ORCID Profile
0000-0002-5074-2606
Current Organisation
Charles Sturt University
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Labour Economics | Aged Health Care | Health Economics | Applied Economics
ANZSRC Socio-Economic Objective (SEO)
Macro Labour Market Issues | Ageing and Older People | Employment Patterns and Change |
Related Links
Publications
Advances in Contemporary transcultural nursing
Publisher: Informa UK Limited
Date: 08-2005
'You never come back the same': The challenge of spiritual care in a deployed military nursing context
Publisher: Wiley
Date: 17-02-2017
DOI: 10.1111/JOCN.13685
Abstract: To explore the experience of spirituality and spiritual care by military nurses on deployed operations. Despite an increasing body of research addressing spirituality in nursing care in a variety of clinical settings, the deployed military nursing context remains poorly understood. A qualitative, philosophical hermeneutic design. Ten Australian military nurses were interviewed about their experiences of spirituality and spiritual care while on deployed operations. Analyses were performed using a phenomenological method informed by philosophical hermeneutics. The participants perceived that they had an important role in the provision of spiritual care in the absence of family on deployed operations. However, the nurse also needed to care for their own spiritual needs. The results suggested that spirituality and spiritual care may provide positive benefits in protecting against the long-term psychological, emotional and spiritual impacts of military service on deployed operations. Military nurses need to understand the factors that influence spiritual care delivery in their practice setting. Nurses need to be cognizant of the importance of spiritual care in the deployed military context, not only for their patients and colleagues, but also for themselves. Spirituality is argued as a protective factor against the challenges and consequences often associated with deployment. Well-developed spiritual resilience may assist in ensuring that military personnel return home emotionally, psychologically and spiritually 'fit'. To provide effective spiritual nursing care to deployed military populations, the nurse needs to understand the complex military practice environment, the personal and in idual nature of spiritual expressions and their own spiritual care requirements. Meaningful spiritual care aids resilience against the psychological, emotional and spiritual dangers of deployment.
Understanding people's experience of vitreo-retinal day surgery: A Gadamerian-guided study
Publisher: Wiley
Date: 04-08-2012
DOI: 10.1111/J.1365-2648.2011.05720.X
Abstract: This paper is a report of a study that aimed to understand the in idual's experience of day surgery for repair of vitreo-retinal pathology. Day surgery evolved as a global phenomenon in response to tensions existing between community demand for health-care services and fiscal limitations. Since then vitreo-retinal surgery has been routinely performed as day surgery. Whilst studies have reported on patients' experience's following inpatient surgery, there has been limited investigation of vitreo-retinal day surgery from the patient's perspective. In-depth unstructured interviews with 18 people were conducted between July 2006 and December 2007. Data analysis using philosophical hermeneutic techniques enabled a co-constructed understanding, where, the 'conditions of understanding' as described by Gadamer were established. Guided by a Gadamerian approach to analysis, four constitutive themes were identified: 'the physical Self', 'the psychological Self', 'the historically located Self' and 'the Self located in the community'. Within each theme the participant's positive and negative experiences were understood in the context of human need, and gaps in nursing care became illuminated. These experiences included: pain, nausea, problematic self-care and psychological angst. Insights into the experience of vitreo-retinal day surgery, gained from this study can be used to inform nurses planning care for people with vitreo-retinal pathology. Nursing care must address broader patient needs that span multiple human domains, particularly when vision has been threatened by complex pathology.
