ORCID Profile
0000-0003-1564-8574
Current Organisation
Murdoch University
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Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.IJNURSTU.2019.103474
Abstract: Australia has vast areas of desert, wilderness and offshore islands where nurses provide the majority of health care services. The residents of Australia's remote communities generally have poorer health status than their metropolitan counterparts. Despite recognition of Primary Health Care 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 employ the Primary Health Care model in practice. This study described and explained from the perspective of nurses, the actions and interactions involved in the delivery of Primary Health Care in remote communities. This study was conducted from a Constructivist Grounded Theory perspective. The setting was community health centres or Aboriginal Medical Services located in 'remote' or 'very remote' areas. Communities with inpatient health services were excluded. Twenty four Nurse Practitioners, Registered Nurses and nursing academics participated. Participants had worked or were working, in a variety of remote communities across Australia. Length of service ranged from three months to over 15 years nursing in remote areas. Data were collected through 23 telephone interviews and an expert reference group. Theoretical s ling and constant comparative analysis were used to reach theoretical saturation. The core issue participants faced was the inability to provide Primary Health Care. Four conditions impacted on the core issue: understanding the social world of the remote community, availability of resources, clinical knowledge and skill and, shared understanding and support. The process of doing the best you can with what you have, emerged as the way participants dealt with the inability to provide Primary Health Care. 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 Primary Health Care. This study describes the substantive theory: making compromises to provide Primary Health care services in the remote Australian setting. Understanding the process of making compromises could direct employers and educators in their efforts to improve the provision of Primary Health Care in a variety of settings. Increased attention to the education, resources and support of nurses is likely to increase access to safe, quality care for remote communities.
Publisher: SAGE Publications
Date: 15-10-2019
Abstract: The use of nursing assistants has increased across health systems in the past 20 years, to alleviate licensed nurses' workload and to meet rising health care demands at lower costs. Evidence suggests that, when used as a substitute for licensed nurses, assistants are associated with poorer patient and nurse outcomes. Our multimethods study evaluated the impact of a policy to add nursing assistants to existing nurse staffing in Western Australia's public hospitals, on a range of outcomes. In this article, we draw the metainferences from previously published quantitative data and unpublished qualitative interview data. A longitudinal analysis of patient records found significantly higher rates adverse patient outcomes on wards that introduced nursing assistants compared with wards that did not. These findings are explained with ward-level data that show nursing assistants were added to wards with preexisting workload and staffing problems and that those problems persisted despite the additional resources. There were also problems integrating assistants into the nursing team, due to ad hoc role assignments and variability in assistants' knowledge and skills. The disconnect between policy intention and outcomes reflects a top-down approach to role implementation where assistants were presented as a solution to nurses' workload problems, without an understanding of the causes of those problems. We conclude that policy makers and managers must better understand in idual care environments to ensure any new roles are properly tailored to patient and staff needs. Further, standardized training and accreditation for nursing assistant roles would reduce the supervisory burden on licensed nurses.
Publisher: Wiley
Date: 30-06-2022
DOI: 10.1111/AJR.12899
Abstract: Remote area nurses provide primary health care services to isolated communities across Australia. They manage acute health issues, chronic illness, health promotion and emergency responses. This article discusses why their generalist scope of practice should be formally recognised as a specialist nursing practice area. Constructivist grounded theory, using telephone interviews ( n = 24) with registered nurses and nurse practitioners. Primary health care clinics, in communities of 150–1500 residents across Australia. A total of 24 nurses participated in this study. Nurses' perceived their clinical knowledge and skill as insufficient for the advanced, generalist, scope of practice in the remote context, especially when working alone. Experience in other settings was inadequate preparation for working in remote areas. Knowledge and skill developed on the job, with formal learning, such as nurse practitioner studies, extending the in idual nurse's scope of practice to meet the expectations of the role, including health promotion. Remote area nursing requires different knowledge and skills from those found in any other nursing practice setting. This study supports the claim that remote area nursing is a specialist–generalist role and presents a compelling case for further examination of the generalist education and support needs of these nurses. Combined with multidisciplinary collaboration, developing clinical knowledge and skill across the primary health care spectrum increased the availability of health resources and subsequently improved access to care for remote communities. Further research is required to articulate the contemporary scope of practice of remote area nurses to differentiate their role from that of nurse practitioners.
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.PEC.2008.04.011
Abstract: This paper describes a translational project that explored the feasibility and effect of introducing a coordinated approach to emotional care. The project was undertaken using Action Research on one ward at St John of God Hospital Subiaco, Western Australia. A senior Registered Nurse was appointed to provide the leadership and direction to staff regarding emotional care and an education program for staff was provided. The project was evaluated using both quantitative and qualitative data. Data demonstrated an increase in the patient's evaluation of emotional care, although levels were found to fluctuate throughout the project. Factors such as the emotional distress of the staff were hypothesised as impacting on the delivery of emotional care. The approach used in this project was found to be a useful method of improving emotional care. However, the data collected in this study revealed the complexity of emotional care delivery and the possible impact of a number of factors within the environment. Emotional care delivery can be improved by using a coordinated research-based educational approach led by a clinical ch ion. However, the impact of other factors within the hospital environment needs to be considered and more research is required.
