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1
Jones, Bronwyn Elizabeth. "The construction and regulation of nursing practice in Australia." Thesis, Jones, Bronwyn Elizabeth (2001) The construction and regulation of nursing practice in Australia. PhD thesis, Murdoch University, 2001. https://researchrepository.murdoch.edu.au/id/eprint/52145/.
Full textAbstract:
The regulation of nursing practice has been shown to be an important component of the accountability which professional nurses are committed to in the delivery of care. A qualitative descriptive study was undertaken of the perception of nurses working in hospitals of the effect of regulation on their ability to practise nursing in the way they expect or desire. A theoretical framework was constructed to enable a description and interpretation of twenty-two female nurses’ perceptions about the nature of their practice in relation to the context of professional regulation and the context of the bureaucratic workplace.
Data analysis showed a high degree of agreement among the participants with regard to the social construction of nurses and nursing work. There was however little understanding of the nature of professional regulatory control beyond the initial requirement for licensure to practice. The hierarchical and bureaucratic construction of the modern hospital was seen by participants to affect their ability to carry out the quality of nursing care they expected to be able to implement. And whilst this does not cause them to be disillusioned with nursing itself, it leads to frustration and can contribute to poor practice. The results have implications for consumers of nursing care, the nurse regulatory authorities, and the health care delivery system and for nurses who wish to practice as reflective, accountable and responsible practitioners.
Several recommendations arose from the findings in relation to further research and policy making. There should be ongoing assessment of professional competence to practice in the workplace. This assessment could be used, by the nurse, as evidence for maintenance of the license to practice. Collaboration between the regulatory authority, the practising nurse and the managers and employers of nurses could contribute to an in depth explication of nursing practice and contribute to a more informed allocation of scarce resources for quality nursing care.
2
Cramer, Jennifer H. "Nursing practice in a remote area : an ethnographic study." Thesis, Curtin University, 1998. http://hdl.handle.net/20.500.11937/32.
Full textAbstract:
The solitary position of nurses who practise in geographically isolated communities to provide direct health care to a predominantly Aboriginal population characterises nursing in remote areas. Munoz & Mann (1982) described this practice as unique. The uniqueness of this practice, however, has remained shrouded in superficial descriptions featuring service delivery at a one or two-nurse-post, the physical distance of nursing posts from hospital facilities and the autonomy with which nursing is performed. Only glimpses of the reality of nursing practice in a remote area have been revealed through the study of the educational needs of remote area nurses (Munoz & Mann 1982, Cameron-Traub 1987, Philp 1988, Kreger 1991a, Bell, Chang & Daly 1995). A key problem is the lack of a systematic description and detailed analysis of nursing as it is practised in a remote area.The purpose of this study was to explore, describe and analyse nursing practice in a remote area. The research was undertaken at Warburton, an isolated community mainly inhabited by the Ngaanyatjarra people in the Central Desert of Western Australia. An ethnographic design was chosen for this exploratory inquiry into the social and cultural pattern of everyday nursing practice. In a pre-entry study a suitable setting and informants were found. Fieldwork was conducted at the Warburton nursing post by the researcher and involved living on site for a year. Data gathering techniques were participant observation together with interviewing, collection of pertinent documents and the daily chronological recording of fieldnotes, memos and a personal journal. Data analysis was performed concurrently with data gathering. The process followed the Developmental Research Sequence Method by Spradley (1980). Through a cyclical process of data collection and analysis the domains, taxonomies and componential variables in the culture of remote area nursing practice emerged.Amorphous practice was the overall theme revealed in the underlying cultural patterns that shaped the practice of nursing in the remote area. The term amorphous practice is defined as the changeable nature of practice from nurse to nurse, from situation to situation, from time to time. This was observed in the recurrent differences between nurses in their knowledge, abilities and attitudes as well as in the variability between nurses in their management of client care. Contributors to the phenomenon of amorphous practice were found in three distinct, but inter-related, tributary themes termed detachment, diffusion and beyond the nursing domain. Detachment explained the nurses' feelings of separateness from the usual professional and organisational structures needed for the enactment of nursing. Diffusion encapsulated the broad spread of the nurses' role in remote area practice. Beyond the nursing domain described an unregulated practice considered to be outside the responsibilities of nursing care. The substantive theory of amorphous practice provided a detailed description of how nursing was practised in the remote area. It also explained why it was so different from nursing as it is generally understood by the profession.
3
Cramer, Jennifer H. "Nursing practice in a remote area : an ethnographic study." Curtin University of Technology, School of Nursing, 1998. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=11936.
Full textAbstract:
The solitary position of nurses who practise in geographically isolated communities to provide direct health care to a predominantly Aboriginal population characterises nursing in remote areas. Munoz & Mann (1982) described this practice as unique. The uniqueness of this practice, however, has remained shrouded in superficial descriptions featuring service delivery at a one or two-nurse-post, the physical distance of nursing posts from hospital facilities and the autonomy with which nursing is performed. Only glimpses of the reality of nursing practice in a remote area have been revealed through the study of the educational needs of remote area nurses (Munoz & Mann 1982, Cameron-Traub 1987, Philp 1988, Kreger 1991a, Bell, Chang & Daly 1995). A key problem is the lack of a systematic description and detailed analysis of nursing as it is practised in a remote area.The purpose of this study was to explore, describe and analyse nursing practice in a remote area. The research was undertaken at Warburton, an isolated community mainly inhabited by the Ngaanyatjarra people in the Central Desert of Western Australia. An ethnographic design was chosen for this exploratory inquiry into the social and cultural pattern of everyday nursing practice. In a pre-entry study a suitable setting and informants were found. Fieldwork was conducted at the Warburton nursing post by the researcher and involved living on site for a year. Data gathering techniques were participant observation together with interviewing, collection of pertinent documents and the daily chronological recording of fieldnotes, memos and a personal journal. Data analysis was performed concurrently with data gathering. The process followed the Developmental Research Sequence Method by Spradley (1980). Through a cyclical process of data collection and analysis the domains, taxonomies and componential variables in the ++culture of remote area nursing practice emerged.Amorphous practice was the overall theme revealed in the underlying cultural patterns that shaped the practice of nursing in the remote area. The term amorphous practice is defined as the changeable nature of practice from nurse to nurse, from situation to situation, from time to time. This was observed in the recurrent differences between nurses in their knowledge, abilities and attitudes as well as in the variability between nurses in their management of client care. Contributors to the phenomenon of amorphous practice were found in three distinct, but inter-related, tributary themes termed detachment, diffusion and beyond the nursing domain. Detachment explained the nurses' feelings of separateness from the usual professional and organisational structures needed for the enactment of nursing. Diffusion encapsulated the broad spread of the nurses' role in remote area practice. Beyond the nursing domain described an unregulated practice considered to be outside the responsibilities of nursing care. The substantive theory of amorphous practice provided a detailed description of how nursing was practised in the remote area. It also explained why it was so different from nursing as it is generally understood by the profession.