A pre-emptive pain management protocol to support self-care following vitreo-retinal day surgery
Publisher: Wiley
Date: 25-02-2014
DOI: 10.1111/JOCN.12572
Abstract: To describe the development and evaluation of a pre-emptive and multimodal pain management protocol that aims to improve patient experiences following vitreo-retinal day surgery. Vitreo-retinal surgery has been increasingly performed as day surgery that requires patients to undertake postoperative self-care, including the management of pain. While vitreo-retinal surgery is known to be painful in the convalescent period, pain management following day surgery has been described as problematic across many surgical specialties. One hundred patient audit and in-depth qualitative interviews with nine participants. A pain management protocol was developed from research evidence, established knowledge and expert opinion, then implemented and evaluated. The pre-emptive and multimodal protocol used intravenous Parecoxib in conjunction with regional ocular anaesthesia and oral paracetamol. Parecoxib 40 mg was administered prior to discharge, and participants were instructed to take the paracetamol six hours post-regional anaesthesia. Rescue analgesia was also provided. Following implementation of the protocol in a single clinical site, low levels of pain were reported in the audited patient cohort and confirmed in the qualitatively explored experiences of nine participants. The results of this study were encouraging, in that post vitreo-retinal day surgery pain appeared to have been successfully self-managed with a multimodal and pre-emptive protocol. The protocol was flexible and sensitive to patient comorbidities, surgical complexity, previous experiences and medical preferences. Further research is required to consolidate the success of this protocol to effectively support patients' self-care pain management and provide capacity to generalise the findings. Knowledge developed through this clinically based research has the potential for informing future patient care across many sites where day surgery is an integral component of treatment for people with vitreo-retinal disease.
Understanding the Diverse Forms of Spiritual Expression of Older People in Residential Aged Care in Australia
Publisher: Springer Science and Business Media LLC
Date: 07-12-2018
DOI: 10.1007/S10943-018-00742-1
Abstract: The ability of older people to express their spirituality is an important component of aged care. Spirituality is not specifically religiousness although, for some, religion offers a means for spiritual expression. This paper aimed to explore what constitutes spiritual life for residents in three residential aged care facilities in South Australia. The findings of the research demonstrated that the majority of older resident participants defined spirituality as 'connection/s'. Three unexpected results of the study became obvious during analysis, reported here as 'loss', 'adaptation' and 'they're busy'. It is offered here that these adjustments enabled participants to compensate for their losses.
Voices from the coalface
Publisher: Springer Netherlands
Date: 28-09-2014
A thematic review of men's experiences during the waiting period between prostate-specific antigen and prostate biopsy results
Publisher: Elsevier BV
Date: 12-2011
E-learning & information communication technology (ICT) in nursing education: A review of the literature
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.NEDT.2013.05.002
Abstract: To examine primary research articles published between January 2001 and December 2012 that focused on the issues for students and educators involved with E-learning in preregistration nursing programs. The literature was systematically reviewed, critically appraised and thematically analyzed. E-learning is arguably the most significant change to occur in nursing education since the move from hospital training to the tertiary sector. Differences in computer and information literacy for both students and educators influence the success of implementation of E-learning into current curricula. Online databases including CINAHL, MEDLINE, OVID, the ProQuest Central, PubMed, ERIC and Science Direct were used. The criteria used for selecting studies reviewed were: primary focus on electronic learning and issues faced by nursing students and/or nurse educators from undergraduate preregistration nursing programs all articles had to be primary research studies, published in English in peer reviewed journals between January 2001 and December 2012. Analysis of the 28 reviewed studies revealed the following three themes: issues relating to E-learning for students use of information technologies educator (faculty) issues involving pedagogy, workload and staff development in E-learning and associated technology. The review highlighted that commencing preregistration nursing students required ongoing education and support surrounding nursing informatics. This support would enable students to progress and be equipped with the life-long learning skills required to provide safe evidence based care. The review also identified the increased time and skill demands placed on nurse educators to adapt their current education methodologies and teaching strategies to incorporate E-learning.
The factors that influence nurses' use of physical restraint: A thematic literature review
Publisher: Wiley
Date: 24-03-2011
Resident decision-making in the context of residential aged care
Publisher: Elsevier BV
Date: 10-2018
Improving socially constructed cross-cultural communication in aged care homes: A critical perspective.
