Dissertations / Theses on the topic 'School: Graduate School of Nursing, Midwifery and Health'

The purpose of this study is to investigate and develop a substantive theory, of the processes adopted by nurses and medical practitioners when patients with serious illness refuse medical treatment. The study seeks to identify the main constraints confronting nurses and medical practitioners and to explain the key factors that moderate the processes of dealing with refusal decisions. Using a grounded theory method, a sample of 18 nurses and 6 medical practitioners from two public hospitals in Melbourne were interviewed. In addition, observations and documentary evidence were utilised. The basic social psychological problem shared by nurses and medical practitioners is conceptualized as Competing Perspectives: Encountering Refusal of Treatment, which reflects the diverse perceptions and beliefs that confront participants when patients decide to forgo therapy. In utilizing the grounded theory method of analysis, it is recognised that participants deal with this problem through a basic social psychological process conceptualized as Endeavouring to Understand Refusal: Agreeing on a Way Forward. This core variable represents the manner in which participants, to varying extents, deal with the situations they face and it incorporates the various influences which moderate their activities. Endeavouring to Understand Refusal: Agreeing on a Way Forward comprises a series of three transitions. The first involves a struggle for participants to come to terms with, or even recognize that patients are rejecting treatment. The second transition illustrates the varied responses of participants as they interact with patients, relatives and each other, in order to clarify and validate decisions made during episodes of care. The third transition reflects the degree to which patients and family members are incorporated into treatment decisions, and highlights a shift in emphasis, from a focus on the disease state, to the patient as a person with individualistic thoughts and wishes. The remaining social processes evident in the study consist of four categories. The first, Seeking Clarification, embodies exploration undertaken by participants and their recognition that treatment is actually being refused. The second category, Responding to Patients and Families, demonstrates the level of expertise of participants communicating, and their ability to encourage reciprocity in the professional-patient relationship. The third category, Advocating, highlights the extent and manner in which patient and family wishes are promoted to members of the treating team. The fourth category, Influencing, reveals the ability of participants to utilize a degree of authority or power in order to shape particular outcomes. The findings also indicate that over arching the core variable and categories are various contextual determinants that moderate the way nurses and medical practitioners deal with patient refusal of treatment. These determinants are categorized into three main influences: The Context of Work, describes the of the environment and organisational factors pertinent to public hospitals; Beliefs and Behaviours, illustrates the perceptions of, and values held, by four key groups involved in decisions, namely, nurses, medical practitioners, patients, and family members; and Legal and Ethical Frameworks, examines the existing principles that support or guide professional practice in situations where patients with serious illness refuse medical treatment.

The purpose of this study is to investigate and develop a substantive theory, of the processes adopted by nurses and medical practitioners when patients with serious illness refuse medical treatment. The study seeks to identify the main constraints confronting nurses and medical practitioners and to explain the key factors that moderate the processes of dealing with refusal decisions. Using a grounded theory method, a sample of 18 nurses and 6 medical practitioners from two public hospitals in Melbourne were interviewed. In addition, observations and documentary evidence were utilised. The basic social psychological problem shared by nurses and medical practitioners is conceptualized as Competing Perspectives: Encountering Refusal of Treatment, which reflects the diverse perceptions and beliefs that confront participants when patients decide to forgo therapy. In utilizing the grounded theory method of analysis, it is recognised that participants deal with this problem through a basic social psychological process conceptualized as Endeavouring to Understand Refusal: Agreeing on a Way Forward. This core variable represents the manner in which participants, to varying extents, deal with the situations they face and it incorporates the various influences which moderate their activities. Endeavouring to Understand Refusal: Agreeing on a Way Forward comprises a series of three transitions. The first involves a struggle for participants to come to terms with, or even recognize that patients are rejecting treatment. The second transition illustrates the varied responses of participants as they interact with patients, relatives and each other, in order to clarify and validate decisions made during episodes of care. The third transition reflects the degree to which patients and family members are incorporated into treatment decisions, and highlights a shift in emphasis, from a focus on the disease state, to the patient as a person with individualistic thoughts and wishes. The remaining social processes evident in the study consist of four categories. The first, Seeking Clarification, embodies exploration undertaken by participants and their recognition that treatment is actually being refused. The second category, Responding to Patients and Families, demonstrates the level of expertise of participants communicating, and their ability to encourage reciprocity in the professional-patient relationship. The third category, Advocating, highlights the extent and manner in which patient and family wishes are promoted to members of the treating team. The fourth category, Influencing, reveals the ability of participants to utilize a degree of authority or power in order to shape particular outcomes. The findings also indicate that over arching the core variable and categories are various contextual determinants that moderate the way nurses and medical practitioners deal with patient refusal of treatment. These determinants are categorized into three main influences: The Context of Work, describes the of the environment and organisational factors pertinent to public hospitals; Beliefs and Behaviours, illustrates the perceptions of, and values held, by four key groups involved in decisions, namely, nurses, medical practitioners, patients, and family members; and Legal and Ethical Frameworks, examines the existing principles that support or guide professional practice in situations where patients with serious illness refuse medical treatment.