4
Duffield, Patricia. "A Pilgrim's Tale : Travelling the landscape of rural and regional practice nursing." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2007. https://ro.ecu.edu.au/theses/271.
Full textAbstract:
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.
5
Suppiah, Dall Veronica-Ann. "Factors influencing nurses’ attitudes towards information technology in nursing practice in Western Australia." Thesis, Curtin University, 2014. http://hdl.handle.net/20.500.11937/1589.
Full textAbstract:
To understand factors that influence Western Australian nurses’ attitudes towards using information technology in nursing practice, a mixed-methods approach involving quantitative and qualitative approaches was used. A questionnaire was responded to by 134 registered nurses and this was followed by interviews with selected participants. Various barriers that hampered nurses’ embracing computers and information technology were identified.
6
Ryder, Mary. "Exploring leadership and research in nurse practitioner roles across Australia and Ireland: A mixed-methods study." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2020. https://ro.ecu.edu.au/theses/2337.
Full textAbstract:
Introduction
The Nurse Practitioner role is recognised as the highest level of clinical nursing. Leadership and research are identified as core attributes for Nurse Practitioners in the regulatory frameworks. There is an expectation that as clinical leaders, Nurse Practitioners have the ability to transform healthcare delivery within their specialist area of practice.
Background
The voice of Nurse Practitioners is limited in the current literature related to how they view their leadership contribution to Nursing. There has been some criticism in the evidence to date related to volume, consistency and transferability of Nurse Practitioner research. However, there is a shortage of evidence related to research from Nurse Practitioners, including their interpretation of research within their role.
Design
A mixed-methods, sequential explanatory study was completed. Nurse Practitioners from Ireland and Australia were contacted via their respective Professional Associations to participate in the research.
Methods
Phase one conducted an electronic survey to ascertain Nurse Practitioner leadership and research activities across Ireland and Australia. Phase two data collection was conducting through semi-structured interviews with participants to explore their understanding of leadership and research in their role.
Results
Nurse Practitioners perceive that they provide strong clinical leadership in transforming healthcare delivery for patient populations. Research is perceived by Nurse Practitioners in the traditional sense, of generating new knowledge, and they do not value the research work they do. Leadership and Research in the Nurse Practitioner role is similar in Ireland and Australia. Leadership of research was not found, due to a lack of time allocated to research and a lack of confidence to undertake research.
Conclusion
Nurse Practitioners provide patient focused clinical leadership in healthcare. Autonomy in clinical decision-making and the freedom to change healthcare delivery was evident. There is a reliance on interprofessional leadership and assistance to embed the role, ensuring its success. A lack of clarity pertaining to research requirements for Nurse Practitioners was identified. A translational research continuum has been proposed, as an alternative to the traditional definition of research for Nurse Practitioners
7
Harvey, Clare Lynette Eden, and clare harvey@flinders edu au. "Through the Looking Glass: The Politics of Advancing Nursing and the Discourses on Nurse Practitioners in Australia." Flinders University. School of Nursing and Midwifery, 2010. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20100708.110421.
Full textAbstract:
Nursing has a tradition of subservience and obedience. History provides an account of secular and religious orders of nursing shaping a view of virtuous and tireless dedication in carrying out the doctors orders. Nurse Practitioners were first introduced to the health care system in the 1960s as a solution to the medical shortage being experienced in United States of America at that time. They assumed clinical tasks, traditionally regarded as doctors work. Since then the Nurse Practitioner movement has expanded globally.
Australia introduced the Nurse Practitioner role in 1998, heralding a new era in the health system of that country. Its introduction has created diverging views which are influence role implementation. This study examines social and political discourses that are affecting the development of Nurse Practitioners in Australia, using text and language to identify discursive practices. It has set out to determine whether Nurse Practitioners have the autonomy that professional nursing leaders have described in policy, or whether the introduction of the role has merely shifted nursings sphere of influence within a traditional health care system.
Using Faircloughs notion of power behind discourse, the language and discourses of Nurse Practitioners were explored in relation to what was happening around role development and how Nurse Practitioners positioned themselves within the environment where they worked. The use of a Critical Discourse Analysis has allowed for the various social, historical and political perspectives of nursing to be examined. Faircloughs three levels of social organisation have been used to identify the divergent discourses between the truths of implementation of the role at individual and organisational level and comparing it to that of the rhetoric of health policy.
The discourses surrounding the creation of this advanced nursing role have been the focus of analysis. This analysis has revealed how role development is controlled by powerful groups external to the nursing profession. The dominant discourses use the traditional health care divisions of labour to maintain control through a financially driven focus on health care which does not necessarily revolve around clinical need. Further complicating the position of Nurse Practitioners is the internalisation of those dominant discourses by the nurses themselves. It reinforces Faircloughs view that the dominant power lies behind the discourse, using the system itself to maintain a status quo, rather than overtly opposing it.
Nurse Practitioners, despite being held out by the nursing profession as clinical leaders, are not able to influence change in health care or in their own roles. The results have further shown that nursing managers do not have an influence over the direction that health care and nursing takes. Further research is necessary to examine the broader leadership role of nursing within health care nationally and internationally, in order to establish the real position of nursing within the decision making framework of health care service development.
8
Duke, Janet School of Social Work UNSW. "Silent values : contextualising justice within the disjunctures between care discourses, regulatory requirements and nursing practice realities." Awarded by:University of New South Wales. School of Social Work, 2002. http://handle.unsw.edu.au/1959.4/19127.
Full textAbstract:
The notion of 'Care' has occupied a central place as foundation in nursing theory, ethics and practice. An examination of critical and authoritative documents reveals that the term is vague and ill defined. The literature on care does not theorise the concept as fully as expected in a profession where the concept is considered central. Moreover, even the best theories of care neglect justice. Applying Wittgenstein's concept of family resemblance allows the debate to move on from definitional issues to assess the applicability of 'care' to the practice of the profession. An examination of a range of assessments of nursing practice shows that although 'care' is frequently used in connection with nursing, it does not appear to be a major consideration in key areas of appraisal. This thesis explores the relationship between care and justice in nursing and proposes that they be integrated within nursing theory. A theory for nursing that does not exclude care, but that has justice as its basis is proposed. Care, when used in the context of justice provides nursing with a theory that is appropriate not only for nursing theory and ethics but also assists the profession meet the demands of modern practice.
