which incorporated questions about the use of 36 physical assessment skills. The survey, on a onetime participation basis, was conducted for all registered nurses rostered on a fortnightly period in April 1987. A 66.7% response rate was achieved. The responses were analyzed and the findings, results and recommendations are included in the appropriate sections of this thesis.

Research Doctorate - Doctor of Philosophy (PhD)
Mechanical Ventilation is arguably one of the most common practices in Intensive Care Units and one of the main reason patients need admission to Intensive Care. The research in this thesis focuses on the provision of structured continuing education on mechanical ventilation undertaken in the clinical workplace as a component of nurses’ continuing professional development. A systematic review of the literature was conducted to determine whether the implementation of continuing education on mechanical ventilation for intensive care nurses results in the transfer of learning beyond the individual level and towards better patient outcomes. The aim of the review was to appraise and establish the best available evidence on the effectiveness of education programs that resulted in the improvement of patient outcomes. The next step taken in the research was the investigation of : (1) the role that intensive care unit nurses play in managing ventilated patients; (2) the knowledge registered nurses have about mechanical ventilation after finishing the undergraduate course in Australia; (3) and the quality of continuing education on mechanical ventilation at a post-registration level concerning building on, and maintaining nurses’ knowledge and skills looking after ventilated patients, and potentially influencing patient outcomes. This thesis reports the results of a sequential, two phase mixed methods study, which includes a cross-sectional study (Phase One), followed by individual interviews and focus groups (Phase Two). The research aims are to describe the provision of the continuing education program on mechanical ventilation provided at a major tertiary referral hospital, to explore the intensive care unit nurses’ perceptions of this education, their views of their scope of practice, to identify the barriers and motivators to participating in continuing education, and to investigate the nurses’ recommendations for improvement or change in the program. The research setting during Phase One and Two was a 22 bed intensive care unit of a large, regional tertiary referral hospital in Australia, which employed approximately 160 registered nurses. For Phase One applied in 2011, all nurses from the study intensive care unit were sampled for the survey and asked about their perception of the continuing education on invasive mechanical ventilation with focus on two main components: a Self-directed learning package (SDLP) titled Adult ventilation management and the Recognition in Prior Professional Learning, Experiences, and Skills program (RIPPLES) – titled Care of a ventilated patient in intensive care. The results of Phase One were used to inform Phase Two which was undertaken in 2015 where all nurse managers and nurse educators were sampled for individual interviews and three focus groups with purposively selected samples of expert, experienced and novice intensive care unit nurses were undertaken. The interviews and focus groups explored in-depth the managers’ educators’, and intensive care nurses’ overall perceptions of the continuing education on mechanical ventilation to provide a broader and more comprehensive picture of the phenomenon. The survey addressed content, methods of education, learning styles, factors associated with the completion of the main educational components, and the nurses’ recommendations on the continuing education on invasive mechanical ventilation. The data was collected through a mix of structured closed questions and fewer open-ended questions, where respondents could provide more detailed answers as a better way of getting to the nuances of opinions, which sometimes may be missed when only structured questions with limited responses, are used. Descriptive statistics and multivariate statistical tests were used to analyse the quantitative component, whereas content analysis was used for the open-ended questions. The interviews and focus groups explored in-depth the survey findings and portrayed mechanical ventilation as a whole topic including invasive and non-invasive ventilation. In addition, they included the nurse’s perception of: (1) how important they though this education was, (2) the program and support available for all levels of nursing experience, (3) the responsibility for continuing professional development, and (4) the nurses’ role when looking after ventilated patients. The interview and focus group data were collected by the Candidate using semi-structured and open-ended questions and interpreted using thematic analysis. The findings from the systematic review shows limited empirical evidence of the effectiveness of the continuing education on invasive mechanical on patient outcomes. Phase One and Two suggests there is a mechanical ventilation knowledge gap between students finishing the undergraduate Bachelor of Nursing course and becoming a registered nurse in intensive care. Thus, nurses rely strongly on continuing education provided by their workplace to guarantee patient safety and currency with evidence based practice in the intensive care setting. The two main components used for the continuing education on invasive mechanical ventilation were perceived to be valuable and beneficial. However, experienced nurses perceived them to be relevant mostly at an introductory level. Overall, intensive care unit nurses perceived that the education delivered matched their learning style and acknowledged the diverse education programs available, but they perceived that more interactive and hands-on practice education such as bedside teaching should be more available. Nurses managers’ and nurses educators’ support was viewed as a necessity to increase nurses’ participation in workplace education opportunities, and more funded study days should be offered. Managers and educators on the other hand, perceived that nurses should be willing to participate in education opportunities outside their working hours in their own time. Experienced nurses perceived that most of education opportunities targeted novice nurses. In addition, managers and educators reported more difficulty engaging with experienced nurses about their learning needs and education opportunities than with novice nurses. The intensive care unit nurses, independent of their role and job position perceived that most of the ventilated patient management was within the nurses’ scope of practice. However, managers and educators were hesitant as to whether this scope of practice was supported by the national nursing board and critical care nurse association. Nurses’ autonomy was dependent on organization structure, nurses’ knowledge and individual characteristics. Finally, ICU nurses, managers and educators agreed that nurses have responsibility for their own education and professional development; however, ICU nurses perceived that managers and educators had to facilitate and provide education opportunities and resources for them. In conclusion, this work indicates a need for improvements in the continuing education on mechanical ventilation to match all nurses’ level of experience, and to increase nurses’ participation, especially experienced nurses. Three other points are also important, namely the provision of more interactive teaching activities, more funding to support nurses’ education, and more detailed regulation regarding the ICU nurse’s scope of practice for the management of ventilated patients. These conclusions, along with the detailed analysis of the survey, interviews and focus group responses, might be a valuable source of information for nurses managers, educators, and other health stakeholder involved in the provision of continuing education on mechanical ventilation in similar ICU environments, both in Australia and overseas.

