Nursing - Theses
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ItemA study of the clinical supervision implementation strategy for nurses at a rural health care organisation in Victoria(University of Melbourne, 2006)
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ItemFrom lunatic to client : a history/nursing oral history of Western Australians who experienced a mental illness( 2001-08)This study investigates the development of services and treatment modalities for the mentally ill of Western Australia from a nursing perspective. The thesis moves from the influences of Europe to focus on the emergence of services for the mentally ill in Western Australia. In particular the process of change that has occurred in the treatment of Western Australia’s mentally ill from colonisation to the end of the 1980s is considered. The study has a central focus on nursing care, and how nursing has adapted to changes in treatment modalities for mental illness as well as emerging government policy, fiscal restraint and community beliefs concerning mental illness. Through exploration of the role and care provided by mental health nurses and a description of the environment where this care was administered, an insight into how the mentally ill were perceived and treated is gained.
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ItemGoverning recovery: a discourse analysis of hospital stay length( 2002-12)This research examines hospital length of stay as a feature of contemporary health care reforms. The ideas of Michel Foucault on governmentality enable length of stay to be studied, not as numerical values of hospital use, but rather as one of the social and political processes through which certain concepts are made susceptible to measurement and part of practice. In this study length of stay is examined as a programmatic rationality, evident in the reengineering of the modern hospital. However, the focus of analysis is not the ‘effect’ of this reengineering, as seen in the substantial changes to hospital treatments and the shifting burden of responsibility for health and ill-health care to individuals and communities. Rather, analysis is directed at understanding how such rationalities make possible reengineering or shifts in the local contexts of hospital care practices. (For complete abstract open document)
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ItemThe relationship between images of nursing and person-environment fit( 2005)The public image of nurses has been of great concern to the nursing profession. This image views nursing as a female occupation with nurses having little power over their practice. Researchers claim that the stereotypical public image of nursing could constrain nursing practice. For instance, nursing skills may be under- utilised and the health care environment may not adequately reward nurses for their performance. There has also been a concern that the constraints arising from the stereotypical public image of nursing may adversely affect nurses’ work behaviour. Based on the Person-Environment-Occupation Model of Occupational Performance, the thesis examined how the public image of nurses could impact on nursing practice. The thesis also explored the person-environment (mis)fit in nursing, which is characterised as (in)congruence between nurses’ professional orientation (i.e., nurses’ self-image, role expectations and work values) and their actual practice (i.e., nurses’ perception of the image of nurses held by the public, and nurses’ perceptions of their actual roles and the rewards available to them in practice). In addition, the thesis investigated the factors that could moderate nurses’ perception of the person-environment fit, and how this fit could impact on their job performance and turnover intention. (For complete abstract open document)
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ItemThe reforms to mental health and their impact on the empowerment of consumers and carers( 2002-02)The intention of this thesis is to explore and discuss the experiences of consumers and carers with psychiatric disability support services. In particular their participation in service development and delivery and the degree to which their relationship with services and providers has influenced this participation, is explored and discussed. These relationships are particularly relevant in the context of the dynamics that determine power and the strategies that consumers have adopted so that they become more empowered and have control over their own lives. Consumers and their carers are placing greater demands on the mental health service system within Victoria. Reforms to mental health and psychiatric disability support service delivery and practice have resulted in deinstitutionalisation, recognition of fundamental human rights and changes to mental health legislation. Participation by consumers and carers in service development and delivery has been viewed by governments as necessary and important in contributing to care, treatment and support systems. The National Mental Health Policy developed by the Australian Health Ministers paid substantial attention to the need to include consumers and carers in decisions that shape mental health services. These are underpinned by the World Health Organisation’s doctrine that people have the right and duty to participate individually and collectively in the planning and implementation of their health care. (WHO 1990, p. 14). In Victoria, the National Mental Health Policy lead to the development of a framework for mental health services that reinforced consumer and carer participation in service development and delivery. A qualitative methodology was used for this investigation. In-depth interviews were conducted with consumers and carers to gain a thorough understanding of their experiences and perceptions of the current mental health system. A review of available literature on the developing mental health consumer movement and on the concepts and practices of empowering strategies was undertaken. The opportunities for participation in the design, development and delivery of services in the context of actual experiences, are discussed with consumers and carers with particular emphasis on consumers’ perceptions of power and empowerment. The transition from institution to community, known as deinstitutionalisation, has not been an easy one to accept by consumers and carers alike. The changes to service design and delivery with a greater focus on community and out reach services, and the necessary changes in attitudes by providers toward consumers as a result of these changes, have established major challenges for the mental health and psychiatric disability support services sector. Consumers and carers argue that the rhetoric inherent in the decision to implement deinstitutionalisation policies and practices that have lead to a shift to services primarily delivered outside of institutions, needs to be taken to another level. They want to ensure that they are recognised and accepted as bringing essential knowledge and experience to a service system that should be designed to support consumers and carers who face life altering circumstances as a result of a mental illness. The information provided by consumer participants suggests that the reforms to some degree have provided them with more opportunities to take control over their own lives particularly in relation to their involvement in community based psychiatric disability support services. However, they describe the attitudes of providers as remaining the greatest barrier to advancing consumer participation. Carers on the other hand describe their experiences with psychiatric disability support services as disempowering. Their disillusionment with the mental health system is attributed to the lack of support and their perceived lack of recognition in their role as carers.