The relationship between nurse and patient is important to nursing care and health outcomes. This relationship can be therapeutic for both nurse and patient. However, the current lack of conceptual consensus and descriptive clarity in nursing theory has precluded the relationship from the realms of therapy and healing. The goal of this study was to discern, from descriptions given by nurses and patients, the essential structure, dynamics, practical application and advantages to nursing practice of a therapeutic relationship between nurse and patient.

Breastfeeding benefits the mother as well as the baby. Breast milk is a complete food for newborn human infants, adequately supplying all nutritional needs for at least the first 4- 6 months of life (Kramer & Kakuma, 2002). In 1993, the Commonwealth of Australia recommended the following goals for promoting breastfeeding by the year 2000 and beyond (Nutbeam, Wise, Bauman, Harris & Leader, 1993): For infants to the age of three months, 60% should be fully breastfed or 80% should be partially breastfed. For infants to the age of six months, 50% should be fully breastfed or 80% should be partially breastfed. However, according to the most recent national survey, these targets have not been met (Donath, 2000). In effect, breastfeeding figures have not changed in the last ten to fifteen years (Mortensen, 2001). Research indicates that the largest decrease in breastfeeding occurs between two weeks and six weeks after birth (Binns & Scotts, 2002; Stamp & Crowther, 1995; Mogan 1986), with women giving Insufficient Milk Supply (IMS) as the major reason for stopping. Despite research in the field of physiology, biochemistry, psychology and socioeconomics, this phenomenon of IMS remains an 'enigma' (Hill, 1991, p. 312). However, failure to thrive in infancy can be seen in babies who do not achieve an adequate weight gain within the normal time span. According to lactation consultants at the Royal Women’s Hospital Breastfeeding Assessment Service in Melbourne, some babies who are breastfed present with inadequate weight gain due to IMS. Women with low breastmilk supply who wish to persist with breastfeeding often look for some means to increase their milk supply. There are very few alternative treatment to assist them. For over a thousand years mothers in China have used acupuncture to increase their supply of breast milk. Within the last decade, several authors have published results of studies on the effect of Traditional Chinese Acupuncture (TCA) on lactation (Wu, 2002; Huang & Huang, 1994; Tureanu, 1994; Dong, 1988; Kang, 1990). These study all indicated improvement in lactation after TCA therapy. However, all these studies have been uncontrolled clinical trials. This research is a first single blind controlled clinical trial to investigate the effectiveness of Traditional Chinese Acupuncture for the treatment of IMS. The aim of the study is to find out whether a course of Traditional Chinese Acupuncture treatment would help mothers diagnosed with insufficient breast milk supply produce more milk. This clinical trial was conducted by a qualified Traditional Chinese Medicine practitioner. The researcher gained a Bachelor of Medicine degree in TCM after completing the five years program at the Beijing College of TCM in China. The researcher has been in clinical practice for more than 15 years. This is a pilot study. The final number of subjects in the study was 27,: 9 in the Traditional Chinese Acupuncture (TCA) Group; 6 in the Sham Acupuncture (SA) Group and 12 in the Non-Treatment Control Group. The major finding of the study was that - 'Other things being equal, infants whose mothers received TCA weighed 160.13 grams more on average than those whose mothers received SA. This effect is marginally significant (p less than 0.1)'. The finding generally confirms that the Traditional Chinese Acupuncture intervention to the mother is effective in increasing infant weight gain.