Policies underpinning the processes used by nurse regulatory authorities to assess overseas - qualified nurses ( OQNs ) vary from country to country. Some countries ' policies are to undertake paper - based assessments of nurses ' initial and post registration education and experience, while others require all nurses to undertake a generic examination. How these policies were developed and why, were pivotal questions in this study. The aim of the study was, to critically analyse the policy development and policies relating to assessment of overseas - qualified nurses in thirteen nurse regulatory authorities from Australia and overseas. Using Critical Social Theory as the theoretical underpinning a critical policy analysis was undertaken. Data was obtained from policies and procedures, interviews, organisational websites, annual reports and Nurses Acts. The process of development of these policies and procedures was analysed using Bridgman and Davis ' policy cycle. The study revealed that only one organisation used a framework to develop policies on the assessment of OQNs. Policy analysis in most organisations was based on anecdotal evidence and experiential knowledge of Board staff. No organisation had conducted research on whether overseas - qualified nurses were competent to practice following a paper - based assessment or an examination. This study demonstrated that policies used to assess OQNs were not developed from an evidence - based perspective. This highlights the need to undertake internationally collaborative research on the evaluation of current policies, in order to develop future policies that determine the competence of a nurse to practice in another country.
Thesis (Ph.D.)--School of Population Health and Clinical Practice, 2006.

Policies underpinning the processes used by nurse regulatory authorities to assess overseas - qualified nurses ( OQNs ) vary from country to country. Some countries ' policies are to undertake paper - based assessments of nurses ' initial and post registration education and experience, while others require all nurses to undertake a generic examination. How these policies were developed and why, were pivotal questions in this study. The aim of the study was, to critically analyse the policy development and policies relating to assessment of overseas - qualified nurses in thirteen nurse regulatory authorities from Australia and overseas. Using Critical Social Theory as the theoretical underpinning a critical policy analysis was undertaken. Data was obtained from policies and procedures, interviews, organisational websites, annual reports and Nurses Acts. The process of development of these policies and procedures was analysed using Bridgman and Davis ' policy cycle. The study revealed that only one organisation used a framework to develop policies on the assessment of OQNs. Policy analysis in most organisations was based on anecdotal evidence and experiential knowledge of Board staff. No organisation had conducted research on whether overseas - qualified nurses were competent to practice following a paper - based assessment or an examination. This study demonstrated that policies used to assess OQNs were not developed from an evidence - based perspective. This highlights the need to undertake internationally collaborative research on the evaluation of current policies, in order to develop future policies that determine the competence of a nurse to practice in another country.
Thesis (Ph.D.)--School of Population Health and Clinical Practice, 2006.