Publisher: Wiley
Date: 14-06-2018
DOI: 10.1111/NIN.12208
Abstract: Cultural ersity between residents and staff is significant in aged care homes in many developed nations in the context of international migration. This ersity can be a challenge to achieving effective cross-cultural communication. The aim of this study was to critically examine how staff and residents initiated effective cross-cultural communication and social cohesion that enabled positive changes to occur. A critical hermeneutic analysis underpinned by Giddens' Structuration Theory was applied to the study. Data were collected by interviews with residents or their family and by focus groups with staff in four aged care homes in Australia. Findings reveal that residents and staff are capable of restructuring communication via a partnership approach. They can also work in collaboration to develop communication resources. When staff demonstrate cultural humility, they empower residents from culturally and linguistically erse backgrounds to engage in effective communication. Findings also suggest that workforce interventions are required to improve residents' experiences in cross-cultural care. This study challenges aged care homes to establish policies, criteria and procedures in cross-cultural communication. There is also the challenge to provide ongoing education and training for staff to improve their cross-cultural communication capabilities.
The relational model of spiritual engagement depicted by palliative care clients and caregivers
Publisher: Wiley
Date: 02-2013
DOI: 10.1111/IJN.12035
Abstract: This paper aims to explicate the essence of spiritual engagement from the perspective of palliative care clients and their caregivers. Van Manen's hermeneutic phenomenological approach guided this study. In-depth interviews of 14 rural Australian participants with experience of a life-limiting condition provided rich discourse of the lived experience of spiritual engagement. This research highlights spiritual engagement represented in a relational model developed from a creative synthesis of the emerging themes. Spiritual engagement is associated with 'personal transformation', 'human values of love, compassion and altruism', 'maintaining relationships', 'participating in religious practices' and 'culture'. The findings of this research are supported by Mayes' observations on spirituality, that is, the 'pursuit of a trans-personal and trans-temporal reality that serves as the ontological ground for an ethic of compassion and service'.
Resident and family member perceptions of cultural diversity in aged care homes.
Publisher: Wiley
Date: 03-08-2017
DOI: 10.1111/NHS.12302
Abstract: Similar to many developed nations, older people living in residential aged care homes in Australia and the staff who care for them have become increasingly multicultural. This cultural ersity adds challenges for residents in adapting to the care home. This study explores: (i) residents' and family members' perceptions about staff and cultural ersity, and (ii) culturally and linguistically erse residents' and family members' experiences. An interpretive study design employing a thematic analysis was applied. Twenty-three residents and seven family members participated in interviews. Four themes were identified from interpreting residents and family members' perceptions of the impact of cultural ersity on their adaptation to aged care homes: (i) perceiving ersity as an attraction (ii) adapting to cross-cultural communication (iii) adjusting to diet in the residential care home and (iv) anticipating in idualized psychosocial interactions. The findings have implications for identifying strategies to support staff from all cultural backgrounds in order to create a caring environment that facilitates positive relationships with residents and supports residents to adjust to the care home.
Nurses' experience of providing home‐based palliative care in the country setting: An integrated literature review
Publisher: Wiley
Date: 19-08-2019
DOI: 10.1111/IJN.12773
Abstract: The aim of the study is to explore the experiences of nurses providing home-based palliative care for patients who live in country settings. This study is an integrated literature review. Electronic databases, specific journals of interest, and reference lists were searched using key words and Boolean operators. Descriptive thematic analysis was undertaken to identify main themes and subthemes. Critical appraisal of the articles was conducted using the qualitative Critical Appraisal Skills Program guidelines. Primary research articles published in English, in peer-reviewed journals from 1990 to 2017, were included. Twelve articles were included in this review. Two main themes emerged including the nature of nursing in country communities and nurses' emotional responses. The first main theme had the subthemes of community connections, geographical distance and isolation, organizational deficits, lack of education, and resources. The second main theme consisted on five subthemes including feeling rewarded, autonomy and professional isolation, hope and hopelessness, frustration, and fear. Literature is sparse reporting the lived experience of nurses providing palliative care in country areas for patients wanting to die at home. An increase in demand for a home-based palliative nursing service will require additional funding globally to meet this increase in the future.