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Pryor, Julie Anne, and mikewood@deakin edu au. "A grounded theory of nursing's contribution to inpatient rehabilitation." Deakin University. School of Nursing, 2005. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20051110.112022.
Full textAbstract:
There is growing awareness of the benefits of rehabilitation both in Australia and overseas. While the provision of rehabilitation services is not new, recognition of this type of health service as an integral part of health care has been linked to changes in the provision of acute care services, advances in medical technology, improvements in the management of trauma and an ageing population. Despite this, little attention has been paid to nursing's contribution to patient rehabilitation in Australia. The aim of this grounded theory study, therefore, was to collect and analyse nurses' reports of their contributions to patient rehabilitation and to describe and analyse contextual factors influencing that contribution.
Data were collected during interviews with registered and enrolled nurses working in five inpatient rehabilitation units in New South Wales and during observation of the nurses' everyday practice. A total of 53 nurses participated in the study, 35 registered nurses and 18 enrolled nurses. Grounded theory, informed by the theoretical perspective of symbolic interactionism, was used to guide data analysis, the ongoing collection of data and the generation of a substantive theory.
The findings revealed six major categories. One was an everyday problem labelled incongruence between nurses' and patients' understandings and expectations of rehabilitation. Another category, labelled coaching patients to self-care, described how nurses independently negotiated the everyday problem of incongruence. The remaining four categories captured conditions in the inpatient context which influenced how nurses could contribute to patient rehabilitation. Two categories, labelled segregation: divided and dividing work practices between nursing and allied health and role ambiguity, were powerful in shaping nursing's contribution as they acted individually and synergistically to constrain nursing's contribution to patient rehabilitation. The other two categories, labelled distancing to manage systemic constraints and grasping the nettle to realise nursing's potential, represent the mutually exclusive strategies nurses used in response to segregation and role ambiguity.
From exploration of the relationship between the six categories, the core category and an interactive grounded theory called opting in and opting out emerged. In turn, this grounded theory reveals nursing's contribution to inpatient rehabilitation as well as contextual conditions constraining that contribution. The significance of these findings is made manifest through their contribution to the advancement of nursing knowledge and through implications for nursing practice and education, rehabilitation service delivery and research.
10
Baker, Melanie Jane. "The application of evidence based practice in the acute care hospital setting: A grounded theory study of the perspective of nurses in Western Australia." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2020. https://ro.ecu.edu.au/theses/2377.
Full textAbstract:
Evidence based practice (EBP) in nursing is an important part of care provision, both in Australia and globally. The experience of applying evidence in practice presents many challenges for nurses. This study focused on the application of EBP in the acute care hospital setting. Grounded Theory methodology was used and 21 semi-structured recorded interviews with Registered Nurses from two acute care hospitals were conducted. Data were analysed using the constant comparative method.
A substantive theory was developed, Traversing the EBP Conundrum, as the process used to manage the core issue: The Challenge of Applying EBP. Time Constraints, Nurses’ Inherent Traits, and The Organisation Talking the Talk but not Walking the Walk, were conditions affecting the nurses’ daily practice. These conditions resulted in a discrepancy between the ideal mandated by the nursing profession and organisations, and the reality of working in a context of Consideration for Quality and Safety. In applying the process, nurses were found to Survive the Conundrum: Navigating Alternative Pathways; by Getting Lost in the Bush: Going Their Own Way; by Scaling New Heights Working Over and Above to Optimise Outcomes.
This study raises questions regarding the quality and safety of patient care, as well as the wellbeing of nurses, and the ideal of EBP which is mandated by professional bodies. The findings lead to recommendations including: further research into the reality of EBP for nurses and its impact upon patient outcomes, safety, nurses job satisfaction and nurse retention; consideration by the professional body as to how realistic professional and organisational expectations of EBP are in nursing; and a review of decision making by leaders in relationship to EBP, therefore quality and safety.
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McCullough, Kylie. "The delivery of Primary Health Care in remote Australian communities: A Grounded Theory study of the perspective of nurses." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2018. https://ro.ecu.edu.au/theses/2153.
Full textAbstract:
Around 85% of Australia’s landmass is remote and sparsely populated. Across these vast areas of desert, wilderness and tropical islands, nurses provide the majority of health care services. The residents of Australia’s remote communities have poorer health status than their metropolitan counterparts. The proportion of Indigenous people is high and health and social disadvantage is widespread. The characteristics of each remote community are unique and often reflect challenges associated with distance to tertiary health services and limited health resources. As a result, nursing practice within this context is very different to other nursing contexts. Despite recognition of Primary Health Care (PHC) as a comprehensive model of acute and preventative care well suited to areas of high health and social need, there is little known about how nurses use the PHC model in practice and research pertaining to this nursing context is limited.
This study was conducted from a Constructivist Grounded Theory perspective to generate a substantive theory. Data were collected through 23 telephone interviews and an expert reference group.
This study adds previously unknown information to the body of work about remote area nursing. The context of providing PHC in a remote setting was described as social with a focus on illness prevention and equality of care. Participants described personal satisfaction as a feeling of making a difference to the health and wellbeing of the community. However, the core issue participants faced was the inability to provide PHC. Four conditions that impacted on the core issue, were described as: understanding of the social world of the remote community, availability of resources, clinical knowledge and skill and, shared understanding and support. The process labelled doing the best you can with what you have emerged as the way participants dealt with the inability to provide PHC. The process involved four primary activities: facilitating access to health care, continually learning, seeking understanding, and home‐making in a work environment. The outcome of this process was considered to be making compromises to provide PHC.
This study proposes a substantive theory to understand and explain Australian remote nursing practice. Recommendations include further exploration, testing and refinement of the substantive theory. The implications for practice include development of education and support programs and the findings promote the case for providing additional resources to health services in remote areas in order to support nurses in providing PHC.
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Forrester, Kim, and n/a. "The Impact of Structural (Legislation and Policy), Professional and Process Factors on the Outcomes of Disciplinary Tribunals and Committees in Cases of Sexual Misconduct and Incompetent or Unsafe Practice." Griffith University. School of Nursing, 2004. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20040615.144659.