University of Technology Sydney. Faculty of Health.
[Background] There are workforce shortages in the nursing and midwifery professions in Australia. Many factors have been associated with these shortages such as high workloads, an inadequate skill mix, low nurse/midwife-to-patient/woman ratios, and heightened acuity, all of which can lead to professional burnout for staff. Connected to these shortages are perceptions of inadequate remuneration, experiences of bullying and work-related stresses, the lack of managerial action to tackle these issues and a perceived lack of opportunities for career diversity and progression. Much of this is well known in the nursing discipline, however it is unclear how these factors are similarly impacting midwifery and therefore, research into the workforce experiences of Australian midwives is timely. [Objective / Purpose] To explore early workforce participation trends, experiences and choices of midwives who graduated from one Australian university (graduating years 2007 and 2008). Participants were educated either in Bachelor of Midwifery or Graduate Diploma of Midwifery programs (n = 113). Further objectives of the study were to identify work environment and personal factors that may influence workforce experiences, and to compare any workforce trends by midwifery course. [Methods] A sequential explanatory mixed methods design was conducted. Phase 1 survey collected mainly quantitative demographic and workforce participation data. Three validated instruments were also used: Maslach Burnout Inventory (MBI); Practice Environment Scale of the Nursing Work Index (PES-NWI); and Perceptions of Empowerment in Midwifery scale (PEMS). Due to sample size restrictions, analysis was restricted to non-parametric measures including frequency distribution and simple correlations (p ≤ 0.01). Phase 2 was a qualitative study using semi-structured interviews with qualitative content and contextual analysis. [Results] In Phase 1, the survey response rate was 66 percent (n = 75). Fifty-nine were working as midwives, half of them in full-time employment. Personal factors contributing to workforce choices were only a cause of concern for a small number of midwives. The main reason for having exited from the profession was child rearing. There was a low degree of burnout and high levels of empowerment. Inadequate clinical resources and ineffective managerial support in the workplace were also identified. Bachelor of Midwifery participants were older than the Graduate Diploma midwives but no other relationship between the midwifery course and any of workforce measure existed. In Phase 2, 28 participants were interviewed. Three themes, each comprising of subthemes, were generated: (i) ‘sinking and swimming’; (ii) ‘needing a helping hand’; and (iii) ‘being a midwife… but’. The initial transition into midwifery was overwhelming for most participants, particularly when providing intrapartum care. Coping within the experience was dependent upon support. Job satisfaction was strongly related to the midwife-woman relationship and working to the full scope of practice ability, both which encouraged midwives to remain in midwifery. Dissatisfaction stemmed from poor remuneration, inflexibility of rostering, high workloads and poor managerial approaches. Experiences of bullying were ubiquitous. Factors inducing midwives to stay in the midwifery profession were not the absence of those that caused dissatisfaction. The midwife-woman relationship sustained their practice despite those factors that generated job dissatisfaction. [Conclusion] Elements of the early workforce experiences of these midwives paralleled many of those evident in the Australian nursing profession and similar workforce factors contributing to job satisfaction and dissatisfaction were identified. The midwife-woman relationship was a source of job satisfaction and inspired these midwives to remain in midwifery. Exiting the profession- temporarily or permanently- was mainly due to child rearing. [Implications for practice] Any vacuum created by eliminating factors of job dissatisfaction will require an amplified investment of factors that bring job satisfaction in order to have genuine content in midwives. Strategies that deliver transitional support, rostering flexibility, leadership training and address workplace bullying, will be ameliorative in the face of staffing shortages. Employment models that enhance relational aspects of midwifery are integral for job satisfaction in midwives. Health systems and services have a duty to support the continued professional development and accessibility of career progression for midwives, to allow individuals to cultivate their midwifery skills and work to their potential.

The researcher’s experiences as a clinical facilitator culminated in this research project that sought to explore a paradigm shift in nursing education that had the potential to reduce the theory-practice gap. Quantum Learning and Campbellteaching were integrated and trialed to determine if their focus on accelerated learning, visualisation, and the methods specific to their pedagogical and andragogical processes, could assist in the retention of knowledge and the application of theory in nursing practice. The paradigm of Freirean pragmatism sought the potential of each student and allowed for a multiphase mixed method research design that framed the study. Quantitative and qualitative data was gathered from two cohorts, who participated in two core units of study in the Diploma of Nursing Program: Confirm Physical Health Status and Analyse Health Information. The first unit dealt with the Anatomy and Physiology of the human body and the latter provided a broad overview of health issues, and the role of a multidisciplinary team. The data was collected sequentially and concurrently. Qualitative data provided insight into students’ experiences of learning in a nursing course that could not be drawn out by quantitative data alone. By implementing accelerated learning techniques, alongside diagrammatic learning with explicit dialogue, and a linking table could students retain and recall theory, experience deep reflection that could give rise to critical thinking that in turn, could assist in linking theory to practice. Findings suggested that the quality of student reflection aligned to their capacity to connect theory to their practice. In addition, the research outcomes affirmed that the combination of Quantum Learning and Campbellteaching had the potential to decrease the theory-practice gap by enhancing student nurses’ theoretical knowledge and the linking of their theory to their practice. An important aspect of this research was the expert knowledge of the teacher, and their ability to facilitate a cohesive and culturally safe learning environment. This was coupled with their attitude and belief in their students’ ability to succeed.