Publisher: Elsevier BV
Date: 04-2019
Publisher: Hindawi Limited
Date: 16-04-2018
DOI: 10.1111/HSC.12576
Abstract: Neurological conditions represent leading causes of non-fatal burden of disease that will consume a large proportion of projected healthcare expenditure. Inconsistent access to integrated healthcare and other services for people with long-term neurological conditions stresses acute care services. The purpose of this rapid evidence assessment, conducted February-June 2016, was to review the evidence supporting community neurological nursing approaches for patients with neurological conditions post-discharge from acute care hospitals. CINAHL Plus with Full Text and MEDLINE were searched for English-language studies published January 2000 to June 2016. Data were extracted using a purpose-designed protocol. Studies describing community neurological nursing care services post-discharge for adults with stroke, dementia, Alzheimer's disease, Parkinson's disease, multiple sclerosis or motor neurone disease were included and their quality was assessed. Two qualitative and three quantitative studies were reviewed. Two themes were identified in the narrative summary of findings: (i) continuity of care and self-management and (ii) variable impact on clinical or impairment outcomes. There was low quality evidence of patient satisfaction, improved patient social activity, depression scores, stroke knowledge and lifestyle modification associated with post-discharge care by neurological nurses as an intervention. There were few studies and weak evidence supporting the use of neurology-generalist nurses to promote continuity of care for people with long-term or progressive, long-term neurological conditions post-discharge from acute care hospital. Further research is needed to provide role clarity to facilitate comparative studies and evaluations of the effectiveness of community neurological nursing models of care.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.NEPR.2019.02.011
Abstract: This study compared final year nursing students' error rate and use of strategies to maintain SA when undertaking specific nursing care in a simulated clinical environment pre and 10 weeks post a planned SA education intervention. Students were observed using a Performance Based Situation Awareness Observation Schedule (PBSAOS) undertaking two tasks in a simulated clinical environment pre and post the SA education. For task 1, post educational intervention, there was no significant increase in the error rate for any performance measures, and there were significant decreases in the error rates for three performance measures. For task 2, post educational intervention, there was a significant decrease in the error rate for two measures and a significant increase in the error rates for seven performance measures. In considering the overall group error rate when excluding uncompleted tasks, there was a significant (x = .0001) decrease in the error rate for task 1 post educational intervention (41.4% compared to 26.6%), and significant (x = 0.01) increase in the error for task 2 post educational intervention (39.6% compared to 47.3%). The findings of this study demonstrate that the implementation of an intervention designed to increase SA actually appear to have resulted in hyper-vigilance and subsequent non-completion of required tasks.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2014
Publisher: Wiley
Date: 28-09-2015
DOI: 10.1111/JOCN.12971
Abstract: To describe modifications to a second extended version of the Nordic Musculoskeletal Questionnaire for online use in nursing populations, and check validity and reliability. The Nordic Musculoskeletal Questionnaire has been used to assess the severity and impact of musculoskeletal symptoms in occupational groups. The reliability of a previous extended version was established for paper-based, self-administration among nursing students. This current study extended the questionnaire to collect more information regarding musculoskeletal symptoms in all nine body regions and their work-relatedness, as an instrument is needed to gather evidence about the impact of fitness levels on occupational musculoskeletal disorders among nurses. Psychometric evaluation. Sixty-five undergraduate nurses completed the online extended Nordic Musculoskeletal Questionnaire twice. Content validity was examined by expert review and construct validity by exploratory factor analysis of 90 responses from the first completion. Reliability was checked by examining internal consistency, kappa statistics, proportions of observed, and positive and negative agreements, intra-class correlation coefficient and standard error of measurement. The instrument had high internal consistency and exploratory factor analysis revealed it was a relatively homogenous (unidimensional) measure of musculoskeletal symptom severity. Age of onset of symptoms questions were reliable, with high mean intra-class correlation coefficients and low mean standard errors of measurement. Overall, questions showed high mean strengths of agreement and proportions of observed agreement: three-quarters of the prevalence questions and 99% of the severity/impact questions had 10% or fewer disagreements. Modifications to the Nordic Musculoskeletal Questionnaire and online administration did not diminish its validity or reliability for obtaining information about the severity of nurses' musculoskeletal symptoms. Occupational musculoskeletal disorders are an issue for nurses. This questionnaire can be used to monitor nurses' musculoskeletal health, and in musculoskeletal disorder prevention studies.
Publisher: Informa UK Limited
Date: 04-05-2022
DOI: 10.1080/10376178.2022.2086892
Abstract: Neurological conditions produce considerable disease burden. To describe quality of life in patients with neurological conditions and informal caregivers receiving postdischarge generic community neurological nursing services, and caregiver burden. A descriptive cross-sectional design was used with researchers administering the WHOQOL-BREF Australian Version questionnaire and Zarit Burden Interview. Most patients and caregivers rated quality of life as 'Good'. The patients' physical, psychological and environment domain scores, and caregivers' physical domain scores, were below norms. Half of the caregivers experienced burden and 42% had risk for depression. A heterogeneous group of patients with neurological conditions had considerable care and support needs for fundamental functioning postdischarge. Quality of life and caregiver burden measures highlight the impact of their circumstances on their health and wellbeing. Research is warranted to determine a comprehensive set of generic needs to guide integrated community nursing services for building patient and caregiver self-management capacity.