Full textAbstract:
This study was conducted in the context of the regulation of professional nursing and midwifery practice in the Australian health care system. In this environment, professional regulatory authorities established by State and Territory legislation in all jurisdictions, regulate and control the work of health professionals. In Queensland, registered nurses, enrolled nurses and midwives are regulated by the Queensland Nursing Council, the statutory body created by the Nursing Act 1992 (Qld). Part of the regulatory role of this and other authorities is to discipline professionals whose conduct or behaviour falls short of appropriate and acceptable standards of practice. All regulated health professionals, including nurses and midwives, are potentially subject to professional disciplinary action if a complaint is lodged in relation to their conduct. This being an important issue in the management and delivery of health care, and an increased trend among health care consumers, the dearth of existing research into the disciplinary process is a major concern. This exploratory study examined the disciplinary role of the Queensland Nursing Council in adhering to its legislative mandate to ensure safe and competent nursing practice. The study focused on the extent to which structural (legislation and policy), professional, and process factors impacted on the outcomes of disciplinary Tribunals and Committees in cases of incompetent or unsafe practice and sexual misconduct. The study was situated within the interpretive paradigm using a case study approach. Specifically, it investigated cases of sexual misconduct by nurses and unsafe or incompetent practice by midwives. The study was guided by Donabedian's conceptual framework of structure-process-outcome. This framework was seen to be most suited to the aims of the study and provided a template for in-depth analysis of the data emerging from the two cases. The findings of this study provided insight into the factors underpinning the decisions of the disciplinary bodies in making determinations and formulating outcomes. There was found to be a lack of consistency and predictability in both the legislative frameworks and the interpretation of terms and concepts used to identify conduct warranting a disciplinary response from regulatory authorities. Although the processes of disciplinary proceedings are prescribed by both legislation and policy, their practical application was characterised by considerable challenges, which resulted in varying outcomes. The thesis reports this information so that it can be used as an initial basis to build a body of knowledge from practical experience with disciplinary proceedings that will inform future processes. Subsequent case studies in other contexts and systems will increase the level of knowledge available to nurses, other health care providers, health care institutions and regulatory authorities. The initial base of evidence suggests implications for practice, education and further research which are outlined in the final chapter of the thesis.
13
Fry, Margaret. "Triage Nursing Practice in Australian Emergency Departments 2002-2004: An Ethnography." University of Sydney, 2004. http://hdl.handle.net/2123/701.
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This ethnographic study provides insight and understanding, which is needed to educate and support the Triage Nursing role in Australian Emergency Departments (EDs). The triage role has emerged to address issues in providing efficient emergency care. However, Triage Nurses and educators have found the role challenging and not well understood. Method: Sampling was done first by developing a profile of 900 nurses who undertake the triage role in 50 NSW EDs through survey techniques. Purposive sampling was then done with data collected from participant observation in four metropolitan EDs (Level 4 and 6), observations and interviews with 10 Triage Nurses and the maintenance of a record of secondary data sources. Analysis used standard content and thematic analysis techniques. Findings: An ED culture is reflected in a standard geography of care and embedded beliefs and rituals that sustain a cadence of care. Triage Nurses to accomplish their role and maintain this rhythm of care used three processes: gatekeeping, timekeeping and decision-making. When patient overcrowding occurred the three processes enabled Triage Nurses to implement a range of practices to restore the cadence of care to which they were culturally oriented. Conclusion: The findings provide a framework that offers new ways of considering triage nursing practice, educational programs, policy development and future research.
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Fry, Margaret Mary. "Triage nursing practice in Australian emergency departments 2002-2004 an ethnography /." Connect to full text, 2004. http://hdl.handle.net/2123/701.
Full textAbstract:
Thesis (Ph. D.)--University of Sydney, 2005.Title from title screen (viewed 19 May 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Family and Community Health Nursing, Faculty of Nursing. Degree awarded 2005; thesis submitted 2004. Includes bibliographical references. Also available in print form.
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De, Bellis Anita Marie, and anita debellis@flinders edu au. "Behind Open Doors - A Construct of Nursing Practice in an Australian Residential Aged Care Facility." Flinders University. School of Nursing & Midwifery, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061107.122002.
Full textAbstract:
This thesis explored the relationship between the discourses of nursing care, the nursing care provision, and the perceived nursing care needs of three highly dependent residents in a residential aged care facility in Australia. Residential aged care in this country has undergone major reforms since 1987 and the nursing profession has struggled with these changes because of the documentation, validation, and accreditation requirements; the inadequate determination of dependency on nursing care for funding; the Registered Nurse (RN) being removed from the bedside to a role of scribe and delegator; the increasing acuity and complexity of the residents' needs; an increase in the turnover of residents; a rise in the nursing staff attrition rate; the delivery of care by untrained and unqualified persons; the RN being accountable and responsible for the care given by 'non-nurses' from a distance; and, the inadequate skill mix and staff to resident ratios provided in these institutions. The interest of this thesis was to research gerontological nursing practice in the context of residential aged care.
Residential Aged Care Facilities (RACFs) in Australia that care for the highly dependent elderly were identified in the thesis as disciplinary institutions that used 'subjectivation' as a means to control the efficiency and effectiveness of the labour force and the 'docile' bodies of the residents, whilst at the same time the government rhetoric is that of the quality of life standards and the rights of residents in these institutions. As well as the discourse analysis, an historical overview of the aged care reforms in Australia was undertaken for the period from 1975 to 2006 that demonstrated the effects the reforms have had on the voice of nurses and nursing care in these institutions. This analysis highlighted where nurses have been silenced and found the federal government determining what is nursing care and what is not nursing care, and also who is providing this nursing care.
Using a case study approach and discourse analysis each of the three residents was studied using data from five sources namely the resident or relative, a RN, a careworker (CW), the current documentation pertaining to the resident's nursing care, and the non-participant observation of the nursing care provided. These discourses on the nursing care and perceived residents' nursing care needs were analysed using the theoretical base developed from the philosophy and research interest of Michel Foucault (1926-1984), who questioned the apparatus and institutions of Western cultures and searched for discontinuities in the practices of what he termed 'disciplines'.