Autologous blood cell transplantation (ABCT) has been successfully used to treat a variety of haematological cancers and some solid tumours. The number of patients who are long term survivors and free of disease following this treatment is growing rapidly. To enable nurses and health care workers to provide optimal supportive care for these patients, an understanding of how the transplant has affected their quality of life (QOL) is essential. In the last two decades numerous studies have focused on QOL issues in this patient group. However, the majority of these studies tend to approach QOL from a bio-physiological perspective, generating knowledge about the treatment and its side effects. Little is known about the patients' experiences and how they interpret their QOL in the years following their transplants. The purpose of this study was to explore QOL issues from the perspectives of 12 patients who had undergone an ABCT. Heideggerian phenomenology (interpretive phenomenology) was chosen as the theoretical framework for the study, as it allows for the transparent world of people's everyday lived experiences to be illuminated, and so reveal how they interpret their QOL. The aims of this study was to gain a deeper understanding of QOL issues through the participants interpretations of their experiences, and to uncover themes and different patterns of meaning which embody the participants' QOL. Data was collected through in-depth, unstructured interviews with each participant. Thematic analysis, exemplars and paradigm cases were utilised to present the participants' interpretations of their QOL. The findings showed that the participants' QOL was influenced by their interpretations of embodiment, being in time, being in society and re-appraisal of life. The findings also revealed that QOL following an ABCT is a highly individualised, dynamic experience that depends on the challenges the participants confront in their everyday lives. As the participants re-interpreted their lives following their transplants, their perspectives on their QOL changed. For some this was a positive experience, but for others their QOL diminished. The implication of this study is that nurses must be committed to providing individualised, patient focused care following an ABCT. The findings of this study offer a deeper understanding of patients' everyday lived experiences and their QOL following an ABCT, and will enable nurses and other health professionals to develop supportive care infrastructure to assist patients during their recoveries, thus improving their QOL.

The purpose of this evaluative case study was to evaluate the effectiveness of a 48 hour Medical Unit in relation to Patient Satisfaction, Patient Care, Nursing Staff Job satisfaction and the Average Length of Stay for patients' Pre and Post a Rapid Assessment Medical Unit's (RAMU) inception. The study used a combination of Patient Satisfaction Survey's, Interviews, and data of the average length of stay of patients pre and post RAMU. This report aims to provide a comprehensive description of the research process and the results obtained from the collection of data throughout this research project. An evaluative case study using Yin (2003), as a framework of this study was deemed appropriate, as no research to date had been conducted on 48 hours Medical Wards, because of their uniqueness. A case study allowed for "multiple sources of evidence gathering", thus ensuring that the findings to this study are more likely to be accurate if based on several different sources of information. Despite the study's limitations, the results to this study were surprisingly supportive and positive of those patients who had participated in this research project. Nursing Staff on both wards that participate in the interviews had a positive attitude in relation to how well RAMU is functioning. The findings indicate there are a few minor changes that are required and further research is recommended, however the hospital and staff have managed to find a formula that works extremely well in providing patient satisfaction, patient care and job satisfaction in a short period of time.