Publisher: Wiley
Date: 10-09-2004
Publisher: Wiley
Date: 14-05-2004
Publisher: Elsevier BV
Date: 10-2019
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.IJNURSTU.2014.06.010
Abstract: Hospital patients experience significant pain, which can delay healing and increase the risk of developing chronic pain. Nurses are affected by patients' ongoing pain and may cope with consequent anxiety and helplessness by distancing themselves from such patients. Understanding nurses' responses to patients in severe pain will inform strategies to support their coping, their patients and, ultimately, their retention in the nursing workforce. The aim of the study was to develop a substantive theory explaining the hospital nurse's perspective of caring for patients in severe pain. The study used grounded theory method. Data were collected on four acute care wards in a 610 bed Australian hospital. The s le included 33 nurse participants and 11 patient participants. Selection criteria for nurse participants were those who worked in the four study wards, cared for patients who experienced severe pain, and consented to be included. Selection criteria for patient participants were those who self-reported pain at intensity of seven or more on a scale of 0-10, were aged 18 years or older, could speak and read English, and consented to be included. Theoretical s ling directed the collection of data using semi-structured interviews with nurses and participant observation, including structured observations of nurses who cared for patients in pain. Data were analysed using constant comparison method. Nurse participants encountered a basic psychosocial problem of feelings of disempowerment when their patients experienced persisting severe pain. In response, they used a basic psychosocial process of seeking empowerment to provide comfort in order to resolve distress and exhaustion associated with disempowerment. This coping process comprised three stages: building connections finding alternative ways to comfort and quelling emotional turmoil. The substantive theory proposed a link between the stress of nurses' disempowerment and a coping response that provides direction to support nurses' practice. Strategies indicated include enhanced communication protocols, access to advanced practice nurses, use of nonpharmacological comfort measures, utilization of ward-based pain resource nurses, and unit-specific pain management education. Further research to verify and extend the substantive theory to other settings and nursing populations is warranted.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.NEDT.2018.01.019
Abstract: Several studies report that patient safety skills, especially non-technical skills, receive scant attention in nursing curricula. Hence, there is a compelling reason to incorporate material that enhances non-technical skills, such as situation awareness, in nursing curricula in order to assist in the reduction of healthcare related adverse events. The objectives of this study were to: 1) understand final year nursing students' confidence in their patient safety skills and 2) examine the impact of situation awareness training on final year nursing students' confidence in their patient safety skills. Participants were enrolled from a convenience s le comprising final year nursing students at a Western Australia university. Self-reported confidence in patient safety skills was assessed with the Health Professional in Patient Safety Survey before and after the delivery of a situation awareness educational intervention. Pre ost educational intervention differences were examined by repeated measures ANOVA. No significant differences in confidence about patient safety skills were identified within settings (class/clinical). However, confidence in patient safety skills significantly decreased between settings i.e. nursing students lost confidence after clinical placements. The educational intervention delivered in this study did not seem to improve confidence in patient safety skills, but substantial ceiling effects may have confounded the identification of such improvement. Further studies are required to establish whether the findings of this study can be generalised to other university nursing cohorts.
Publisher: Wiley
Date: 13-08-2018
DOI: 10.1111/JOCN.14632
Abstract: To explore the impact of an initiative to add unregulated nursing support workers to wards in acute care hospitals. Adding nursing support workers to existing nurse staffing may be one solution to reduce nursing workloads and improve outcomes. However, the effects of this addition on nurse, patient and system outcomes are not well documented. In one state of Australia, a trial deployment of nursing support workers to wards across the public health system provided opportunity for the exploration of their impact in a natural, real-world, environment. Cross-sectional study. A s le of five wards where nursing support workers had been added matched to a group of five wards where there were no nursing support workers. Data were collected via patient survey (n = 141) and nurse survey (n = 154). Analysis was comparative with regression models constructed for the different ward types. Nursing leadership, staffing and resources, and nurse experience were linked to outcomes on both ward types. Instability was a significant predictor of reduced quality of care and increased turnover intention on wards where support workers were added. Adding nursing support workers to ward staffing did not lead to improvements in patient care. Findings suggest that staffing a nursing ward is a complex activity and that a simple approach to staffing is unlikely to be successful. Future research should explore the process of implementation and the conditions under which this strategy is likely to be successful. Ward-level factors are key in making appropriate staffing and skill mix choices to limit instability and to consequently avoid negative patient, staff and system outcomes. Consideration of the ward context, alongside effective delegation processes and integration into the care team are imperative when adding nursing support workers.
Publisher: SAGE Publications
Date: 03-2014
DOI: 10.1177/082585971403000103
Abstract: The provision of care that enhances the quality of life at the end of life is a fundamental goal of palliative care services. This pilot study explored the application of the Quality of Life at the End of Life (QUAL-E) instrument in a s le of 52 patients who were hospitalized in two metropolitan Western Australian hospitals. Participants were given the option to complete the QUAL-E either as a self-report (n=9, 17.3 percent) or, aided by a research assistant, as a structured interview (n=43, 82.7 percent). The instrument demonstrated patient acceptability and face validity, particularly when it was administered with the assistance of a research assistant. Despite having difficulty with some questions, patients expressed their appreciation at being given the opportunity to contribute to the research and to reflect upon and give voice to their thoughts and feelings. Health practitioners indicated that the instrument could be a valuable tool for holistic assessment and service evaluation. We suggest that minor changes be made to the QUAL-E before it is used further in an Australian context we also recommend that this instrument be tested in other settings and populations.
Publisher: Wiley
Date: 26-11-2012
DOI: 10.1111/J.1440-1584.2012.01313.X
Abstract: To explore the knowledge of a panel of experts to develop possible ways of minimising the risk of occupational violence towards remote area nurses. The Delphi method using open-ended questionnaires and an online survey to measure support for suggested control measures. Remote area nursing posts across Australia. A panel of expert remote area nurses (n = 10) from geographically erse regions. Identified and described measures with the potential to reduce the risk of violence. A 'toolbox' of strategies was suggested in recognition of the complex nature of occupational violence within the remote health context. Job-specific education included de-escalation techniques, risk assessment and cultural safety training. Professional support included access to counselling and debriefing services. Organisational responsibilities included: adequate staffing to provide backup, policies and procedures and action from management when hazards are identified. Community collaboration with the health service in developing orientation programs, safety plans and addressing violence within the community was also recommended. A variety of strategies were identified that could be used to reduce the risk of occupational violence towards remote health care staff. Further development and assessment of this 'toolbox' of strategies is recommended to address the high incidence of violence towards remote health professionals in Australia and overseas.