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ItemA descriptive exploratory study of nurses’ and parents’ perceptions of family-centred care in paediatrics wards in hospitals in Semarang, Central Java, Indonesia( 2003)The study was conducted with the main purpose to explore the attitudes and understanding of family-centred care of nurses and parents in paediatric settings at four hospitals in Semarang, Central Java, Indonesia. The literature review highlighted that the nurses and the parents/families could work collaboratively to maximise the hospitalised child's welfare. However, nurses tend to have difficulties fulfIlling their obligation towards the parents of hospitalised children, for a number of reasons. In addition, the parents feel that they require expanding their roles to care for their children. Appropriate information regarding the children's health progress is needed by the parents to reduce their apprehension. The method applied was by administering questionnaires to the nurses who worked at paediatric wards and to the parents of hospitalised children who had stayed at least three days in hospital. The study was conducted at Dr. Kariadi Hospital, Semarang Municipal Hospital, Telogorejo Hospital and St. Elisabeth Hospital in Semarang, Indonesia. The participants were asked to complete the questionnaires anonymously and the questionnaires were collected in a sealed collecting box within two months. The findings demonstrated that there were some differences in the perceptions of roles in dealing with the children in hospital, the view and the experiences working together to care for the sick children. The results suggest despite these differences, both nursing staff and parents support the implementation of the family-centred care approach in the paediatric setting. Further research is essential to ensure the understanding of family-centred care in paediatric setting.
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ItemWarfarin therapy in infants and children( 2004)Much of the evidence that guides anticoagulant management in infants and children has been presumptively extrapolated from adult medicine. We now know that there are several reasons as to why such extrapolation may not be ideal. This study sought to explore key outcomes of warfarin management in infants and children. The medical literature supports a direct association between patient knowledge and the stability of warfarin therapy. Phases One and Two of this project respectively investigated Parental and Nursing staff understanding of warfarin therapy in the paediatric population. Phase Three constituted a retrospective audit of warfarin management at a single tertiary paediatric centre over a two-year period. Data collected aimed to shed light upon the efficacy and safety outcomes of warfarin therapy in this cohort. Phase Four consisted of the development and implementation of a novel parent education program, which was piloted in a trial of home monitoring of warfarin therapy. Results of Phases One and Two demonstrated that parental and nursing understanding of warfarin therapy in children is poor. Although a causative link cannot be proven between the level of knowledge each of these cohorts possess, the role nurses play as educators must be reviewed in light of these outcomes. Phase Four demonstrated that parental understanding of warfarin therapy significantly improved following implementation of a novel education program, and these improved knowledge outcomes can be sustained over time. This program facilitated the implementation and evaluation of a home INR monitoring pilot study. Target therapeutic range (INR) achievement compared favourably with studies reported in adult patients, despite the presence of numerous confounding factors in the paediatric population. However, adverse event rates were higher than has previously been reported for similar paediatric populations. The incidence of adverse events appeared to be greater in patients not managed by a dedicated anticoagulant clinic. Warfarin management in children presents unique challenges that must be addressed if optimal anticoagulant therapy is to be achieved.