Breastfeeding benefits the mother as well as the baby. Breast milk is a complete food for newborn human infants, adequately supplying all nutritional needs for at least the first 4- 6 months of life (Kramer & Kakuma, 2002). In 1993, the Commonwealth of Australia recommended the following goals for promoting breastfeeding by the year 2000 and beyond (Nutbeam, Wise, Bauman, Harris & Leader, 1993): For infants to the age of three months, 60% should be fully breastfed or 80% should be partially breastfed. For infants to the age of six months, 50% should be fully breastfed or 80% should be partially breastfed. However, according to the most recent national survey, these targets have not been met (Donath, 2000). In effect, breastfeeding figures have not changed in the last ten to fifteen years (Mortensen, 2001). Research indicates that the largest decrease in breastfeeding occurs between two weeks and six weeks after birth (Binns & Scotts, 2002; Stamp & Crowther, 1995; Mogan 1986), with women giving Insufficient Milk Supply (IMS) as the major reason for stopping. Despite research in the field of physiology, biochemistry, psychology and socioeconomics, this phenomenon of IMS remains an 'enigma' (Hill, 1991, p. 312). However, failure to thrive in infancy can be seen in babies who do not achieve an adequate weight gain within the normal time span. According to lactation consultants at the Royal Women's Hospital Breastfeeding Assessment Service in Melbourne, some babies who are breastfed present with inadequate weight gain due to IMS. Women with low breastmilk supply who wish to persist with breastfeeding often look for some means to increase their milk supply. There are very few alternative treatment to assist them. For over a thousand years mothers in China have used acupuncture to increase their supply of breast milk. Within the last decade, several authors have published results of studies on the effect of Traditional Chinese Acupuncture (TCA) on lactation (Wu, 2002; Huang & Huang, 1994; Tureanu, 1994; Dong, 1988; Kang, 1990). These study all indicated improvement in lactation after TCA therapy. However, all these studies have been uncontrolled clinical trials. This research is a first single blind controlled clinical trial to investigate the effectiveness of Traditional Chinese Acupuncture for the treatment of IMS. The aim of the study is to find out whether a course of Traditional Chinese Acupuncture treatment would help mothers diagnosed with insufficient breast milk supply produce more milk. This clinical trial was conducted by a qualified Traditional Chinese Medicine practitioner. The researcher gained a Bachelor of Medicine degree in TCM after completing the five years program at the Beijing College of TCM in China. The researcher has been in clinical practice for more than 15 years. This is a pilot study. The final number of subjects in the study was 27,: 9 in the Traditional Chinese Acupuncture (TCA) Group; 6 in the Sham Acupuncture (SA) Group and 12 in the Non-Treatment Control Group. The major finding of the study was that - 'Other things being equal, infants whose mothers received TCA weighed 160.13 grams more on average than those whose mothers received SA. This effect is marginally significant (p less than 0.1)'. The finding generally confirms that the Traditional Chinese Acupuncture intervention to the mother is effective in increasing infant weight gain.