Publisher: Wiley
Date: 10-2011
DOI: 10.1111/J.1365-2702.2011.03846.X
Abstract: Aims and objectives. This paper describes further testing of the instrument Patient Evaluation of Emotional Care during Hospitalisation. Background. In 2005, a questionnaire was developed that could be completed by patients to evaluate the quality of emotional care received during their time in hospital. This questionnaire was tested at an acute care private hospital in Perth, Western Australia, with encouraging estimates of reliability and validity. The purpose of this study was to further test this questionnaire in a larger s le of inpatients at a public hospital in the same state. Design. Psychometric evaluation. Method. A hospital‐wide survey of 13 wards of a public hospital was conducted. Two hundred and fifty‐one patients completed the questionnaire. Results. Psychometric testing of the Patient Evaluation of Emotional Care during Hospitalisation demonstrated acceptable internal consistency reliability. Confirmatory factor analysis substantiated the four sub‐scales as follows: Level of Security, Level of Knowing, Level of Personal Value and Level of Connection. The Level of Connection sub‐scale was assessed for the first time in this study. This sub‐scale had the lowest mean score of all the sub‐scales across the hospital as well as in each of the wards surveyed. Qualitative data substantiated, from the patients’ perspective, a lack of connection with hospital staff. Conclusions. Further psychometric testing of the Patient Evaluation of Emotional Care during Hospitalisation instrument has confirmed its psychometric properties and usefulness as an instrument to measure emotional care during hospitalisation. Relevance to clinical practice. The Patient Evaluation of Emotional Care during Hospitalisation is a reliable and valid tool with which the emotional care of patients in hospital can be measured and the effectiveness of interventions assessed.
Publisher: Springer Science and Business Media LLC
Date: 06-11-2009
DOI: 10.1007/S00520-008-0516-Z
Abstract: Decision making in the context of palliative care is particularly complex given the unpredictable illness trajectories experienced by patients and the number of in iduals who may be part of decision-making processes. This study aimed to describe the significant issues that influence the processes of care decision making, from the perspective of patients with advanced illness. Patients (14), family members (7) and health professionals (18) were interviewed and field observations (100 h) of decision-making practices were undertaken in two Australian palliative care services. A systematic approach using grounded theory to collect and analyse the data was used to develop a theory of decision making from the patient's perspective. The main issue experienced by palliative care patients was identified as a lack of involvement in decision making. One of the significant factors affecting the decision process is the type of relationship with health professionals that patients believe enhances their involvement in decision making. This was determined by the manner and focus of the health professional, their trustworthiness as well as the healthcare culture and environment. This paper provides a greater understanding of the perspective of patients in relation to their involvement in decisions related to palliative care.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.IJROBP.2014.06.054
Abstract: Deodorant use during radiation therapy for breast cancer has been controversial as there are concerns deodorant use may exacerbate axillary skin toxicity. The present study prospectively determined the use of both aluminum-containing and non aluminum containing deodorants on axillary skin toxicity during conventionally fractionated postoperative radiation therapy for breast cancer. This 3-arm randomized controlled study was conducted at a single center, tertiary cancer hospital between March 2011 and April 2013. Participants were randomized to 1 of 2 experimental groups (aluminum-containing deodorant and soap or non-aluminum containing deodorant and soap) or a control group (soap). A total of 333 participants were randomized. Generalized estimating equations were used to estimate and compare the odds of experiencing high levels of sweating and skin toxicity in each of the deodorant groups to the odds in the control group. The study evaluated a range of endpoints including objective measurements of axilla sweating, skin toxicity, pain, itch and burning. Quality of life was assessed with a validated questionnaire. Radiation characteristics were similar across all groups. Patients in the deodorant groups did not report significantly different ratings for axillary pain, itch, or burning compared with the control group. Patients in the aluminum-containing deodorant group experienced significantly less sweating than the control the odds of their sweating being barely tolerable and frequently or always interfering with their daily activities was decreased by 85% (odds ratio, 0.15 95% confidence interval, 0.03-0.91). We found no evidence that the use of either aluminum-containing or non-aluminum containing deodorant adversely effects axillary skin reaction during conventionally fractionated radiation therapy for breast cancer. Our analysis also suggests patients in the aluminum-containing deodorant arm had significantly less sweating without increased symptoms of axillary radiation skin toxicity. These results add to the evidence that the prescription of deodorants during radiation therapy for breast cancer is now questionable.