The results of the discourse analysis found nursing care practices that were alarming around the residents' perceived nursing care needs, the documentation of the nursing care provision, and the observed 'actual' nursing care provided. A questionable standard of nursing care was evidenced even though this facility had recently been accredited. A custodial level of mechanistic care was provided to residents in an extremely noisy and public environment within a culture of haste and bustle by unknowledgeable CWs, under the distant gaze of a RN, and the direction of the government documentation requirements. This resulted in unsafe, unethical, unprofessional, and negligent practices, as well as fraudulent, illegal, and dangerously out of date documentation practices. This was ultimately affecting each resident's quality of life, nursing care, and wellbeing and was an added burden on the residents' relatives. Many discontinuities, dissonances, conflicts, and contradictions in nursing practice were uncovered for these three highly dependent residents that may be transferable and similar to other highly dependent residents in this and other institutions. Indeed it may mirror other disciplines that provide care services, such as mental health care, acute care, and disability care provision.
The concerns for the nursing profession have epistemological, ethical, and political ramifications for the residents and their relatives, the nurses, the non-nurses doing nursing work, the government, and the industry. Epistemologically new nursing 'knowledges' were being developed that were not resident focussed or based on evidence. Ethically, the legislated rights of residents were not being supported, despite the accreditation, funding, and complaint mechanisms in place - and this has the potential to have punitive ramifications for the industry. Professionally and politically, CWs were identified as non-nurses doing nursing work of a poor standard. This care was not based on accepted nursing practice, but developed through the documentation requirements of the federal government department, the applied constraints, and the CWs themselves. Furthermore, the documentation requirements were found to be a pretence in regard to funding through validation and accreditation, as well as a charade in nursing practice.
There is presently a substantial third level of nurses who are identified legally and political as non-nurses doing non-nursing work (known as 'personal' care); but these non-nurses are doing nursing work and are identified by the nursing profession and the public as 'nurses' doing nursing work. These non-nurses who provided nursing care are not educated, licensed, or regulated, and are not accountable professionally to nurses or legally to the public. It is proposed that CWs are in need of licensing under nurses' boards requiring at the very least a minimum of training and education. It is further proposed that documentation requirements resort back to professional nursing documentation; funding be dependent on an predetermined minimum skill mix and staff/resident ratio; and the funding of residents be based on a minimum data set and untied from nursing practice. The professional nursing practice of assessment, planning, implementation, and evaluation of nursing care needs resorting to a nursing domain of knowledge, practice, accountability, responsibility, and documentation.
If an acceptable quality of life is to be realised for residents in the residential aged care system, given that highly dependent residents are reliant on quality nursing care that is fundamentally imperative to their very quantity and quality of life, then changes in the residential aged care system and the nursing profession will be necessary. This thesis will contribute to opening up such dialogue between the government, the industry, and the nursing profession in Australia, and it also highlights areas of aged care nursing practice in need of further research.
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Crevacore, Carol. "Delegation practices between the registered nurse and the assistant in nursing in the acute care setting in Western Australia." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2021. https://ro.ecu.edu.au/theses/2477.
Full textAbstract:
Background:
Delegation is an essential skill that allows the Registered Nurse (RN) to allocate aspects of patient care to other team members including the unregulated Assistant in Nursing (AIN). Concerns have been raised about the activities delegated to AINs in the acute care environment.
Aim:
The aim of this research was to explore the practice of delegation between the RN and the AIN in the acute care environment. This delegation practice was examined through the lens of both the RN and the AIN.
Methodology:
This study used a mixed method explanatory sequential design. The participants were RNs and AINs working in an acute public hospital in Western Australia. The surveys completed by the RNs (n = 100) included their attitude to delegation, the risk management process undertaken prior to delegation and the tasks that they delegated to the AIN. The surveys completed by the AINs (n = 79) included their experience with RNs during delegation and the activities they complete while working in the clinical environment. The survey data were analysed using descriptive statistics. The findings from these data informed the questions for the semi structured interviews which formed the second phase of this research. Interviews with RNs (n = 12) and AINs (n = 11) were conducted, transcribed verbatim and analysed using Braun and Clarke’s thematic analysis. Results from both phases were triangulated to provide a richer understanding of the phenomena.
Results:
Five factors were identified that influence the RN’s decision-making surrounding delegation: 1) personality characteristics of the RN; 2) the multifaceted act of delegation, 3) understanding of the AIN scope of practice; 4) clinical decision-making, and 5) undergraduate nursing students working as AINs.Two factors were identified that influence an AIN’s decision to accept a delegation; wanting to be thought of as a valuable team member and, the quality of the handover.
Conclusion:
Shortages in skilled nursing staff, financial constraints, and increasing patient acuity within healthcare have resulted in the increased use of the AIN. Nursing staff need to work effectively with these staff to ensure safe, efficient care delivery. Therefore, it is essential that RNs have the skills, knowledge and experience to delegate effectively to the unregulated workforce.
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James, Jennifer Ann, and n/a. "The extent to which registered nurses in the ACT state that they use physical assessment skills as a basis for nursing practice." University of Canberra. Education, 1988. http://erl.canberra.edu.au./public/adt-AUC20060406.121506.
Full textAbstract:
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.
18
McCarthy, Karen Ann. "The ward-based Nurse Clinical Educator: Impact on student learning outcomes and student and preceptor experiences." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2019. https://ro.ecu.edu.au/theses/2221.
Full textAbstract:
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.
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Wright, Helen Worsley. "Genomics in nursing practice in Australia: a critical realist case study." Thesis, 2018. https://researchonline.jcu.edu.au/63432/1/JCU_63432_Wright_2018_thesis.pdf.
Full textAbstract:
Genomic research continues to 'change the landscape' of healthcare worldwide (Camak, 2016, p.86). Genomics is beginning to reshape healthcare delivery by changing the way we prevent, diagnose, treat and monitor illness, providing the opportunity to offer more precise and tailored treatments. As genomic developments change healthcare, so too are they changing the nursing profession. This revolution has led to a new responsibility for all nurses to be knowledgeable of genomics and incorporate genomics into nursing practice. Research addressing the integration of genomics into nursing practice in Australia is limited. The aim of this study was to determine how nurses engage with genomics in nursing practice in this country.
Case study research was used to achieve the research aim. A case study is 'an empirical inquiry that investigates a contemporary phenomenon (the 'case') in depth and within the real-world context' (Yin, 2014, p. 16). A single holistic case study design drawing on the works of Robert Yin (2014) was conducted. This case study was underpinned by a critical realist philosophy. Critical realism is concerned with the nature and knowability of the social world and social phenomena (Schiller, 2016), making it a suitable framework to guide an exploration of Australian nurses' engagement with genomics.