An increasing number of people with chronic illness use complementary and alternative medicine (CAM) (Metz, 2000) and rarely disclose such use to treating biomedical physicians [B/M] (Adler & Fosket, 1999). Although the incidence of CAM use amongst people with chronic illness has been investigated (Nader et al., 2000; Sharon & Mark, 2006; Yang et al., 2002) research specifically examining that section of people who require ongoing biomedical treatment from a very early age until death has never before been conducted. This thesis examined the patterns of self-prescribed and CAM practitioner prescribed CAM use, reasons for CAM use and disclosure of CAM use to treating physicians, among people with a lifelong medical condition, thalassaemia major (TM). To examine the reasons for use and disclosure of CAM in this population, 21 people (eight males, 13 females) aged between 24 and 43 years volunteered for the three-phase study, which forms the thesis. The participants were English speakers whose physical and cognitive capacities did not prevent participation in the study. Interviews were conducted in the participants’ homes and followed standard consent procedures. All phases were conducted face-to-face. In Phase 1, using an in-depth unstructured questionnaire and two structured questions, participants were asked about their medical history, CAM use and whether they disclosed such use to their biomedical physician/s. In addition, the participants were asked to nominate any CAM practices they had heard of, that people might use. A written list was devised as the participants mentioned CAM therapies/treatments. The participants were then asked which of these CAM therapies/treatments they had used. In Phase 1, all of the participants reported having multiple co-morbidities and at least one major surgical procedure. Twelve of the participants reported using CAM when asked a dichotomous choice question. All participants were found to be CAM users when CAM was estimated according to the substances and therapies that participants reported using. Phase 1 showed that CAM estimates varied according to which CAM definition was applied to analyse the data. In Phase 1 there was only one participant out of 21 (4.76%) who reported CAM disclosure and disclosure was ongoing in that case. The reasons for CAM use and disclosure were elicited using in-depth conversational interviews, which constituted Phases 2 and 3 respectively. The operational definition of CAM devised for this thesis was based on the intent of CAM use and not prescribed by a biomedical physician. Based on the operational definition of CAM proposed for thesis there were 21 CAM users. Examination of the reasons the participants gave for CAM use confirmed there were 21 CAM users. Phase 2 showed the participants wanted safe and effective treatment to manage and cure the primary illness and co-morbidities. Phase 2 also indicated that CAM was used, at times in lieu of biomedicine, to prevent illnesses and to enhance quality of life (QoL) and to increase life expectancy. Phase 2 showed biomedical failure and adverse outcomes from biomedicine motivated CAM use. These reasons shaped perceptions of dissatisfaction with biomedical treatment and the prescribers of such treatment. Phase 3, addressed CAM disclosure, showed most of the participants considered they had disclosed their CAM use when they asked their treating biomedical physician about CAM. Phase 3 demonstrated most participants attempted to disclose CAM use and whilst they felt it was important for the treating physician to know about such use, they abandoned disclosure because of dissatisfaction with biomedical practitioners’ responses to their attempts to disclose. Other reasons for non-disclosure or aborted disclosure included a desire to maintain privacy and a belief that CAM was harmless. Phases 2 and 3 showed core reasons for CAM use and CAM non-disclosure were dissatisfaction and a loss of confidence in biomedicine. The one person who did disclose CAM use stated disclosure symbolised their dissatisfaction with biomedicine. This thesis showed people with a serious life-long illness used CAM because biomedicine was often ineffective, frequently palliative and sometimes considered deleterious to health. These aspects of biomedical care instigated dissatisfaction and a loss of confidence in biomedicine treatment and practitioners. The negative perceptions held by the participants of biomedical treatment and biomedical physicians were the primary motivators for CAM use and disclosure. All participants were found to be CAM users and this might have serious implications for their on-going biomedical treatment because some CAM products have a pharmacological effect that might interact with prescribed biomedicine medication. The findings suggest CAM was beneficial in an environment in which biomedicine could only offer palliative care, but this finding requires further research. This thesis showed that CAM use and disclosure are complex issues, deserving indepth examination in people with a range of medical conditions, as well as in the general population.

At a time when quality health care is increasingly dependent on the use of information and computer based technologies, Nursing Informatics, which encompasses the use of such technologies, is of increasing importance as it facilitates practitioners' access to current information on which to base such care. The purpose of this study was to investigate the congruence between the informatics competencies educators believe should be included in the undergraduate nursing curriculum and those identified by newly registered nurses as relevant to their clinical practice. This two-phased study used the Delphi Technique, a research methodology for determining group opinion. In Phase One a purposively selected group of nurses experienced in the informatics domain generated a list of informatics competencies. In Phase Two a panel of nurse educators and a panel of newly registered nurses reviewed these competencies to establish their relevance to the areas of education and practice.

During the last century, much of the literature that discussed loss and grief was developed within an empirical-analytical paradigm. Stage models and theories of grief were proposed to explain and describe a universal process of grieving. Nurses, to a large extent, accept and perpetuate these notions of loss and grief and continue to provide prescriptive care in order to help their patients through each stage of grief. These theories and models fail to recognise individuals' unique circumstances that shape their actions and reactions to loss. Especially, these theories and models are inadequate in informing nurses when caring for people whose loss is not through death. The aim of this hermeneutic phenomenological study was to explore spousal carers' lived experience of loss. Ten spousal carers of partners with Multiple Sclerosis participated in this study. In-depth, unstructured interviews were conducted and transcribed verbatim. The data were analysed using a modified form of the method outlined by Diekelmann, Allen, and Tanner, (1989). Three relational themes: experiencing the loss, caring as worrying and reinterpreting life meaning, were identified. The constitutive pattern that emerged was weaving through a web of paradoxes. Within this web were three paradoxes: loss/gain, limiting/enabling and vulnerability/strength. The relational themes and constitutive pattern explicated illuminate these carers' experiences of loss from their perspective thus enabling deeper insight of their experience. The constitutive pattern provides understanding into what these participants (and their families) are living through, their personal strengths, weaknesses, hopes and resources in coping with loss not through death. The findings of the study therefore have implications for nursing practice, education and research, and health service provision.