Finding the Hidden Professional Culture of Mental Health Nursing—Spiritual Care for Individuals with a Co-morbid Life-Limiting Illness
Publisher: Informa UK Limited
Date: 21-09-2023
The importance of spiritual assessment when caring for older adults
Publisher: Cambridge University Press (CUP)
Date: 05-09-2016
DOI: 10.1017/S0144686X14001007
Abstract: There is a growing body of literature documenting the positive effects of both religiousness and spirituality on human health, particularly among those who are ageing or diagnosed with a life-limiting illness. These positive effects provide buffers to life's stressors such as those associated with mental illness, care-giver burden, substance abuse and social disruption resulting from war. An important aspect of health care for in iduals of all ages involves completion of a spiritual assessment. This paper explores the concept of spirituality and spiritual assessment, which has many definitions in the literature, and also provides ex les of assessment tools from theology, nursing, social work and medicine.
The 'Connection Health Care Providers Make with Dying Patients
Publisher: Informa UK Limited
Date: 20-07-2006
New Migrants in Residential Aged Care: Managing Diversity in Not-for-Profit Organisations
Publisher: Springer Science and Business Media LLC
Date: 08-03-2018
The lived experiences of people with bladder cancer and their partners
Publisher: RCN Publishing Ltd.
Date: 06-11-2014
Hope rising out of despair: the spiritual journey of patients admitted to a hospice
Publisher: Informa UK Limited
Date: 20-04-2004
Suprapubic catheters--a shared understanding, from the other side looking in
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2007
A thematic literature review: The importance of providing spiritual care for end-of-life patients who have experienced transcendence phenomena
Publisher: SAGE Publications
Date: 11-07-2016
Abstract: The purpose of this review was to investigate within the literature the link between transcendent phenomena and peaceful death. The objectives were firstly to acknowledge the importance of such experiences and secondly to provide supportive spiritual care to dying patients. Information surrounding the aforementioned concepts is underreported in the literature. The following 4 key themes emerged: spiritual comfort peaceful, calm death spiritual transformation and unfinished business. The review established the importance of transcendence phenomena being accepted as spiritual experiences by health care professionals. Nevertheless, health care professionals were found to struggle with providing spiritual care to patients who have experienced them. Such phenomena are not uncommon and frequently result in peaceful death. Additionally, transcendence experiences of dying patients often provide comfort to the bereaved, assisting them in the grieving process.
The relative contributions of function, perceived psychological burden and partner support to cognitive distress in bladder cancer
Publisher: Wiley
Date: 07-12-2016
DOI: 10.1002/PON.4054
Abstract: Bladder cancer is a genitourinary disease of increasing incidence. Despite improvements in treatment, outcomes remain equivocal with high recurrence rates. It is associated with poor psychosocial outcomes due to reduced functioning of the genitourinary system. The objective of these analyses was to query whether reported loss of function or the perception of psychological burden caused by this functional impedance was the key to understanding psychosocial outcomes. The s le comprised 119 participants with a confirmed diagnosis of bladder cancer. They completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale and standard sociodemographic details. Simple mediation and serial mediation were used to explore the potential for psychological burden to mediate associations between loss of function and cognitive distress, and the potential additional contribution of positive partner support on these relationships. Age and duration of cancer were considered as covariates. Simple mediation demonstrated that the association between function and cognitive distress was fully mediated by perceived psychological burden. Serial mediation, which allowed for the addition of partner support, again demonstrated full mediation, with partner support being the key predictive variable. These analyses emphasise the importance of an appreciation of in iduals' interpretation of the burden occasioned by bladder cancer and the role of a supportive partner. The implications for management discussions and support services in alleviating negative psychological outcomes in bladder cancer are highlighted. Copyright © 2015 John Wiley & Sons, Ltd.
The spiritual dimensions of care in military nursing practice
Publisher: Wiley
Date: 10-2003
DOI: 10.1046/J.1440-172X.2003.00441.X
Abstract: Spirituality has been the subject of numerous journal articles and books in recent years. Research into this topic has been conducted in many spheres of nursing practice with the notable exception of military nursing. This article goes a small way to addressing the apparent lack of research into spirituality in a military nursing setting by summarizing the findings of one study into this significant area of nursing care. The findings are derived from a mixed method quantitative/qualitative study of registered nurses in the Royal Australian Air Force. The major finding indicated that two distinct concepts of "family" define the way in which this small group of nurses perceive, assess and implement care for the spiritual needs of their patients. These concepts comprise a traditional family structure and an extended military family structure that includes the person's unit and comrades-in-arms.
