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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ItemCrystallising meaning: attitudes of listening to illness narratives( 2008)This study involves listening to illness narratives embedded in in-depth life review processes. The method of multiple interview and multi-modal analysis and reflective responding utilised in the study aims to add to the existing field of research by expanding the understanding of what it is like to be heard or not heard, for people who are either patients, or family members. The study also aims to demonstrate how self-aware ,compassionate and reflective listening, particularly in healthcare relationships, can allow meaning to emerge from within the illness experience, thus enriching the wellbeing of patients, family members and their various healthcare professionals. Stories of disruption arising within healthcare settings often confronted me during more than forty years of nursing experience and also resonated within my personal experiences. These stories express a gulf between patients, family members, or residents in healthcare institutions, and the healthcare organization and its staff. A recurring theme was that these people felt that they had not been listened to by those they trusted to give them care, with a lasting sense of disruption to their wellbeing. In focusing on the dimensions of reflective listening and intersubjective responding, the implications of being heard on the well being of both narrator and listener can be elucidated. An objective of the research became to articulate the attributes and values of compassionate, reflective listening and elucidate the complex nature of the narrating and listening relationship. (For complete abstract open document)
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ItemA study of pain management practices during the prolonged hospitalisation of infants.( 2007-05)Purpose: The purpose of this study was three-fold; to investigate the use of pain assessment tools and pain reduction strategies during minor painful procedures in neonatal units in Australia; to map the history of an infant’s prolonged hospitalisation in a tertiary neonatal intensive care unit with respect to painful procedures and pain management practices, and to describe the effectiveness of oral sucrose in reducing procedural pain during the course of an infant’s prolonged hospitalisation (greater than/equal to 28 days). (For complete abstract open document)
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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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ItemProfessional aspirations and consumer expectations: nurses, midwives, and women's health( 2009)This thesis undertakes a history of midwifery's present in the arena of Victoria, Australia. It asks: what lies behind midwifery's aspiration to differentiate itself as a profession, separate and distinct from nursing? The thesis applies contemporary and historical inquiry in two parts. In Part I, the contemporary arm, a review of discourses and policies was combined with individual (n=22) and group interviews (n=4) to discover the perspectives of nurses, midwives, consumers, and others, on midwifery's separation from nursing via its professionalising process. In the larger arm, Part II, midwifery's and nursing's historical and professional trajectories in Victoria were mapped from European settlement in the 1840s through to the present. This was achieved by detailed examination of a range of primary sources, including records of the Melbourne Women's Hospital, the Victorian parliament and its delegated authorities, and professional associations. The Foucauldian concept of government frames this interpretation of women's health care history. Government encompasses the themes of regulation and expertise, both of which are key elements in claiming status as a profession, and are argued here to be central in nursing's and midwifery's history. Because tensions over the status of pregnancy and birth as health states or potential illness states are longstanding, the concepts of health and illness also inform this inquiry. Midwifery's history is shown to be a contingent and complex history, intricately intertwined with that of nursing since the earliest days of settler society. Throughout 170 years of history following European settlement in Victoria, two themes dominate the provision of care to women, and the roles of midwives and nurses in that care. The primary theme is the safety of women. An interconnected theme is the politics of women's health, that is, the politics of delivering safety. Stemming from concerns about women's safety and how to achieve it, the arena of women's health care and the roles of midwives and nurses within it is characterised by a perennial cycle of seemingly intractable issues. These issues include: questions about who should practice midwifery/maternity care, under what conditions, what education and training is required for the role, perceived disparities between city and rural services, consumer choice, autonomy, and the cost of services. While the context in which these perennial problems are played out has changed considerably over time, and while the meaning of safety has shifted over time, the issues, themselves, have remained consistent. These intractable issues are a permanent feature of the women's health care arena. Over the 170 years of history examined here, they have not been resolved by the formation or reframing of professional identities, by the reconfiguration of education pathways, or by new models of care. Thus, the promise of a reformed maternity care service for the betterment of all women may not be achieved by midwifery's separation from nursing. In the Victorian setting, midwifery has had, and continues to have, much in common with nursing. A grasp of these historically-enduring commonalities confirms that there may be a lot to lose by midwifery's separation from nursing.
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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.