This study investigated childbirth education programs in Victoria from the perspective of the educators themselves. Prior to the study the Ministerial Review of Birthing Services in Victoria (1990) entitled “Having a Baby in Victoria” identified shortcomings in the childbirth education programs offered to expectant women and their partners. The study sought to interpret the experiences of the childbirth educators with regard to the development, implementation, delivery and evaluation of their programs.

Over 456,000 Australians spend time holidaying in South East Asia each year; it is Australia's top tourist destination. Much of the attraction of South East Asia is the novelty of exotic tropical environments. However, these can result in strange and diverse health hazards. This exploratory research used sequential in-depth interviews to explain the relationship between the travel health advice tourists receive and their behaviour while holidaying in South East Asia. When providing travel health advice to tourists travel health advisers need to understand the psychology underlying reasoned behaviours such as travel health behaviours if they want to persuade tourists to practice preventative health measures. After review of the relevant literature it would appear that this is the first time that the theory of reasoned action, developed by Ajzen and Fishbein in 1980, had been used to explore travel health beliefs, attitudes, intentions and behaviours. The research found that the travel health advice received by tourists had marginal effect on their travel health behaviours as the source, extent and relevance of the advice was left wanting. The tourists hoped to relax and desired a good time on their holiday by entering into the 'holiday spirit' offered by South East Asia. This impeded their ability to recognise the very real travel health risks they faced.

Autologous blood cell transplantation (ABCT) has been successfully used to treat a variety of haematological cancers and some solid tumours. The number of patients who are long term survivors and free of disease following this treatment is growing rapidly. To enable nurses and health care workers to provide optimal supportive care for these patients, an understanding of how the transplant has affected their quality of life (QOL) is essential. In the last two decades numerous studies have focused on QOL issues in this patient group. However, the majority of these studies tend to approach QOL from a bio-physiological perspective, generating knowledge about the treatment and its side effects. Little is known about the patients' experiences and how they interpret their QOL in the years following their transplants. The purpose of this study was to explore QOL issues from the perspectives of 12 patients who had undergone an ABCT. Heideggerian phenomenology (interpretive phenomenology) was chosen as the theoretical framework for the study, as it allows for the transparent world of people's everyday lived experiences to be illuminated, and so reveal how they interpret their QOL. The aims of this study was to gain a deeper understanding of QOL issues through the participants interpretations of their experiences, and to uncover themes and different patterns of meaning which embody the participants' QOL. Data was collected through in-depth, unstructured interviews with each participant. Thematic analysis, exemplars and paradigm cases were utilised to present the participants' interpretations of their QOL. The findings showed that the participants' QOL was influenced by their interpretations of embodiment, being in time, being in society and re-appraisal of life. The findings also revealed that QOL following an ABCT is a highly individualised, dynamic experience that depends on the challenges the participants confront in their everyday lives. As the participants re-interpreted their lives following their transplants, their perspectives on their QOL changed. For some this was a positive experience, but for others their QOL diminished. The implication of this study is that nurses must be committed to providing individualised, patient focused care following an ABCT. The findings of this study offer a deeper understanding of patients' everyday lived experiences and their QOL following an ABCT, and will enable nurses and other health professionals to develop supportive care infrastructure to assist patients during their recoveries, thus improving their QOL.