Data were collected via a cross-sectional survey of Australian registered nurses and midwives in 2016, and via semi-structured interviews with registered nurses working in oncology departments within a regional Australian hospital in 2018. Key case findings were generated using thematic analysis, and grouped into three categories: Point of learning (education), Point of reference (professional expectations) and Point of care (clinical practice). These three categories were used as a framework to describe the case, and presented in relation to the key tenets of critical realism - (i) the primacy of ontology, (ii) the stratified character of the realworld (reality) and the search for generative mechanisms, and (iii) the interplay between social structures and human agency (Bhaskar, 1975/2008, 1979/1998, 2011).
The case indicated that Australian nurses have limited engagement with genomics at the point of learning, point of reference and point of care. Nurses' inadequacy at each of these points is sequential, meaning that if nurses are not knowledgeable about genomics and are unclear about professional expectations, they cannot be expected to adequately integrate genomics into their practice. The critical realist philosophy underpinning the case led to consideration of the way point of learning, point of reference and point of care form the context for nursing practice. How nurses respond to this context determines the extent to which they are able to transform education, policy and practice.
Australian nurses' limited engagement with genomics has consequences for the nurse, the patient and the wider nursing profession. This limited engagement must be addressed. It is recommended that (i) genomics be embedded throughout the nursing curricula with healthcare applications made clear to the learner (point of education), (ii) nursing policy articulates the alignment between the NMBA's Standards for Practice and genomic competencies (point of reference), and (iii) nurses incorporate genomics knowledge and skills into practice (point of care). The 'genomic revolution' (Jenkins et al., 2005, p.98) will require further development of Australia's capacity, capability and infrastructure if these are to support the integration of genomic information and technology into the national health system (Australian Health Ministers' Advisory Council, 2017b). As the largest component of the Australian health workforce, nursing cannot ignore the opportunity before us.
20
Wilson, Anne 1953 Apr 24. "Self-employed nurse entrepreneurs expanding the realm of nursing practice: a journey of discovery." 2003. http://thesis.library.adelaide.edu.au/public/adt-SUA20030711.100333.
Full textAbstract:
Includes bibliographical references. Electronic publication: Full text available in PDF format; abstract in HTML format. Private practice as a career option for nurses has been slowly increasing since the 1980's. However, the reasons for this development have not been fully investigated so that it can be understood and placed within the changing contexts of health care and health services. The expansion and extension of nurses' roles is a contemporary topic in health care reform and therefore one that deserves investigation. The aims of this study were to develop a theory on private practice nursing and to describe the characteristics and work of the self-employed nurse in Australia. Electronic reproduction.[Australia] :Australian Digital Theses Program,2001.xvii, 350 leaves : ill. (some col.) ; 30 cm.
21
Wilson, Anne. "Self-employed nurse entrepreneurs expanding the world of nursing practice: a journey of discovery." 2003. http://hdl.handle.net/2440/37903.
Full textAbstract:
Private practice as a career option for nurses has been slowly increasing since the 1980's. However, the reasons for this development have not been fully investigated so that it can be understood and placed within the changing contexts of health care and health services. The expansion and extension of nurses' roles is a contemporary topic in health care reform and therefore one that deserves investigation. The aims of this study were to develop a theory on private practice nursing and to describe the characteristics and work of the self-employed nurse in Australia. Nurses working in a variety of settings have been able to provide information on being self-employed. In doing so, this study was able to describe the persona of the nurse entrepreneur, explore the reasons why nurses and midwives in Australia establish private fee-for-service practices, identify the factors which have influenced this action and describe the scope of practice of nurses and midwives in private practice. This combined Delphi technique and Grounded Theory study is the first in-depth study of Australian nurses and midwives in private practice. The study enables nurses to provide direct information on being self-employed and enhances the profession's ability to articulate about this area of nursing. The significance of the research is in increasing the understanding of this area of practice development and affords greater insight into its efforts to improve and maintain quality nursing services within the Australian health care system. One hundred and six nurses and midwives were invited to participate in the study, in which participants completed two rounds of semi-structured postal questionnaires. Delphi technique was applied to rate responses on Likert scales to ascertain respondents' consensus on certain topics. Participants were also provided the opportunity to make additional comments. Results indicated that nurses in private practice are well experienced with an average of 21 years nursing experience and hold several qualifications. Job satisfaction, being able to be more involved in achieving quality health outcomes and maximising skills and abilities are significant influences for private practice. These results suggest that private practice nursing can contribute effectively to broadening the range of primary health services available to the population and to addressing the issues of retention and recruitment of nurses. Self-employed nurse entrepreneurs push the boundaries of the profession and expand the realm of nursing practice. Entrepreneurship is a path for the future of nursing as it offers expanded career opportunities for nurses and opportunities for increased ambulatory health services. In addition, the broad, expert knowledge nurses hold on many aspects of health can be disseminated throughout the health sector to the advantage of corporate health partners. There is further development required in this innovative and expanding area of the nursing profession.Thesis (Ph.D.)--Department of Clinical Nursing, 2003.
22
Cox, Helen M. (Helen Margaret). "Treading lightly : an ecology of healing / Helen M. Cox." 1996. http://hdl.handle.net/2440/18878.
Full textAbstract:
Bibliography: leaves 226-236.xiii, 236 leaves, 1 leaf of plate : [1] col ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
A study which examines the healing experiences of a group of people from a Victorian Community devastated by the 1983 Ash Wednesday bushfire. Using a theoretical framework of constructionism the study identifies amongst those interviewed an 'ecological postmodern cosmology.' This is used to formulate ideas about how this cosmology could inform nurses' work enabling them to create an environment of care and compassion.
Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 1996
23
Chapman, Ysanne 1948. "Dimensions of sadness - expanding awareness of community nurses' practice in palliative care / Ysanne B. Chapman." 1999. http://hdl.handle.net/2440/19482.
Full textAbstract:
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
24
Halcomb, Elizabeth, University of Western Sydney, College of Social and Health Sciences, and of Nursing Family and Community Health School. "Carving a niche for Australian practice nurses in chronic heart failure management." 2005. http://handle.uws.edu.au:8081/1959.7/20689.
