Дисертації з теми "111006 Midwifery"

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

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.

Anorexia nervosa is a complex eating disorder that usually develops during adolescence. Individuals who have anorexia are known to refuse treatment and exhibit challenging behaviours. Many paediatric nurses can develop professional interpersonal relationships with these patients however some can find it difficult to establish these relationships.

Chronic pain is a common problem among elderly people. Proper self-management of chronic pain is crucial in promoting general well-being; however, elderly people who live in Thai rural communities have limited access to self-management resources. Understanding the way these people self-manage chronic pain within their life context will provide guidance on how to support them to achieve effective self-management, which in turn, enhances their well-being. The broad aim of the study was to describe and understand the ways in which elderly people, aged 60 years or over, who lived in rural communities in north-east Thailand, self-managed their chronic pain. The specific objectives were to: examine the strategies that they used to self-manage their chronic pain; identify the factors that moderated the way they self-managed their chronic pain; develop a substantive theory that explained the experience of self-managing chronic pain; and evaluate the developed theory within the context of current literature in the area.

The purpose of this study was to develop a substantive theory of the processes used by midwives in exercising their scope of practice when caring for women and babies during normal birthing. The grounded theory approach of Strauss and Corbin (Corbin & Strauss, 2008; Strauss & Corbin, 1998, 1990) was employed to inform data collection and analysis, including the use of participant observation and in-depth interviews with seventeen midwives practising in a hospital maternity unit. From this approach, the core category of Promoting normal birthing: Aspiring to develop a midwife-led scope of practice emerged, illustrating the processes utilised by midwives in practice to support normal birth.

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.

The concept of palliative care as an holistic approach to the management of patients with incurable conditions has its roots in the hospice movement. It has since grown into an established field of practice for health professionals of all disciplines and has been recognised as a medical specialty since 1987. Palliative care remains relatively underdeveloped in the paediatric setting for a number of reasons. Firstly, death in childhood is now relatively rare due to the advent of antibiotics, immunisation and advances in the treatment of malignancies. This means that any health professional's individual exposure to palliative care issues is limited, making the development and maintenance of skills difficult. Secondly, the traditional model of palliative care, as a path to be taken when all curative options have been explored, does not adequately serve children and adolescents where the transition to palliative care may be less clear due to a broader range of diagnoses and patterns of disease progression. Children also present added dimensions to palliative care including developmental, ethical and physiological considerations. The involvement of parents as care givers and decision makers further increases the complexity of providing palliative care. Research is lacking and the evidence on which to base practice is limited. Nevertheless, there are theoretical constructs that can be utilised to build a framework for research in this area. The works of Glaser and Strauss, Corr and Copp on theories of death and dying coupled with earlier works by Freud, Erikson and Piaget on theories of childhood development provide a suitable theoretical framework. Corr's 'task' based model described in 1992 allows us to view the process of providing pediatric palliative care from many different perspectives, and thus provides for a rich multi-dimensional model of pediatric palliative care to be constructed. This study was done to analyse and investigate the knowledge, attitudes and needs of both providers and recipients of palliative care in a major tertiary paediatric hospital, the Royal Children's Hospital (RCH), Melbourne, Australia and, in addition, to examine various models of delivery of paediatric palliative care in use around the world, and to identify from the literature the constituents of care that make up 'best practice' as regards paediatric palliative care. From this investigation it is hoped to develop a model of care that will best serve the RCH and its patients.

Nursing brings together two persons' worlds, one being that of the nurse and the other of the patient. Their worlds embody past experiences, expectations, limitations and potential. Nurse theorists have described this bringing together as an intersecting intersubjectivity or presence. This Heideggerian phenomenological study enabled the researcher to explore six registered nurses' meaning of presence as experienced within their clinical practice. These registered nurses were all clinicians with extensive experience in a variety of clinical settings. A hermeneutical analysis of their experiences revealed that presence is a powerful intersecting of nurses' and patients' subjective worlds. Presence, according to these nurses, was an enriching experience within nursing practice that provided them with immense professional satisfaction. It was from the spiritual connectedness of care that their need to care for and be with patients in meaningful interactions was fulfilled. Despite the difficulties these participants encountered, their commitment to care and need to find meaning in their practice motivated them to transcend these encumbrances and connect with patients in deep meaningful ways. This study recommends strategies be implemented within nursing to acknowledge these experiences, and for nurses to create times and space to share these subjective experiences.

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.

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.

Nursing recruitment and turnover is a significant issue for the health care system, as high turnover rates can contribute significantly to negative outcomes in terms of cost and quality of care. Both critical care and regional nursing have been highlighted as areas of specific concern in the literature (Department of Human Services, 2001), but no studies have focussed on the retention of regional, critical care nurses. This research is an exploratory, descriptive study to. investigate the outcomes of tertiary critical care nursing courses based in Victorian regional hospitals in terms of employment and retention of graduates and the factors which influence this.

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.

Current research and evidence into Continuing Professional Development (CPD) has mostly centred on effective delivery formats to engage consumers. The perceptions and approaches that influence an individual engaging in CPD have yet to be explored, particularly in nursing. This qualitative research grounded in critical social constructionism and critical ethnography explores the perceptions and influences for regional intensive care nurses from Victoria, Australia as they engage in CPD. Participants from three field sites participated in semi-structured interviews. Through interviews the major themes of fear and vulnerability, isolation, professional inconsistencies and a myriad of concern for the nursing profession were identified. Threaded throughout each theme was the social influence of workplace upon nurses’ perceptions and their approaches toward CPD and the sharing of acquired knowledge amongst colleagues. The theoretical perspective of Pierre Bourdieu have been used to explore and discuss the findings of the research through the positions of orthodoxy and heterodoxy. These two positions allow the reality and the rhetoric of mandatory CPD for Australian nurses to be revealed, as shared by the participants. Orthodoxy and heterodoxy bring to light a disconnect between the regulatory body of the Australian Nursing and Midwifery Board (NMBA), and the nurses it registers. Nurses engage in CPD influenced by peers and often as a means of protection or a strategic tool to acquire and hold capital and power. The NMBA mandates CPD for knowledge growth and practice change. The findings reveal that nurses’ and the NMBA appear to be playing a game creating a state of illusio, with many nurses looking to mandatory CPD to maintain their employability rather than, public protection. This research highlights the symbolic power of CPD exposing the influences of social culture, habitus and the field in which nurses’ practice. Recommendations of this research suggest that the current model of CPD is fundamentally flawed. Significant changes need to be undertaken to achieve the goal of public protection through a contemporary and knowledgeable workforce.

High quality of working life is vital for maintaining an adequate workforce, and given the current global nursing workforce shortage, the quality of nurses’ working lives is of particular importance. The literature suggests that ensuring working conditions are attractive enough to retain nurses in the workforce is the most cost-effective and sustainable strategy for addressing the nursing shortage. Drawing upon the Theory of Work Adjustment as a theoretical framework, this cross-sectional, mixed-method study sought to explore the opinions about quality of working life held by nurses working in public hospitals in Victoria. Differences in opinion about key aspects of working life between nurses who planned to continue a career in nursing and those who planned to make a career change were also sought. Data were collected using a Likert-style survey and semi-structured interviews and were analysed by means of the SPSS computer program and qualitative content analysis.