South Africa has a high incidence of childhood mortality and morbidity. More than fifty percent is attributed to mild and moderate malnutrition and the highest incidences occur in rural communities such as North Kwa Zulu Natal (NKZN). Despite recent South African government interventions, such as the Integrated Nutrition Programme, Integrated Management of Childhood Illnesses and the introduction of Food Based Dietary Guidelines, malnutrition is still a severe problem. Nutritional research studies on children aged one to five years confirmed that malnutrition results from inadequate intake of nutrient and energy rich food. However, contextual influences on the mothers' food choices for their children had not been reported. The purpose of this study was to explore and understand, from the perspective of NKZN mothers, the influences on their choices of food for their children aged one to five years. A qualitative research design using a naturalistic approach was implemented. The strategies used for collecting data from eight mothers of children with identified nutrition related illnesses included interviews, observations and a focus group discussion. Indepth interviews and a focus group discussion were conducted to explore food choices from the mothers' perspectives. Further understanding of their food practices was gained by observing the broad features of each informant's home, living conditions, surrounding environment and various food preparation practices and resources. The data were analysed for common patterns of meaning and categories of influence in the mothers' choice of food. The influences on the mothers' food choice that emerged from the study included the geographic location of the informants in the form of isolation from shops, their living conditions, family income and seasonal availability of food. Social and cultural changes, such as declining numbers of adult males in each household and the shift from subsistence farming to the dependence on the cash economy, were substantial influences. Most importantly, limited knowledge of food value and of nutrition related illnesses influenced the choice of food that NKZN mothers provided to their children. This study discovered that despite the many problems confronted by NKZN mothers, they were enthusiastic in their request for knowledge to improve the health of their children, albeit requiring the assistance and cooperation from health care professionals and policy makers. Insight of the contextual influences will enable health care professionals and policy makers to develop appropriate programmes that assist NKZN mothers in the provision of energy and nutrient-rich food for their children.

Naturalistic inquiry was the method used in this qualitative study, examining the experience of the menopause and climacteric of women in Australia from a non-English speaking background. Women form over one-half of the Australian population, with 12% of this number being from a non-English speaking background country, and 14% of these women speaking a language other than English (LOTE) in the family home. These women seek health-care in a care system which was established and is maintained in the Anglo-Celtic tradition. As these women approach the menopause and the climacteric years, how culturally appropriate is our health-care service for these women? The study was conducted in the Western suburbs of Melbourne which has a higher percentage of people born overseas (34.6%) than the national or Victorian percentage of 22%. Data was collected by in-depth interviews with 33 women from the countries of Vietnam, the Philippines, China, Malta, Italy, Greece and Lebanon. Issues explored and contained in the data included the women's difficulties with their own health at the time of menopause, the significant beliefs and practices about menopause in their countries of origin, availability of culturally relevant information and treatment in the health care system. Findings included negative attitudes to menopause and usage of hormone replacement therapy, cultural overtones in the women's beliefs about menopause, religion being a determinant in acceptance and coping with menopause and the climacteric, inadequate information provided by health-care professionals, and the unavailibility of printed information in the appropriate language. The provision of Medicare was an important factor in the women's ability to access health care. As Australia is a multicultural country, it would appear from this study that the health-care system needs to address the issue of culturally congruent care.