Full textAbstract:
Chronic and complex conditions are a significant concern within contemporary health care systems. The ageing population and improvements in survival from acute cardiac illness have seen an increasing incidence of heart failure (HF). Heart failure represents a significant burden on both the individual and the wider community. Despite effective pharmacotherapy and established evidence-based management guidelines, the overall prognosis from HR is poor. The complexity of the disease process and the highly developed evidence-base makes HR an excellent exemplar for the management of a range of chronic conditions. Studies undertaken as part of the ‘Carving a niche for Australian practice nurses’ project have led to the development of a model of care that integrates the role of the practice nurse with those of other health care providers to improve outcomes for people with chronic and complex conditions. Whilst the model of care developed from these studies requires empirical testing to validate its utility, it is currently being incorporated in clinical planning and ongoing pragmatic research. The systematic, sequential derivation of data from this ‘Carving a niche for Australian practice nurses’ project will inform the development of primary care and provide a conceptual framework for future intervention studies in Australian general practice.Doctor of Philosophy (PhD)
25
Dickson, CL. "The nature of learning to nurse through clinical practice experience for international culturally and linguistically different students in Sydney, Australia : an interpretive description." Thesis, 2013. http://hdl.handle.net/10453/23474.
Full textAbstract:
University of Technology, Sydney. Faculty of Health.Nursing in Australia is a practice based discipline that is governed and structured by national authorities that aim to maintain safe, effective and professional standards of care for the population. These standards reflect the notion of care, the role of the nurse, and the language of nursing as it is constructed in the Australian social culture. Undergraduate nursing courses are expected to prepare students to meet the professional and social expectations of the Australian nurse, so that they are prepared for graduate practice. These courses rely on the clinical practice learning experience to socialize students into the profession as well as integrate theory with practice. International culturally and linguistically different students (ICALD) who come to Australia to study nursing have been found to experience difficulty with learning to nurse in the clinical environment. Through the method of interpretive description, this study presents a comprehensive understanding of learning to nurse in the clinical environments of Sydney, Australia, for international students who come from countries where their language and culture is not western. The findings reveal the complexity of the nature of learning that often remains hidden to clinical educators and facilitators. ICALD students’ motivation to learn to nurse is underpinned by cultural pressure and personal circumstance that sustained them for the three years of the degree. The participants in this study came to Australia with very little knowledge of the culture or the population, armed with a learner level of English that was inadequate for full engagement in the clinical environment. Their ideas about nursing were constructed by their own experience and culture and therefore varied from the Australian ideal; therefore having ‘to do’ nursing as it is constructed here, often placed participants in moral peril and at risk of damaged reputations. The participants also felt that they were different to the Australian nurses they worked with, which affected their socialisation into the role. Despite these issues, the participants took ownership of their clinical learning experience and sought to become Australian nurses. The doctoral portfolio completing this thesis provides an examination of current and pertinent policy that influences the education of nurses and has informed the actions undertaken to address clinical learning issues. The ICALD student should be seen as a student of cultural literacy, for the wider Australian society and for the nursing profession, and the clinical learning environment as a space for language learning.
26
Browne, Michael. "The role of collaborative reflections in clinical practice: using an asynchronous online learning environment to promote reflective learning in nursing education." Thesis, 2018. https://vuir.vu.edu.au/38656/.
Full textAbstract:
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.
27
Sheehy, Annabel Dorothy. "The early workforce experiences of midwives who graduated from two different education courses in Australia." Thesis, 2016. http://hdl.handle.net/10453/52938.
Full textAbstract:
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.
28
Desborough, Jane Louise. "The Australian Capital Territory Patient Enablement and Satisfaction Study (ACTPESS): A mixed methods study examining the impact of nursing care on the quality of care in Australian general practice." Phd thesis, 2016. http://hdl.handle.net/1885/101465.
Full textAbstract:
BACKGROUND: In response to demographic changes, increasing rates of chronic disease and demand for primary health care services, since the early 2000’s Australia has increased the number and roles of general practice nurses (GPNs). There is a scarcity of evidence establishing whether the increased availability and use of nursing care in general practice has resulted in improved patient outcomes. Two key quality outcomes – patient satisfaction and enablement – have been examined extensively as outcomes of general practitioner care; however an evidence gap exists regarding these outcomes in relation to GPN care. The aim of this study was to examine the relationship between general practice and GPN consultation characteristics, and patient satisfaction and enablement. METHODS: A concurrent mixed methods study was conducted. The quantitative component consisted of a cross-sectional study of 678 patients (response rate = 41%) receiving GPN care in 21 general practices in the Australian Capital Territory. Patient Enablement and Satisfaction Surveys were distributed to these patients between September 2013 and March 2014. Multilevel mixed effect models were used to analyse these data. The qualitative component took a grounded theory approach to in-depth interviews with GPNs (n=16), patients (n=23) and practice managers (n=9) from these same general practices. Data generation and analysis were conducted concurrently using constant comparative analysis and theoretical sampling. After the separate quantitative and qualitative analyses, findings were integrated. This involved quantification of selected qualitative variables for inclusion in multilevel analyses and a secondary integration of findings. FINDINGS: The results of this study provided evidence of: ● a significant association between patient satisfaction and Nursing scope of practice and autonomy, Continuity of GPN care, Patients making appointments to see a particular GPN, Consultation type and Duration of consultation; ● a significant association between patient enablement and Nursing scope of practice and autonomy, Consultation type and Duration of consultation;● behaviours that characterise ‘the just right nurse’; ● an interconnection between patient satisfaction and enablement. This evidence is presented in the form of a theoretical model called, developing a positive patient experience with nurses in general practice: an integrated model of patient satisfaction and enablement. This process-based model includes general practice and GPN consultation characteristics underpinning actions and interactions that support the triggering of health care partnerships between patients and GPNs, and tailoring care to meet each patient’s unique needs.
The effectiveness of this model is contingent on the general practice context in which it operates. Examination of characteristics that support broad scopes of nursing practice coupled with high levels of autonomy facilitated an understanding of ‘enabling’ and ‘less-enabling’ general practices. CONCLUSION: This integrated model of patient satisfaction and enablement is a practical tool to inform education and training for GPNs and other clinicians, particularly in relation to the management of patients with chronic and long-term conditions. This evidence provides impetus to deepen our insight into general practice models of care that facilitate enhanced nursing scope of practice and autonomy, continuity of care and adequate time for nursing consultations. Integral to patient-centred care, these interprofessional models are the key to optimising GPN roles and the associated quality patient outcomes.
29
James, Jennifer P. "An analysis of the breastfeeding practices of a group of mothers living in Victoria, Australia." Thesis, 2003. https://vuir.vu.edu.au/15279/.