Repairing the effects of childhood trauma: The long and winding road
Publisher: Wiley
Date: 22-03-2020
DOI: 10.1111/JPM.12581
Abstract: WHAT IS KNOWN ON THIS SUBJECT?: Domestic and family violence contributes to mental distress and the development of mental illness and can reverberate throughout a person's life. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Therapeutic work with people who experience domestic and family violence needs to take considerable time to allow the process to unfold. Understanding the triggers that cause past traumas to be re-experienced helps people to recognize and change their conditioned emotional responses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Time needs to be invested to develop a secure and trusting relationship to enable a person to work through childhood experiences that have the potential to overwhelm. It is important for adults who have experienced childhood trauma to have an opportunity to process the abuse to help minimize its intrusion in their lives.
A mixed method thematic review: the importance of hope to the dying patient
Publisher: Wiley
Date: 09-09-2016
DOI: 10.1111/JAN.12765
Abstract: To review the literature and investigate the meaning of hope to patients receiving palliative care and to examine the themes that foster hope in those patients. Hope is often linked to the future and is a significant factor for patients dealing with adversity, such as a terminal illness. The concept of hope is underreported in the literature. Mixed method thematic review. CINAHL, Scopus, PsychINFO, Informit, PubMed, Science Direct, ProQuest, Web of Science and Google Scholar online databases were searched using keywords and inclusion and exclusion criteria published between 2003-2013. Twelve qualitative articles were thematically analysed using Braun and Clarke's (2006) steps to ascertain major themes and sub-themes. On analysis, the remaining three mixed method studies were found to reflect the themes generated by the qualitative studies. Seven key themes that increased hope were found: disease status positive personal relationships positive character traits quality of life setting and achieving goals spirituality/religion and hope after death. The importance of hope to dying patients was established. Hope is a very complex and personal phenomena requiring hope-enhancing strategies to be in idualized. More research is needed with groups whose culture, youth or type of illness may affect their ability to foster and maintain hope.
Nurses' communication with families in the intensive care unit – a literature review
Publisher: Wiley
Date: 13-01-2017
DOI: 10.1111/NICC.12141
Abstract: This review examined the literature across 12 years that explored nurses' perceptions of their role when communicating with families in adult intensive care units (ICUs). The objectives were: (1) to describe how ICU nurses facilitated communication with families (2) the perceived barriers to that communication (3) strategies to improve their skills. Evidence demonstrates that effective communication by health care providers can improve families' understanding of their situation and decrease their psychological burden. The continuous presence of ICU nurses, combined with the use of effective empathic communication skills, can impact on families' ICU experience in a positive way. Nevertheless, research continues to demonstrate that communication with families in ICU is inadequate and of poor quality. Eight databases were systematically searched to identify peer reviewed studies published in English between 2002 and 2014. The results are presented via a thematic literature review. Four major themes emerged from a synthesis of the review findings: 'Nurses as information and communication facilitators', 'Nurses as family support providers', 'Nurses' non-supportive behaviours' and 'Improving nurses' communication skills'. Most ICU nurses considered communicating with families a vital part of their role, and described supportive behaviours. However, they perceived significant barriers to effective communication some as a result of active decisions on their part, and some beyond their control. These barriers often resulted in nurses believing that families received suboptimal information and support. Peer support and formal training were identified as key strategies to overcome inadequacies. This review summarizes nurses' perceptions of the means and barriers for communicating with families in ICUs. Intensive care nurses need skills and knowledge in how to communicate effectively with families. This skill can be learnt formally, or acquired from role modelling of more experienced peers.
