Nursing - Theses
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ItemBecoming a Nurse: A mixed Methods Study of Student Nurse Employment and Graduate Nurse Experience( 2023-11)Background: Evaluations have demonstrated that employing student registered nurses (RNs) in healthcare roles may improve their clinical skills and confidence and subsequently, the work readiness of new graduate RNs. The recent expansion of student employment models in healthcare, including the Registered Undergraduate Student of Nursing (RUSON) employment model in Victorian public hospitals, has provided an opportunity to explore the influence of student RN employment on graduate nurse transition to practice. Aim: To explore the ways in which student employment impacts student learning and preparation for practice, and investigate how employment influences transition experience. Research questions: 1. How do different models of student employment influence RN transition to practice? 2. What influence do student employment models have on nursing workforce recruitment and retention? Design/Method: A mixed methods study using a sequential explanatory research design was undertaken in two phases of the study. Phase 1: A cross-sectional survey combining an adapted version of the Revised Casey Fink Graduate Nurse Experience (r-CFGNE) survey tool including additional questions related to student nurse employment and the influence of that employment on learning and preparation. Phase 2: Focus groups/interviews, informed by early review of Phase 1 data, included graduate RNs recruited through the survey. Setting: Public and private hospital system in Victoria, Australia. Participants: RNs currently undertaking a graduate nurse program in Victoria, Australia (June to September 2022). Results: Phase 1: Seven hundred and seventeen participants opened and completed at least some of the survey. Five hundred and thirty-four surveys (74%) completed surveys were included in the analysis. Sixty-five percent of participants worked while they were studying for their nursing degree. Participants indicated that employment in a nursing related role while a student RN influenced their learning: employment in health or aged care 76.3% (p-value < 0.001); employment as a RUSON 75.4%, (p-value <0.001). Similarly, preparation for work was reported to enhanced by employment healthcare roles: employment in health or aged care 77.7% (p- value < 0.001), employment as a RUSON 81.8%, (p-value <0.001). Employment as a RUSON was the role most frequently nominated as having the greatest influence (42.5%), the next most frequent was employment as an AiN/HAN/PCA (21.5%). Differences were observed between type of employment undertaken while studying for a degree in nursing and graduate retention. A significantly larger proportion of nurses who had been employed as a RUSON during the course of their degree indicated that they remained with that employer throughout their graduate year; when compared to other survey participants working in health and aged care (55% vs 23.5% p-value <0.001). In relation to retention, while a greater proportion of RUSONs (68.1%) reported intending to stay in nursing compared to those who did not work in health (63.6%) this difference was not significant (p-value = 0.362). Phase 2: Eighteen nurses who completed the survey participated in an interview or a focus group. Analysis of the qualitative data yielded four themes. Thematic analysis demonstrated that employment in health while undertaking a nursing degree had a positive influence on graduate nurse preparation. Students who were employed in positions that worked directly with an RN were also able to develop a greater connection to nursing. Conclusion: Graduate nurse transition is influenced by engagement in the paid employment as a student. This influence is perceived to be most beneficial where employment provides the student with the opportunity to work in clinical areas with more direct care and nursing experience, particularly when the employment is part of a nursing team. This provides the student with informal but important work integrated learning that could be better utilised. The increased connection to nursing and the workplace may also serve to increase opportunities for graduate nurse recruitment and retention. Implications for nursing: Nursing and midwifery continue to be challenged by workforce pressures, including the recruitment and retention of graduate nurses. This research found that the RUSON model can strengthen the graduate nurse experience and support workforce development. The influence of different student RN employment models on the graduate RN workforce requires further exploration. Further research scoping the models over a longer period of time is required to measure the impact on graduate nurse preparedness for work, practice based learning, and graduate nurse recruitment and retention.
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ItemExploring post-treatment care for women with high-intermediate and high-risk endometrial cancer: A mixed methods study( 2022)Endometrial cancer (EC) imposes a significant burden on women and the health system. Intense post-treatment follow-up (FU) for women with high-intermediate (H-I) and high-risk (H-R) disease lasts five years or longer with only 20% likely to develop recurrence. Death from pre-existing conditions is more likely than from EC. No evidence supports FU improving long-term survival or quality of life. Alternative FU needs consideration. The aim of this thesis was to explore current post-treatment FU models for women with H-I and H-R EC to: - Understand the current model of patient care in addressing survivorship issues. - Identify deficiencies in post-treatment care. - Make recommendations that support optimal care based on women's perspectives and needs. A sequential explanatory mixed methods study was conducted in two phases to: examine patterns of care and disease outcomes; explore the extent to which the current model of care 1) meets women’s physical and emotional needs; 2) addresses survivorship issues. Phase 1: A retrospective case audit was conducted of women referred for adjuvant radiation treatment between 2004 and 2014 who subsequently recurred. Data were analysed using descriptive statistics. Phase 2 recruited women without evidence of disease, attending medically-led FU. Purposive sampling targeted a range of experiences post-treatment. Semi-structured interviews were analysed using inductive thematic approach. Quantitative data results revealed of 786 women referred, 19% developed recurrence. Most (63%) had at least two pre-existing comorbidities. Few notes (9%) documented lifestyle discussions. A third (31%) experienced mild/moderate treatment-related side-effects. Most notes (84%) contained no references to emotional status; few (12%) contained exercise recommendations; few (17%) for those working pre-treatment indicated return to work discussions; seven documented nursing consultation. Most recurrence (87%) occurred within three years post-surgery, 70% was symptomatic. Although treating clinicians detected 59% of recurrences, only 46% were during scheduled FU. The majority (59%) had multi-focal recurrence and poor outcomes. Two years post-treatment for recurrence, 31% were alive, 15% without evidence of disease. Eleven survived four years. Analysis of 25 interviews yielded four themes: ‘The safe haven of FU’; ‘Fear of cancer recurrence’ (FOR); ‘It is more than absence of cancer’; ‘Attitudes and relationships to health care professionals’. Women reported little preparation for survivorship. FU focused on physical symptoms; recurrence detection; treatment toxicity. Attending FU both escalated and alleviated FOR. Generally emotional needs were unmet. Health promotion and practical support toward making lifestyle changes was absent. Women valued specialist-led FU and ongoing connection with them. Women perceived limited contact with nurses in FU. Nurse-led care could provide for unmet needs, including emotional and healthy lifestyle support. In conclusion, this thesis indicates the current model is effective in dealing with medical issues from a disease perspective but is inefficient. In 70% of cases recurrence detection was from symptomatic disease rather than FU. For many, the current model is burdensome and does not comprehensively address survivorship issues. Findings indicate revision of national EC FU guidelines, and reforming EC survivorship care models as needed. Shifting the focus of FU towards addressing women’s post-treatment experiences is overdue. Specialist nurse-led FU should be considered.