Full textAbstract:
This research attempted to identify the causes of and variables associated with early weaning (during the first three months) by breastfeeding women. Prior to 1970, there was a decline in breastfeeding rates, with a gradual increase during the 1970's and 1980's. Since the late 1980's, even with increased knowledge, evidence about the benefits and health promotion activity, rates remain relatively static. Of particular concern is the early postnatal through to three months of age group, where there continues to be a marked drop out of almost 50%.
This was a descriptive longitudinal study of 682 primiparous and multiparous mothers and their babies that collected both qualitative and quantitative data via
a series of self-administered questionnaires. They were completed at three monthly intervals over a period of up to twelve months. Participants exited the study following weaning or at the baby's first birth.
30
Penney, Wendy University of Ballarat. "A critical ethnographic study of older people participating in their health care in acute hospital environments." 2005. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/12705.
Full textAbstract:
"While consumer participation is the focus of 21st century health policy, little is known about this concept from the perspectives of people who require acute hospital services. [...]This project set out to explore older people's perspective of participating in their care. Adopting critical ethnographic method, field work included observation of the inpatient experience. Following discharge home people were interviewed about their experiences including what helped and what hindered participation in their care. Similarly nurses involved in [...] a hospital experience were invited to be involved in individual and focus group discussions aimed at defining how they believed they facilitated people to participate as well as barriers that prevent this style of care."Doctor of Philosophy
31
Penney, Wendy. "A critical ethnographic study of older people participating in their health care in acute hospital environments." 2005. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/15381.
Full textAbstract:
"While consumer participation is the focus of 21st century health policy, little is known about this concept from the perspectives of people who require acute hospital services. [...]This project set out to explore older people's perspective of participating in their care. Adopting critical ethnographic method, field work included observation of the inpatient experience. Following discharge home people were interviewed about their experiences including what helped and what hindered participation in their care. Similarly nurses involved in [...] a hospital experience were invited to be involved in individual and focus group discussions aimed at defining how they believed they facilitated people to participate as well as barriers that prevent this style of care."Doctor of Philosophy
32
Sinclair, Peter M. "Using e-learning and the theory of planned behaviour to predict Australian primary health care nurses’ behavioural intentions in chronic kidney disease screening practices." Thesis, 2019. http://hdl.handle.net/1959.13/1407569.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)The aim of this thesis by publication was to design and evaluate an intervention that sought to improve Australian general practice nurses intention to initiate a kidney health check on people who are at risk of Chronic Kidney Disease. Five papers have been published in peer- reviewed journals and the sixth paper was accepted for publication on May 8, 2019. Opportunistic screening in the general practice setting plays an integral role in the early detection and subsequent management of chronic kidney disease. However, there are significant deficits in current screening practices, despite early identification being a national kidney health priority. Consequently, there is a need to identify strategies to improve screening practices. One potential approach is to educate general practice nurses about CKD screening. Yet, equitable access to professional development opportunities, particularly for nurses in rural and remote communities, can be challenging. E-learning presents a potential solution to this issue. An exploratory-sequential mixed methods design with a three phase approach was used for this program of work. Phase one consisted of a systematic review which identified, appraised and synthesised the best available evidence for the effectiveness of e-learning programs on healthcare professional behaviour and patient outcomes. The review identified that e-learning was at least equivalent to traditional learning approaches and superior to no instruction at all, when evaluating the effectiveness of e-learning on teaching skills (i.e. behaviour). Phase two of the study was informed by the Theory of Planned Behaviour and sought to identify the barriers and facilitators to opportunistic CKD screening by general practice nurses through an elicitation study. Barriers were found to be complex, multi-factorial and driven by social and organisational factors. The financial costs associated with non-claimable services, regardless of patient benefit, were hard to justify in a private business environment. This phase assisted in the development of the intervention and its associated instruments in phase three of this program of work. In the third and final phase of this study, a parallel group, double blind randomised controlled trial design was used to evaluate the effectiveness of an asynchronous web-based e-learning module on general practice nurses’ (n = 420) behavioural intentions in relation to opportunistic screening practices for people at risk of chronic kidney disease. Participants were randomised to a targeted behavioural e-learning program (Intervention) or a knowledge based e-learning program (Active control). It also evaluated the effectiveness of an asynchronous web-based e-learning module on general practice nurses’ knowledge about chronic kidney disease risk factors and screening practices. Finally, it evaluated participants’ perceived satisfaction with the e-learning module. This trial was called the CKD-DETECT study. The intervention was designed to influence the behavioural constructs of the Theory of Planned Behaviour namely attitude, subjective norm and perceived behavioural control. Data analysis determined that there were no significant differences in behavioural intention between the intervention and control groups at follow-up, when controlling for baseline values. These results were replicated in a modified intention to treat analysis. Regression models were used to examine the relationship between the change in the Theory of Planned Behaviour constructs and intentions at follow-up for all participants in the CKD-DETECT study. Irrespective of study arm, completing the study had an equivalent effect on all participants. A significant change was identified for all behavioural constructs and intention (sum). These changes were not attributed to the effect of the intervention. Attitude and perceived behavioural control models accounted for approximately 35% of the explained variance in behavioural intentions, and subjective norm accounted for approximately 33% of the variance. The inclusion of all theoretical constructs, explained 37% of the variance in intention. Changes in CKD knowledge were assessed using a pre-test post-test evaluative design and satisfaction scores were measured on completion of the module. Participants’ baseline knowledge scores were poor, with mean pre-test scores of 3.77 [SD 1.66] out of ten. Post test scores revealed a significant improvement (mean difference 1.81, [95% CI: 1.53 – 2.09] p < .01), however overall final scores remained inadequate. The CKD-DETECT trial used a purpose developed satisfaction instrument which evaluated participants’ satisfaction with undertaking the e-learning module/s and their instructional design elements, particularly course design delivery. Participants in the CKD-DETECT trial rated their satisfaction with the design of the e-learning modules used as high. This program of work was the first study to identify the barriers and facilitators of screening and evaluate an intervention specifically designed to target participants’ attitudinal, normative and control barriers to chronic kidney disease screening. While this program of work achieved its stated aims, it produced mixed results. The results provide a persuasive argument for further investment and work in improving knowledge and behavioural intention to initiate opportunistic screening in the general practice setting so that we can reduce disease-related morbidity and mortality, through the early detection of people with chronic kidney disease.