Publisher: Wiley
Date: 29-03-2016
DOI: 10.1111/JAN.12965
Abstract: To assess the impact of adding nursing support workers to ward staffing. Nurses' capacity to provide safe care is compromised by increased workloads and nursing shortages. Use of unregulated workers is an alternative to increasing the number of regulated nurses. The impact of adding nursing support workers on patient, nurse and system outcomes has not been systematically evaluated. A mixed longitudinal and cross-sectional design using administrative data sets and prospective data from a s le of wards. Payroll data will identify wards on which unregulated staff work. To assess the impact on nursing-sensitive outcomes, retrospective analysis of morbidity and mortality data of all patients admitted to Western Australia hospitals for over 24 hours across 4 years will be undertaken. For the cross-sectional study, a s le of 20 pairs of matched wards will be selected: 10 with unregulated workers added and 10 where they have not. From this s le the impact on patients will be assessed using the Patient Evaluation of Emotional Care during Hospitalisation survey. The impact on nurses will be assessed by a nurse survey used extensively which includes variables such as job satisfaction and intention to leave. The impact on system outcomes will be explored using work s ling of staff activities and the Practice Environment Scale. Interviews will determine nurses' experience of working with nursing support workers. The study aims to provide evidence about the impact of adding nursing support workers to ward staffing for patients, staff and the work environment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2015
Publisher: Wiley
Date: 04-1998
DOI: 10.1046/J.1365-2648.1998.00590.X
Abstract: This grounded theory study explored and described the delivery of quality nursing care from the perspective of nurses. Data were gathered by tape recorded interviews, published literature and some participant observation. Ten registered nurses from an acute-care public hospital located in Perth, Western Australia were interviewed. Twelve additional transcripts from interviews conducted by postgraduate students were also used. Quality nursing care was perceived to relate to the degree to which patients' physical, psychosocial, and extra care needs were met. The consequences of quality care were interpreted as 'therapeutic effectiveness', where the therapy provided by nurses was perceived to positively affect patients' healing. This was gauged by the patient's psychosocial and physical response to illness, safety, and satisfaction. Therapeutic effectiveness was facilitated by the development of positive relationships between nurses and patients, nurse's positive attributes and competent practices, as well as a functional nursing team. The problem of nurses' inability to consistently provide quality nursing care to all patients was identified. Insufficient time (caused by a lack of human and physical resources) was perceived as the main reason for this. Dissatisfaction and stress in nurses was related to this problem. To deal with this, nurses used a process named 'selective focusing'. Work was planned to most effectively utilize the time available, within the parameters of safety. Implications for nursing practice, education and management are discussed, and directions for further research are provided.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.CTIM.2018.01.006
Abstract: To examine the effectiveness of a multifaceted complementary therapies intervention, delivered in a systematic manner within an Australian public hospital setting, on quality of life and symptom distress outcomes for cancer patients. Adults receiving treatment for any form of cancer were eligible to participate in this study. Self-referred participants were offered a course of six complementary therapy sessions. Measures were administered at baseline, and at the third and sixth visit. The primary outcomes were quality of life and symptom distress. Linear mixed models were used to assess change in the primary outcomes. In total, 1376 cancer patients participated in this study. The linear mixed models demonstrated that there were significant improvements in quality of life and significant reductions in symptom distress over six sessions. Body-based therapies demonstrated significantly superior improvement in quality of life over counselling, but no other differences between therapies were identified. Reduced symptom distress was not significantly associated with any particular type of therapy. A self-selected complementary therapies intervention, provided in an Australian public hospital by accredited therapists, for cancer patients significantly mproved quality of life and reduced symptom distress. The effect of this intervention on quality of life has particular salience, since cancer impacts on many areas of people's lives and impairs quality of life.
Publisher: Elsevier BV
Date: 05-2006
DOI: 10.1016/J.IJNURSTU.2005.06.004
Abstract: Comfort is a word that is frequently used to describe both physical and emotional aspects of the hospital experience. A number of definitions exist in the literature and there is a lack of clarity in understanding this concept. This paper describes the therapeutic context of emotional comfort that was identified in a qualitative study that sought to explain the perceived therapeutic effect of interpersonal interactions that were experienced by patients during hospitalisation. Grounded theory. Public and private hospitals situated in Perth, Western Australia. 40 patient participants from a variety of settings, and 32 nurse participants. All participants were over the age of 18 and spoke English. Formal and informal interviews, field observations. Patients interpreted the interpersonal interactions that they experienced during hospitalisation in terms of their experience of emotional comfort or discomfort. A central feature of emotional comfort was the patient's perception of personal control. This study provides a greater understanding of the concept of comfort from the perspective of hospitalised patients. It highlights that patients approach their illnesses or injuries perceiving that a connection exists between the mind and the body.
Publisher: Elsevier BV
Date: 10-2001
DOI: 10.1016/S0020-7489(00)00105-X
Abstract: This paper brings together the perspective of both nurses and patients of the experience of nursing care delivery in acute care hospital settings. Initially, two grounded theory studies of the phenomenon of high-quality nursing care were conducted concurrently and in the same settings one focussed on patients' experiences (Irurita, 1993. From person to patient: nursing care from the patient's perspective. Department of Nursing Research, Sir Charles Gairdner Hospital), the other on those of nurses (Williams, 1994. Unpublished report, Department of Nursing Research Sir Charles Gairdner Hospital, Perth, Western Australia). Similarities between the findings of both studies led the authors, using grounded theory methods, to re-examine and compare the findings and raw data, with additional data collected by theoretical s ling. The previous findings were integrated and extended, resulting in the development of a theory of Balancing and Compromising in response to the shared problem of threats to integrity, especially encountered when broader environmental and contextual conditions were unfavourable. This reciprocal process used by nurses and patients to preserve their own and each other's integrity involved: contributing to care--cooperating prioritising and rational sacrificing justifying compromised care and lowering expectations and protecting self by attracting or repelling. Both positive and negative outcomes resulted.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.APNR.2015.02.008
Abstract: This study explored the perspective of experienced intensive care nurses regarding maintenance of their emotional wellbeing. Caring for critically ill patients has been identified as stressful. The demand for critical care nurses continues to grow in a climate of an ongoing nursing shortage and an aging workforce. This study sought to understand what environmental elements optimized the maintenance of emotional wellbeing. Grounded theory. Fifteen experienced intensive care unit registered nurses from a metropolitan hospital in Western Australia, were interviewed. Five categories were identified: 'achieving best care', 'caring for the patient's family', 'autonomy within the ICU environment', 'teamwork', and 'previous nursing and life experience'. The findings from this study increase our understanding of the environmental elements that can optimize the emotional wellbeing of intensive care nurses. These findings will assist in the development of strategies to retain nurses in the ICU area.