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ItemImproving the quality of patient care through a systemic approach to emancipatory practice development( 2006)This study used an emancipatory action research method to explore the significance of practice development as a systemic strategy to improve patient-centred care in a Cardiothoracic Surgical (CTS) Unit. The need for the study arose from recognition that the increasing levels of patient injury and death in healthcare requires a patient-centred and systemic response. The study presents practice development as one such response to engage the whole system of care in improvements and ensure patient-centred care. The study involved the development, implementation and evaluation of a Practice Development Program. An emancipatory action research methodology was used to maximise the participation of staff in the Program and to promote sustainable change. This methodology was also considered suitable as it parallels emancipatory practice development. The Program involved three action research cycles to reflect on patient care in the CTS Unit and make improvements. The first program cycle involved an evaluation of care using an Empowerment Evaluation approach (Fetterman, 2005). This was then complemented with patient and staff interviews and surveys. The evaluation provided the opportunity for staff to see and understand their practice differently and created the momentum for practice change. The second program cycle began with a staff ballot on the value of continuing the Program which identified that ninety percent of staff supported maintaining the Program. At the end of the cycle an evaluation of the Program, to determine opportunities to consolidate successful outcomes, was carried out. This was supported by the development of a local 'Change Achievement Map' or checklist of requirements for successful, systemic practice development. The Map highlighted the challenges involved in implementing a systemic approach and the opportunities to strengthen the Program. Throughout the second program cycle staff continued practice change activities, with 44 staff involved in coordinating projects to improve patient care. As such, the Program established a culture of clinical governance, or held staff accountable for improvements. While staff were held accountable they were also supported to take ownership of change, make sense of it and to work across disciplines and departments to enhance patient care. The third program cycle began with an evaluation of care (similar to the first program cycle) to stimulate a further 12 months of practice development. With the increased ownership that occurred over the course of the Program, staff took more active roles in the evaluation, including facilitating a number of Evaluation Workshops and conducting patient interviews and surveys. The increased level of staff participation led to new insights about the emotional labour of care and the challenges this presented to enhancing patient-centred care. This Program cycle also explored the efforts of staff to sustain the Program beyond the involvement of the External Facilitator. The study involved reflection on the characteristics of practice development and the construction of propositions, or critical theorem, relating to the effects of the Program and how practice development occurred. In addition, propositions about the systemic characteristics of practice development were explored and a new, systemic model of practice development is presented. The study concludes that a systemic approach to practice development is an effective strategy to improve patient care.
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Item“Doing it properly”: transition to motherhood for first time mothers 35 years and above( 2004)This qualitative study investigated the experiences of first mothering for a new social category of mothers, primiparae aged greater than 35 years. Participants were recruited from a tertiary hospital in Melbourne, Australia, a city of more than 3 million people. A total of 22 new mothers were interviewed about their experiences of transition to motherhood. In a smaller sidearm of this study, three focus groups of midwives and maternal and child health nurses were conducted in a bid to identify clinical needs for this particular group of mothers. In general, participants reported high levels of anxiety in the early days of mothering and over 3 in-depth interviews, these women revealed a need for additional social and professional support. However, despite a shaky start, participants ultimately described themselves as both resourceful and proactive, in terms or recruiting information to meet their needs. Despite negative appraisal of their maternal capabilities by a variety of health professionals including midwives and maternal and child health nurses, and common associations of maladjustment, this study found to the contrary. By 6 months postpartum, most participants had, by their own admission, become confident mothers and were overwhelmingly positive about their mothering experiences. Although these women used services and phoned for advice more than perhaps younger mothers, they did not demonstrate the high levels of post-natal maladjustment or depression anecdotally associated with older first-time mothering. Focus group data also clearly indicated that this growing group of mothers had concerns and needs that differed from younger mothers, particularly in regard to confidence building in the first three months post partum. Findings explored ways to provide more meaningful support and improved professional care. The importance of this study is located in the intellectual contribution it makes to the debate surrounding the social context of mothering. An opportunity also presents for health professionals to gain an understanding of the experiences of maternity for contemporary older primiparae. This new understanding may in turn enable health professionals to challenge existing preconceptions of maladjustment among this group of mothers. Finally, an identification of the specific needs of this cohort may give rise to more meaningful maternal support and patient sensitive care.
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ItemShaped to care: a study of subjectivity and emotional labour in nursing theory and practice( 2002)This research is a study of the theoretical understandings of emotion work in nursing. Ideas of poststructuralist subjectivity are used to offer a critical perspective on emotion work in humanist influenced nursing literature. The study reveals profound skill in the way nurses use their emotions at work through examples of routine care. This vital part of nursing practice is invisible and, crucially, it appears effortless. The argument is supported by illustrations from practice, nursing literature, focus group research and a secondary analysis of interview data from a Malignant Wound Care Study (Parker & Aranda, 2000). It is argued that emotional labour is a positive capacity that nurses develop as a skilled part of the work of nursing. This capacity is invisible, unarticulated and being intensely pressured by healthcare restructuring. The thesis contends that if the conditions which facilitate this critical set of practices are eroded, patients will receive markedly inferior healthcare.