Using research evidence to inform staff learning needs in cross-cultural communication in aged care homes
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.NEDT.2018.01.007
Abstract: Developed countries worldwide are facing an unprecedented demand for aged care services, with recent migrants of erse linguistic and cultural backgrounds increasingly recruited as care workers while at the same time there is growing cultural ersity among aged care residents. This situation is compounded by rapidly changing technology and varied educational levels of care workers from erse backgrounds. The objectives were threefold: to identify staff learning needs to enable them to provide high-quality cross-cultural care to improve team cohesion and identify preferred learning approaches. An interpretive qualitative study utilising focus group and interview data informed the development of an education resource. Fifty six care workers from four residential aged care facilities participated in either focus groups or interviews conducted in private meeting rooms within the care facilities. Participants included personal care attendants, registered and clinical nurses, managers, hospitality staff and allied health professionals. Focus group and interview data were categorised and thematically analysed. Data relevant to cross-cultural care, team cohesion and preferred learning approaches informed education resource development, including case studies. Major themes identified the need to promote cultural awareness and understanding, and strategies for cross-cultural care and communication. Themes related to team cohesion demonstrated that staff were already sympathetic and sensitive to cross-cultural issues, and that culturally and linguistically erse staff add value to the workforce and are supported by the organisation. Staff required clear, uncomplicated education resources to equip them with skills to address problematic cultural situations. Preferred learning approaches varied and highlighted the need for varied educational materials and approaches, as well as time efficient, opportunistic education strategies for the busy workplace. An education package was developed to value cultural ersity in the aged care workplace for staff and residents, and provide an exemplar for evidence informed education.
A beginning understanding of caregivers' spiritual needs when relinquishing a loved one to a palliative care setting
Publisher: Informa UK Limited
Date: 2012
The implementation of intentional rounding using participatory action research
Publisher: Wiley
Date: 08-07-2013
DOI: 10.1111/IJN.12101
Abstract: 'Intentional'/'hourly rounding' is defined as regular checks of in idual patients carried out by health professionals at set intervals rather than a response to a summons via a call bell. Intentional rounding places patients at the heart of the ward routine including the acknowledgement of patient preferences and in anticipation of their needs. The aim of this study was to implement intentional rounding using participatory action research to increase patient care, increase staff productivity and the satisfaction of care provision from both patients and staff. Outcomes of the study revealed a drop in call bell use, no observable threats to patient safety, nursing staff and patient satisfaction with care provision. However, any future studies should consider staff skill mix issues including the needs of newly graduated nursing staff as well as the cognitive status of patients when implementing intentional rounding on acute care wards.
A qualitative study of regional anaesthesia for vitreo-retinal surgery
Publisher: Wiley
Date: 19-09-2013
DOI: 10.1111/JAN.12263
Abstract: The aim of this research was to collect experiential knowledge about regional ocular anaesthesia - an integral component of most vitreo-retinal surgery. Anaesthesia for vitreo-retinal surgery has predominantly used general anaesthesia, because of the length and complexity of the surgical procedure. However, recent advances in surgical instrumentation and techniques have reduced surgical times this decision has led to the adoption of regional ocular anaesthesia for vitreo-retinal day surgery. Although regional ocular anaesthesia has been studied from several perspectives, knowledge about patients' experience of the procedure is limited. An interpretive qualitative research methodology underpinned by Gadamer's philosophical hermeneutics. Eighteen participants were interviewed in-depth between July 2006-December 2007 following regional ocular anaesthesia. Interview data were thematically analysed by coding and grouping concepts. Four themes were identified: 'not knowing': the time prior to the experience of a regional eye block 'experiencing': the experience of regional ocular anaesthesia 'enduring': the capacity participants displayed to endure regional ocular anaesthesia with the hope that their vision would be restored and 'knowing': when further surgery was required and past experiences were recalled. The experience of regional ocular anaesthesia had the capacity to invoke anxiety in the participants in this study. Many found the experience overwhelming and painful. What became clear was the participant's capacity to stoically 'endure' regional ocular anaesthesia, indicating the value people placed on visual function.