Publisher: Wiley
Date: 06-2009
Publisher: BMJ
Date: 2017
Publisher: SLACK, Inc.
Date: 08-2019
DOI: 10.3928/01484834-20190719-06
Abstract: No instruments are currently available to assess nursing students' maintenance of situation awareness. The aim of this study was to develop and validate the Performance-Based Situation Awareness Observation Schedule for measuring nursing students' use of situation awareness. Twelve expert clinicians participated in a qualitative, reiterative consensus-driven process to establish the content validity of the tool. The tool was then piloted during the delivery of a situation awareness education program for final-year nursing students. Cohen's kappa was used to assess the interrater reliability. The resultant tool comprised 54 items, which captured strategies to maintain situation awareness and task errors that would infer the presence of situation awareness. The values obtained for Cohen's kappa indicated that the level of agreement was at least substantial for approximately 80% of the items. This study developed a valid and reliable tool to measure nursing students' use of situation awareness. [ J Nurs Educ. 2019 (8):468–473.]
Publisher: SAGE Publications
Date: 20-03-2014
Abstract: Aims: The aim of this study was to explore and describe the experiences of persons attending a cancer support center, providing emotional support to cancer patients through self-selected complementary therapies offered free of charge through qualified volunteer therapists. A grounded theory methodology was used. Sources of data were 16 semistructured interviews with persons attending the center. Interviews were digitally recorded and transcribed verbatim. Analysis was conducted using the constant comparative method. Findings: The overarching theme that emerged in this study was the benefits attributed to attendance at the cancer support center. The center was described as an “oasis” in the hospital, and three aspects relating to this were identified: (a) facilitating comfort, (b) increasing personal control, and (c) helping make sense of the cancer experience. Conclusion: A drop-in center offering complementary therapies appeared to enable coping with the diagnosis and treatment of cancer by facilitating comfort and increasing perceptions of personal control. The center also helped some participants to make sense of their experience with cancer. This research has provided a unique insight into the ongoing emotional needs of cancer patients, and directions for further development and research into the provision of holistic care for patients within a hospital setting.
Publisher: Wiley
Date: 04-05-2015
DOI: 10.1111/JOCN.12845
Abstract: To explore the experiences and perceptions of hospital staff caring for dying patients in a dedicated patient/family room (named Lotus Room). Dying in hospital is a common outcome for people across the world. However, noise and activity in acute environments present barriers to quality end-of-life care. This is of concern because care provided to dying patients has been shown to affect both the patients and the bereaved families. A qualitative descriptive approach was used. Semi-structured interviews were conducted with 17 multidisciplinary staff and seven families provided information through an investigator-developed instrument. Qualitative data analysis generated three categories describing: Dying in an hospital The Lotus Room and the Outcomes for patients and families. The Lotus Room was seen as a large, private and, ultimately, safe space for patients and families within the public hospital environment. Family feedback supported staff perspectives that the Lotus Room facilitated family presence and communication. The privacy afforded by the Lotus Room within this acute hospital provided benefits for the dying patients and grieving families. Improved outcomes included a peaceful death for patients, which may have assisted the family with their bereavement. This study provides evidence of how the physical environment can address well-established barriers to quality end-of-life care in acute hospitals.
Publisher: Wiley
Date: 05-03-2009
DOI: 10.1111/J.1365-2702.2008.02586.X
Abstract: This paper describes the development and preliminary psychometric testing of an instrument that evaluates the emotional care experienced by patients during hospitalisation. Previous qualitative work using the Grounded Theory method identified the characteristics of interpersonal interactions that hospitalised patients perceived to be therapeutic. Three conditions were associated with the patient's experience of emotional comfort: the patient's perceived Level of Security, Level of Knowing and Level of Personal Value. Questions relating to each of these conditions were included in this new instrument. Instrument development and psychometric testing. Preliminary psychometric testing was carried out in four phases: construction of the instrument assessment of face and content validity testing for clarity and feasibility for use with hospitalised patients assessment of reliability, construct validity of the tool and assessment of the internal structure. A hospital-wide survey was carried out and the instrument was completed by a total s le of 132 patients. Two of the three sub-scales achieved an internal consistency estimate of at least 0.70. The construct validity of the tool confirmed the previously identified characteristics of patients in need of additional emotional care. Exploratory factor analysis established two of the sub-scales and identified a fourth sub-scale which was named 'Level of Connection'. Encouraging reliability and validity estimates were obtained and the instrument was improved. Further testing with larger s les is recommended. This questionnaire, which is completed by hospitalised patients, differs from other instruments because it evaluates the interactions of all hospital staff rather than only nursing staff. This instrument can be used to identify patients who may be in need of additional emotional care and to evaluate the effectiveness of interventions directed at improving the emotional well-being of patients.