An increasing number of people with chronic illness use complementary and alternative medicine (CAM) (Metz, 2000) and rarely disclose such use to treating biomedical physicians [B/M] (Adler & Fosket, 1999). Although the incidence of CAM use amongst people with chronic illness has been investigated (Nader et al., 2000; Sharon & Mark, 2006; Yang et al., 2002) research specifically examining that section of people who require ongoing biomedical treatment from a very early age until death has never before been conducted. This thesis examined the patterns of self-prescribed and CAM practitioner prescribed CAM use, reasons for CAM use and disclosure of CAM use to treating physicians, among people with a lifelong medical condition, thalassaemia major (TM). To examine the reasons for use and disclosure of CAM in this population, 21 people (eight males, 13 females) aged between 24 and 43 years volunteered for the three-phase study, which forms the thesis. The participants were English speakers whose physical and cognitive capacities did not prevent participation in the study. Interviews were conducted in the participants’ homes and followed standard consent procedures. All phases were conducted face-to-face. In Phase 1, using an in-depth unstructured questionnaire and two structured questions, participants were asked about their medical history, CAM use and whether they disclosed such use to their biomedical physician/s. In addition, the participants were asked to nominate any CAM practices they had heard of, that people might use. A written list was devised as the participants mentioned CAM therapies/treatments. The participants were then asked which of these CAM therapies/treatments they had used. In Phase 1, all of the participants reported having multiple co-morbidities and at least one major surgical procedure. Twelve of the participants reported using CAM when asked a dichotomous choice question. All participants were found to be CAM users when CAM was estimated according to the substances and therapies that participants reported using. Phase 1 showed that CAM estimates varied according to which CAM definition was applied to analyse the data. In Phase 1 there was only one participant out of 21 (4.76%) who reported CAM disclosure and disclosure was ongoing in that case. The reasons for CAM use and disclosure were elicited using in-depth conversational interviews, which constituted Phases 2 and 3 respectively. The operational definition of CAM devised for this thesis was based on the intent of CAM use and not prescribed by a biomedical physician. Based on the operational definition of CAM proposed for thesis there were 21 CAM users. Examination of the reasons the participants gave for CAM use confirmed there were 21 CAM users. Phase 2 showed the participants wanted safe and effective treatment to manage and cure the primary illness and co-morbidities. Phase 2 also indicated that CAM was used, at times in lieu of biomedicine, to prevent illnesses and to enhance quality of life (QoL) and to increase life expectancy. Phase 2 showed biomedical failure and adverse outcomes from biomedicine motivated CAM use. These reasons shaped perceptions of dissatisfaction with biomedical treatment and the prescribers of such treatment. Phase 3, addressed CAM disclosure, showed most of the participants considered they had disclosed their CAM use when they asked their treating biomedical physician about CAM. Phase 3 demonstrated most participants attempted to disclose CAM use and whilst they felt it was important for the treating physician to know about such use, they abandoned disclosure because of dissatisfaction with biomedical practitioners’ responses to their attempts to disclose. Other reasons for non-disclosure or aborted disclosure included a desire to maintain privacy and a belief that CAM was harmless. Phases 2 and 3 showed core reasons for CAM use and CAM non-disclosure were dissatisfaction and a loss of confidence in biomedicine. The one person who did disclose CAM use stated disclosure symbolised their dissatisfaction with biomedicine. This thesis showed people with a serious life-long illness used CAM because biomedicine was often ineffective, frequently palliative and sometimes considered deleterious to health. These aspects of biomedical care instigated dissatisfaction and a loss of confidence in biomedicine treatment and practitioners. The negative perceptions held by the participants of biomedical treatment and biomedical physicians were the primary motivators for CAM use and disclosure. All participants were found to be CAM users and this might have serious implications for their on-going biomedical treatment because some CAM products have a pharmacological effect that might interact with prescribed biomedicine medication. The findings suggest CAM was beneficial in an environment in which biomedicine could only offer palliative care, but this finding requires further research. This thesis showed that CAM use and disclosure are complex issues, deserving indepth examination in people with a range of medical conditions, as well as in the general population.

The purpose of this evaluative case study was to evaluate the effectiveness of a 48 hour Medical Unit in relation to Patient Satisfaction, Patient Care, Nursing Staff Job satisfaction and the Average Length of Stay for patients' Pre and Post a Rapid Assessment Medical Unit's (RAMU) inception. The study used a combination of Patient Satisfaction Survey's, Interviews, and data of the average length of stay of patients pre and post RAMU. This report aims to provide a comprehensive description of the research process and the results obtained from the collection of data throughout this research project. An evaluative case study using Yin (2003), as a framework of this study was deemed appropriate, as no research to date had been conducted on 48 hours Medical Wards, because of their uniqueness. A case study allowed for "multiple sources of evidence gathering", thus ensuring that the findings to this study are more likely to be accurate if based on several different sources of information. Despite the study's limitations, the results to this study were surprisingly supportive and positive of those patients who had participated in this research project. Nursing Staff on both wards that participate in the interviews had a positive attitude in relation to how well RAMU is functioning. The findings indicate there are a few minor changes that are required and further research is recommended, however the hospital and staff have managed to find a formula that works extremely well in providing patient satisfaction, patient care and job satisfaction in a short period of time.

Many people with schizophrenia are reluctant to take their antipsychotic medications, and this might have adverse implications for their recovery. Numerous approaches have been implemented to enhance medication taking for this population, but results have varied. The overall aim of the study was to assess if consumers with schizophrenia had improved adherence to their oral antipsychotic medication after participation in a problem-solving based peer support program.