Critiquing the Health Belief Model and sexual risk behaviours among adolescents : a narrative review of familial and peer influence

Research into the rising rates of sexually transmitted infections and unwanted pregnancies among adolescents has highlighted the challenge in developing sexual education campaigns that affect behavioural change. Frequent attempts to apply the otherwise robust Health Belief Model to the challenge of high-risk sexual behaviours have yielded confounding results from sexually active teens who discount the seriousness of consequences or their susceptibility to them. Social dynamics involving familial and peer relationships may strongly influence teen sexual risk-taking; the growing population of sexual risk-takers is strongly associated with disengaged family environments and a shift in alliance from family to peer community. This shift in identification to peer groups, in the absence of supportive parental relationships, is correlated with permissive and coercive sexual behaviour and a future of substance abuse, depression, sexually transmitted infections and unwanted pregnancy. This paper seeks to explore the correlation between peer interaction and parental relationships and availability, while assessing the predictive value of the Health Belief Model in relation to adolescent high risk sexual behaviour. Doing so can inform research to further clarify the nature of these associations and investigate new insights into adolescent sexual dynamics and new policy and programming approaches to sexual health promotion

Managing dementia agitation in residential aged care

Agitation is a widespread and challenging problem among aged care residents with dementia. This article draws on empirical and theoretical literature to propose a model for preventing and treating agitation non-pharmacologically. A literature review finds agreed, coherent definition and measurement of agitation to be absent despite numerous agitation remedies having been suggested, yet sufficient material to support evidence-based care planning. Agitation is revealed as resulting from a resident’s interactions with the environment or their internal state, giving rise to unmet needs that attentive care can treat. Agitation treatments are reviewed to find no single effective remedy and a lack of quality evaluation. A higher-order, problem-solving approach is proposed. The described system consists of sequential diagnosis, decision making and treatment options, commencing with individualized and institutional preventative measures removing environmental triggers, followed by individual remediation, with residents’ unmet needs receiving priority consistent with patient-centred care

Transcutaneous CO2 monitoring : effect of electrode position and gestation on arterial partial pressure of CO2 for the first 3 days of neonatal life

Transcutaneous measurement (TCM) yielding transcutaneous –partial pressure of carbon dioxide (TcPCO2) provides a non-invasive method of continuously monitoring CO2 tension in critically ill mature and premature neonates. This study evaluated the relationship between TcPCO2 and the direct measurement of partial pressure of carbon dioxide (PaCO2). The aims were to identify probe sites associated with the highest correlation and least discrepancy between the TCM and the direct PaCO2 measurement by comparing factorial combinations of TCM probe placements and gestational categories of neonates ≤3 days old and to identify safe operating limits for TcPCO2. Over a period of 10 months, PcCO2 and TcPCO2 readings were collected from eligible neonates ≤3 days of age who were admitted to a neonatal intensive care unit (NICU) and required an arterial line and TCM. Readings from four thorasic and four abdominal probe placement sites were analysed. Neonates (n=95) were stratified into three gestational groups for analysis (32 weeks’ gestation). TcPCO2 readings >35mmHg (>4.6kPa) tends to underestimate PaCO2. Large discrepancies between PcCO2 and TcPCO2 show that substantial error of prediction can occur. Regression analysis identified TcPCO2 ranges that predict PaCO2 levels within 35-45mmHg (4.6-6.0kPa) with 90% confidence. In conclusion, although TcPCO2 predicts PaCO2 with well below perfect accuracy, operating ranges of TcPCO2 between 41-45mmHg (5.4-6.0kPa) are likely to maintain PaCO2 within the safe levels of 35-45mmHg (4.6-6.0kPa) on most occasions (90%) during the early neonatal period

The value of participatory action research in clinical nursing practice

This paper demonstrates the value of participatory action research (PAR) and promotes its use by nurses in clinical practice. PAR has gained popularity in nursing and health-care research, offering a way of developing practice-based knowledge that can improve nursing care. PAR is described in detail: what PAR is, how to use PAR in clinical practice, and the steps in the PAR cycle as applied during an exemplar study in which nurses used PAR to address their concerns and develop, implement and evaluate a model of care in an acute medical ward. The authors advocate PAR as a collaborative means to improve the nursing care for patients in varied clinical practice settings

Communication idol : using popular culture to catalyse active learning by engaging students in the development of entertaining teaching and learning resources

Bringing popular culture to tertiary education can potentially increase student engagement with learning tasks and content, especially when the learning task has students producing the content. Using a single-group intervention plus post-test design, this study implemented and evaluated a purposely developed learning and teaching innovation capitalising on popular and consumer culture to promote active over passive learning in a large, interprofessional health science unit. Students were invited to develop educational video presentations in a friendly competition based on high-rating television musical and vocal talent quests, with cash prizes based on peer ratings, this being the intervention. From a cohort of 569 students in 12 undergraduate allied health programs, 14 students in seven teams of 1 to 3 students produced seven, high-quality videos about communication in professional health practice, and recorded their experiences of doing so. Ratings showed the majority found the process fun (85%) and instructive (64%), with 29% finding the task harder than expected. The prospect of prizes along with intrinsic motivators were reasons for producing a video. A further 285 students viewed the productions and for extra marks completed evaluation of the videos’ educational value. Videos were perceived as an educationally valuable yet entertaining way to engage unit content. Producers of videos rated the teaching and learning experience significantly more positively than students not involved in production. Qualitative analysis of open-ended responses supported relevant numerical findings. Barriers to producing videos were identified as time, resources, confidence and lack of a team. Results should encourage educators contemplating similar initiatives. The project highlights benefits of harnessing popular genres with which students identify, to encourage involvement in producing educationally justifiable content that rewards both performer and audience. The project shows how learning content and tasks created and presented in familiar and entertaining formats can catalyse students’ agentic engagement in tertiary curricula