Publisher: Mary Ann Liebert Inc
Date: 03-2012
Abstract: Family caregivers of patients requiring palliative care commonly experience physical, social, and psychological burdens. Although family caregivers are acknowledged as valid service recipients of palliative care, many have unmet needs, and systematic reviews have shown there are limited evidence-based supportive interventions. This study aimed to develop and pilot test a psycho-educational group education program delivered in the inpatient specialist palliative care setting and designed to prepare primary family caregivers for the role of supporting a relative receiving hospital-based palliative care. (1) Development of education session and delivery protocol by the research team and expert panel (2) pilot the intervention in three clinical sites (five sessions in total) (3) evaluate its accessibility and acceptability and (4) preliminary testing of outcome measures used to access the intervention's effectiveness. The results revealed that the intervention was appropriate and acceptable to caregivers. The intervention needs to be tested in a larger s le to determine the potential benefits for caregivers' sense of preparedness and competence, and testing needs to ascertain if the intervention is accessible.
Publisher: Wiley
Date: 06-05-2019
DOI: 10.1111/JAN.13990
Abstract: To describe the exercise, physical fitness and musculoskeletal health of nursing students. Nursing students are prone to musculoskeletal disorders restricting work ability. Physical fitness and leisure-time exercise may affect responses to workplace exposures and risk for work-related musculoskeletal disorders. A cross-sectional study. Between August 2013 and April 2015, a convenience s le of 111 nursing students performed submaximal exercise tests. Nursing work, exercise and musculoskeletal health were surveyed and analysed descriptively. Students' mean age was 30.0 years, 89.2% were female and 20.0% worked in nursing while studying. Highest annual prevalence of musculoskeletal trouble was in low back (45.6%), neck (32.0%) and shoulder (18.5%) regions. Most exercised regularly but did not meet weekly cardiorespiratory, resistance, neuromotor and flexibility exercise recommendations and had poor to average fitness levels. Approximately 40% were overweight or obese 26.1% had risk for obesity-related disease. Interventions to improve nursing students' physical condition before entering the nursing workforce appear warranted. Imbalance between physical work capacity and demanding workloads increases musculoskeletal disorder risk amongst undergraduate nursing students. A large proportion studied reported recent musculoskeletal trouble (particularly low back, neck and shoulder). They exhibited modifiable characteristics of overweight/obese, poor fitness and inadequate leisure-time exercise, predisposing them to work-related musculoskeletal disorders. Undergraduate preparation should raise nursing students' health literacy about physical fitness and ways to achieve it, for their musculoskeletal health and work capacity. Improving nursing students' fitness may enhance their work preparedness and help them achieve longevity in this physically demanding occupation.
Publisher: Elsevier BV
Date: 02-2005
DOI: 10.1016/J.APNR.2004.11.001
Abstract: Previous literature has revealed that patients in various health-care facilities worldwide have experienced dissatisfaction with aspects of the hospital environment. This article focuses on the impact of the hospital environment on patients' perceptions of personal control. The grounded theory method was used, and interviews with 40 patient participants and 75 hours of field observations provided data for this study. Personal control was found to be a central feature of emotional comfort, a therapeutic state that was considered to be an integral part of recovery. This study outlines some new directions for enhancing the therapeutic potential of hospital environments.
Publisher: Wiley
Date: 13-09-2023
DOI: 10.1111/JEP.13763
Abstract: Nursing can be a stressful occupation with many nurses struggling to cope with stress on a day‐to‐day basis. Considerable evidence suggests that positive coping strategies can be an effective part of stress management education programs. This article describes the theoretical rationale for a cognitive framework for stress management that was developed as part of a well‐being educational program for cancer nurses. This framework included an associated mnemonic ( www.pst ) to assist in the recall and utilization of positive coping strategies. The stress management framework was intended to increase nurses’ perceptions of personal control which is central to stress management. The academic coping literature is complex, jargon laden and often conceptually abstract, and may not easily be understood by a nonacademic audience. The cognitive framework described here is an evidence‐based, user‐friendly tool that could be used and evaluated by counsellors, educators, and researchers in different settings.
Publisher: Wiley
Date: 06-2008
DOI: 10.1111/J.1365-2702.2007.02188.X
Abstract: This paper describes the further development of the substantive theory Optimising Personal Control to Facilitate Emotional Comfort. In previous work, emotional comfort was identified as a therapeutic state that was influenced by several factors, one of which was the hospital environment. This paper focuses on aspects within the hospital environment that patients perceive to influence their feelings of personal control. A relationship between control and health has been discussed in previous literature. There are indications that aspects of the hospital environment can impact on a patient's perception of control. This project explored personal control in relation to the hospital environment from the perspective of patients. Grounded theory method was used. Data were collected from patients' interviews and field observations and analysed using the constant comparative method. Interviews were tape-recorded and transcribed verbatim. A qualitative data computer program was used to manage the data. The results confirmed the findings of the original study where hospitalised patients were found to experience feelings of reduced personal control. The conditions of level of security, level of knowing and level of personal value were described in terms of their contribution to the patient's feelings of personal control. Specific directions for further research into the development and evaluation of therapeutic hospital environments that promote personal control and the associated emotional comfort are provided. This research highlights the importance of considering patients' feelings of personal control during their hospital stay. Several directions for establishment of therapeutic environments within hospitals are provided, but more research in this area is recommended.