Education on physical restraint reduction in dementia care: A review of the literature
Publisher: SAGE Publications
Date: 09-10-2013
Abstract: Dementia is a priority area for all countries as populations age and dementia prevalence increases. The use of physical restraint is a possible clinical practice for persons with dementia across settings when behaviours indicate a perceived need. Indeed, this may be the first choice in practice, occurring in part because of lack of education, safety concerns, perceived costs and staffing issues. This article reviews the literature on the issues surrounding, and use of, physical restraint for people with dementia, highlighting the rationales for use and the benefits and barriers to physical restraint. Recommendations include the importance of education and policy to reduce or eliminate physical restraint of persons with dementia to overcome identified barriers at the in idual, cultural and organizational levels. An educational programme from the literature review is proposed specific to the reduction or elimination of physical restraint.
Could standing orders have a place? A phenomenological exploration of experienced ward‐based registered nurses' views on the escalation protocol for patient deterioration
Publisher: Wiley
Date: 31-08-2022
DOI: 10.1111/JOCN.16022
Abstract: To explore experienced ward‐based Registered Nurses’ views on the potential use of standing orders, prior to the escalation protocol, for patient deterioration. Ward based nurses are required to follow set steps of the escalation protocol. The introduction of standing order policies would allow nurses to intervene earlier when deterioration was first detected. Hermeneutic Phenomenology. Ten experienced ward‐based RNs were recruited. Semi‐structured interviews were conducted, with the data subjected to thematic analysis. Diekelmann's framework was used to analyse the texts, seeking the highest level of hermeneutic analysis namely, a constitutive pattern. COREQ guidelines were utilised. Four main themes emerged: (1) Ambiguity in perception: the escalation protocol (2) Observations within acceptable parameters, but the patient is deteriorating (3) Paradoxes of escalation: well laid out protocol, but hard to escalate (4) We could intervene with standing orders, but are we permitted? The constitutive pattern namely, Dualism in Perception related to the dissonance conveyed by participants regarding the escalation protocol. Notwithstanding the benefits of the escalation protocol for junior staff, the RNs offered critique of the established escalation practices and the restrictive role of the protocol. Another aspect of the protocol, that is ‘worried criterion’ was viewed positively. The participants expressed a desire to apply nurse‐driven standing orders, to enable them to intervene earlier for patient deterioration. Organisations should consider new policies introducing standing orders for implementation by experienced RNs. The engagement of experienced ward‐based nurses in forming ‘patient at‐risk teams’ could assist organisations to deal with cases of clinical deterioration prior to activation of the escalation of care protocol.
A mixed methods thematic review: Health-related decision-making by the older person
Publisher: Wiley
Date: 04-2018
DOI: 10.1111/JOCN.14261
Abstract: To undertake a mixed methods thematic literature review that explored how elderly adults approached decision-making in regard to their health care following discharge. A critical time for appropriate health decisions occurs during hospital discharge planning with nursing staff. However, little is known how the 89% of elderly living at home make decisions regarding their health care. Research into older adults' management of chronic conditions emerges as an important step to potentially encourage symptom monitoring, prevent missed care and detect deterioration. All should reduce the risk of hospital re-admission. A mixed methods thematic literature review was undertaken. The structure followed the PRISMA reporting guidelines for systematic reviews recommended by the EQUATOR network. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus online databases were searched using keywords, inclusion and exclusion criteria. References drawn from relevant publications, identified by experts and published between 1995 and 2017 were also considered. Twenty-five qualitative, quantitative and mixed methods studies and reviews were critically appraised (CASP 2013) before inclusion in the review. Analysis of each study's findings was undertaken using Braun and Clarke's (2006) steps to identify major themes and sub-themes. Four main themes associated with health-related decision-making in the elderly were identified: "the importance of maintaining independence," "decision making style," "management of conditions at home" and "discharge planning." Health care decision preferences in the elderly emerged as highly complex and influenced by multiple factors. Development of a tool to assess these components has been recommended. Nurses play a vital role in exploring and understanding the influence that maintaining independence has with each patient. This understanding provides an initial step toward development of a tool to assist collaboration between patients and healthcare professionals involved in their care.
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Related Funding Activities
Linkage Projects - Grant ID: LP150100330
Start Date: 03-2016
End Date: 12-2020
Amount: $195,000.00
Funder: Australian Research Council
View Funded Activity