Interprofessional education (IPE) has been found to improve patient outcomes and increase health practitioner career satisfaction according to The World Health Organization (2010). Despite these identified benefits arising from over thirty years of IPE research in a global context, there is still surprisingly little evidence with regard to how midwives develop their professional identity within the context of IPE. This study examined the interprofessional aspects of professional identity development for students and qualified clinicians in midwifery, including midwifery clinical educators and midwifery academics. This study utilised the theoretical framework of social constructionism. There were fifteen participants involved from three Australian universities, one hospital and one community setting. Using narrative inquiry as the methodology, stories were collected using in-depth interviews and a narrative approach. The individual stories were examined for revelations into the meanings drawn by each participant using a thematic analysis approach. Five themes emerged from the data. These were: shared misconceptions; shared understandings; shared misdirections; shared professional values; and shared misgivings. Then each story was examined for commonalities and differences of meaning drawn across all of the participants, congruent with Clandinin and Connelly’s (2000) narrative inquiry space (NIS) analytical approach of relational, temporal and spatial. From this interpretive analysis, a further lens was developed to more adequately present the interpretation of the participants’ narratives which could not be accommodated with the NIS. This resulted in the fourth element of ‘fluidity’ comprised of the influencers of ‘empowerment’, ‘competence’, ‘value’, and ‘respect.’ It is through the element of fluidity that the nascent nature of professional identity of the midwife in interprofessional education has been explored and presented. Thus, a theoretical understanding of the intersection between IPE and professional identity development in midwifery has been illuminated as a way to potentially enhance the efficacy of interprofessional practice, education and research. Moreover, the focus on student and registered midwives, both in the education sector and in the clinical environment is critical because, as the midwifery workforce, they are charged with the ongoing development of midwifery as a profession promoting improved patient outcomes, their own professional identity and interprofessional practice.

Nurse education has widely adopted reflective practice during clinical practicum in the form of individual reflective journals in order to enhance learning in the clinical experience. Major problems with this style of reflection have become evident through a review of the research literature, including issues with trust, difficulty choosing the experiences that might be reflected upon, the honesty of reflection, lack of feedback and a propensity to reflect at descriptive levels. These deficits have led many to question the value of reflection during the clinical placement, while others argue that a distortion of the purpose of reflection itself occurs. A limited number of studies have challenged the method of reflection during nursing practicum, most producing minor, or resource inhibitive recommendations without meaningful follow-up studies to verify their merits. A reflective asynchronous environment was incorporated into the practicum of first year nursing students in an Australian university. Peers were directed to post reflections and respond to reflections of peers. A case study approach incorporated analysis of data from the peer reflections to determine themes and quality of reflections. A questionnaire and a focus group session were undertaken to corroborate reflective data and provide insight into participant perspectives of the new environment. Findings indicated that improvement in reflective levels related to engagement with the new environment. Participants were able to validate peer experience, leading to enhanced trust, honesty of reflection and quality of reflection, addressing many issues identified in individual reflective journals. This study provides an exploration of a new reflective approach, the merits of which directly challenge the entrenched method of individual reflection.

Despite changes in legislation and increased funding and monitoring, there have been problems related to the quality of care in the aged care sector in Australia for several decades. An appropriately qualified aged care workforce is considered the key to improving aged care practices. Therefore, this study aims to understand the reasons for the ongoing problems in the aged care sector that relate to aged care education. Since the 1990s, many studies have focused on care practices in nursing homes, now known as Residential Aged Care Services (RACS). The terms nursing homes and rest homes are still used in other countries. However, few studies examined the influence of aged care education on care practices in RACS. This thesis examines these issues considering John Dewey's (1859–1952) conceptual framework of pragmatism, which is employed in this qualitative study. The framework uses a mixed methods approach, including qualitative data from interviews and quantitative data from an online survey and document analysis of published documents. The document analysis includes the Department of Education and Training's aged care training packages and the Quality of Care Principles 2014. The findings from the interviews were corroborated with the content analysis from the published documents and the descriptive analysis from the online survey. The results were presented in the context of aged care literature and current practices in aged care. Managers and care workers discussed five main themes: (1) the need for consistent models of care; (2) the need for a better understanding of working within a legislative framework; (3) the need to broaden educational topics on chronic health conditions, documentation and elder abuse; (4) the development of soft skills to meet the challenges of working in an aged care environment; and (5) the need for an application of knowledge through simulation and experiential learning by qualified mentors with experience and knowledge in aged care. The conclusion presents a critical discussion of the results from a pragmatist perspective. It suggests a new pedagogical aged care education model Democratic Experiential Learning Aged Care Education Model that incorporates Dewey's writings on democracy and experiential learning.