Publisher: Wiley
Date: 29-08-2018
DOI: 10.1111/WVN.12318
Abstract: Effective pain management is unlikely to occur without consistent and timely assessments. To improve assessment and management of pain, ward-based pain resource nurses were introduced in 2007 to facilitate hospital-wide evidence-based practice changes using three key targets. One-year post implementation of this quality improvement project, promising results were revealed. The purpose of this study, 8 years post implementation, was to (a) evaluate sustained practice improvements in pain assessment and management, (b) assess current pain resource nurse knowledge and attitudes to pain, (c) explore characteristics of the pain resource nurse role, as well as (d) any perceived contextual changes regarding study findings. A mixed-methods approach was used to address study aims. Quantitative data were collected from documentation audits and a "Knowledge and Attitudes Survey Regarding Pain." Qualitative interviews explored the characteristics of the pain resource nurse role, and a focus group discussion explored the context of change. Significant improvements were observed for the documentation of pain scores on admission and for each nursing shift. Survey results highlighted potential knowledge deficits in key practice areas, even though interview findings suggested that pain resource nurses provided a resource for peers, raised awareness of best practice, and imparted knowledge to other ward staff. An important facilitator for the pain resource nurse role was the ongoing collaboration and support from specific pain teams, and barriers to engage in the role were competing workload priorities, and limited awareness among other ward staff. Implementing and sustaining evidence-based practice change in clinical practice is challenging. Ongoing evaluation is necessary for identifying the long-term implications of practice improvement interventions and issues that influence the adoption of evidence-based practice. Strategies to address barriers, and to increase awareness and engagement of the pain resource nurse role with wider collaboration require further investigation.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.PMN.2010.08.001
Abstract: This action research project explored the feasibility and effect of implementing a hospital-wide coordinated approach to improve the management of pain. The project used a previously developed model to introduce three evidence-based changes in pain management. Part of this model included the introduction of 30 pain resource nurses (PRNs) to act as clinical ch ions for pain at a local level. Both quantitative and qualitative measures were used to assess the feasibility and effect of the changes introduced. Quantitative data were gathered through a hospital-wide document review and assessment of the knowledge and attitude of the PRNs at two time points: time 1 before the introduction of the PRNs and time 2 near completion of the project (11 months later). A statistically significant improvement in the documentation of pain scores on admission and each nursing shift was apparent. However, no difference was found in the percentage of patients who had been prescribed opioids for regular pain relief that had also been prescribed and dispensed a laxative/aperient. Neither were any statistically significant decreases in patient pain scores observed. An assessment of the knowledge and attitudes of the PRNs showed an improvement from time 1 to time 2 that was statistically significant. The qualitative data revealed that despite the barriers encountered, the role was satisfying for the PRNs and valued by other hospital staff. Overall, the results revealed that the new model of change incorporating PRNs was a useful and effective method for introducing and sustaining evidence-based organizational change.
Publisher: Elsevier BV
Date: 06-1994
DOI: 10.1016/0020-7489(94)90048-5
Abstract: This cross-sectional survey examined the relationship of the competence of 529 nurses to their designated career structure levels. The extent of the relationships between nursing education and experience with clinical competence was determined, and attitudes of nurses toward their work environment were measured. Results indicated a wide dispersion in clinical nursing skills and that nurses' designation in the Western Australian Career Structure did not reflect their clinical competence. Clinical experience and education independently exerted a significant effect on competence, but there was no interaction between these variables on increasing competence. Attitudes of the nurses were found to be affected by their work environment.
Publisher: Informa UK Limited
Date: 09-06-2014
Publisher: SAGE Publications
Date: 16-05-2019
Abstract: Newly graduated nurses often encounter a gap between theory and practice in clinical settings. Although this has been the focus of considerable research, little is known about the learning transition process. The purpose of this study was to explore the experiences of newly graduated nurses in acute healthcare settings within Canada. This study was conducted to gain a greater understanding of the experiences and challenges faced by graduates. Grounded theory method was utilized with a s le of 14 registered nurses who were employed in acute-care settings. Data were collected using in-depth interviews. Constant comparative analysis was used to analyze data. Findings revealed a core category, "Theory Becoming Alive," and four supporting categories: Entry into Practice, Immersion, Committing, and Evolving. Theory Becoming Alive described the process of new graduate nurses' clinical learning experiences as well as the challenges that they encountered in clinical settings after graduating. This research provides a greater understanding of learning process of new graduate nurses in Canada. It highlights the importance of providing supportive environments to assist new graduate nurses to develop confidence as independent registered nurses in clinical areas. Future research directions as well as supportive educational strategies are described.
Publisher: Wiley
Date: 18-05-2007
Publisher: BMJ
Date: 24-03-2012
DOI: 10.1136/BMJSPCARE-2011-000131
Abstract: Many family caregivers of palliative care patients experience poor health and have other unmet needs, requiring health professionals' support. However, there are few evidence-based supportive interventions to address these issues. The purpose of this project was to undertake preliminary testing of a psychoeducational group education programme, delivered in an in-patient setting, designed to prepare family caregivers for the role of supporting a relative currently receiving hospital-based palliative care. A pilot phase was conducted to develop the intervention and explore its utility. Thereafter the single session intervention was delivered in five palliative care units in three states of Australia and its effectiveness was examined using a pre-post design. Outcome variables included caregiver preparedness, competence and unmet needs. Psychological wellbeing was measured in order to determine if there were any deleterious psychological outcomes. One hundred and twenty-six participants completed Time 1 data and 107 (84.9%) completed Time 2 data (post-intervention). There were statistically significant improvements in caregivers' sense of preparedness (p=<.001 effect size (ES) 0.43) and a significant reduction in unmet caregiver needs (p=014 ES 0.22). There was no significant effect on psychological wellbeing and the improvement on competence fell short of statistical significance. This study reinforces the notion that psychoeducational interventions for this population can potentially be applicable, acceptable and effective. However, the number of participants who were recruited and attended each session was fewer than anticipated, resulting in methodological implications. It is recommended that the intervention undergo further empirical inquiry, such as via a controlled trial.
No related grants have been discovered for Anne Williams.