A decision model for community nurses providing bereavement care

Community (district) nurses play a significant role in assisting and supporting bereaved informal carers (family members and friends) of recently deceased clients of palliative care. Bereavement care demands a wide range of competencies including clinical decision-making. To date, little has been known about the decision-making role of community nurses in Australia. The aim of this study was to conduct in-depth examination of an existing data set generated from semi-structured interviews of 10 community nurses providing follow-up bereavement care home visits within an area health service of a metropolitan region of Sydney, Australia. A grounded theory approach to data analysis generated a model, which highlights an interaction between ‘the relationship’, ‘the circumstances’ (surrounding the bereavement), ‘the psychosocial variant’, ‘the mix of nurses’, ‘the workload’, and ‘the support’ available for the bereaved and for community nurses, and elements of ‘the visit’ (central to bereavement care). The role of community nurses in bereavement care is complex, particularly where decision-making is discretionary and contingent on multiple variables that effect the course of the family’s grief. The decision model has the potential to inform community nurses in their support of informal carers, to promote reflective practice and professional accountability, ensuring continuing competence in bereavement care

Developing cultural competence through self-reflection in interprofessional education : findings from an Australian university

Interprofessional education and cultural competence are both necessary for health professionals working in interprofessional teams serving diverse populations. Using a pre–post-survey case series design, this study evaluates a novel learning activity designed to encourage self-reflection and cultural competence in an Australian interprofessional education context. Undergraduate health professional students in a large subject viewed three 7–15 minute videos featuring interviews with persons of a minority cultural, linguistic, or sexual group who were living with a disability or managing a health condition. Immediately afterwards, students in interprofessional groups completed a structured activity designed to promote interprofessional and cultural reflection. A localised version of a validated scale measured cultural competence before and after the learning activity. Results suggest the value of video-based learning activities based on real-life examples for improving cultural competence. Despite initially rating themselves highly, 64% of students (n = 273) improved their overall cultural competence, though only by M = 0.13, SD = 0.08, of a 5-point rating-scale interval. A nuanced approach to interpreting results is warranted; even slight increases may indicate improved cultural competence. Suggestions for improving the effectiveness of video-based cultural competence learning activities, based on qualitative findings, are provided. Overall the findings attest to the merit of group discussion in cultural competence learning activities in interprofessional education settings. However, the inclusion of group discussions within such learning activities should hinge on group dynamics

Parental stress and satisfaction in the non-tertiary special care nursery

Title. Parental stress and satisfaction in the non-tertiary special care nursery Aim. This paper is a report of a study examining the effects of using headbox oxygen and continuous oxygen positive airway pressure treatments for respiratory distress on stress and satisfaction of parents with infants in a special care nursery, and the relationship between parental stress and satisfaction. Background. Continuous positive airway pressure respiratory support is increasingly used in special care nurseries worldwide. Almost nothing is known about effects of different types of respiratory support on the stress and satisfaction of parents with babies in the special care nursery. Method. Questionnaires were used from August 2004 to June 2006 in five special care nurseries to measure parental stress using an adaptation of the Parental Stressor Scale: Neonatal Intensive Care Unit and 5-point scales to measure overall stress and satisfaction. Findings. Questionnaires were returned from 42 parents of babies receiving headbox oxygen and 51 parents of babies receiving continuous positive airway pressure (62% response rate). High stress was commonly reported. Stress did not differ statistically significantly between the two treatments. Parents with babies receiving continuous positive airway pressure were more satisfied compared to the headbox group. Stress and satisfaction were not statistically significantly correlated. Conclusion. Clinicians need not favour either method of respiratory support when attempting to minimize parental experience of environmental stress. Further research is needed to test parental stress reduction strategies in the special care nursery

Participant perceptions of a community-based lifestyle intervention : the CHIP

The Coronary Health Improvement Project (CHIP) is a community-based educational initiative designed to improve cardiovascular fitness and other health indicators associated with common, lifestyle-related health disorders in developed societies. Evaluations of the CHIP since the late 1990s, though yielding positive statistical results for change in participant physical health indicators, have not included qualitative assessments of the CHIP experience from the perspectives of CHIP participants. In this study, data were obtained using a mixed methods survey design via a questionnaire completed by 79 respondents (71% female) who had participated in Australian CHIP programs. Responses were analysed using descriptive statistics and thematic analysis. Results indicated that participants commonly undertook the CHIP to fulfil their lifestyle and health aspirations and to target specific health conditions. Improved diet, enhanced exercise and weight loss were the most commonly reported benefits. Participation in the CHIP involves a process of conviction (involving risks and motivation), connection (involving support and reinforcement), challenge (involving control and struggle) and change (involving more and less). This study offers a model of a change process generated from the perspectives of participants of the CHIP in Australia. Not all participants found CHIP lifestyle recommendations straightforward to adopt, as some encountered resistance from within themselves or from family and friends

Community palliative care nurse experiences and perceptions of follow-up bereavement support visits to carers

Community (district) nurses (CNs) are well positioned to provide follow-up home visits to bereaved families and carers of their recently deceased palliative clients. An Australian survey of CN's (n=58, response rate 29%) described their experiences of bereavement support visits, perceptions of their role in bereavement care and their professional support needs. Although positive experiences were commonly reported, with 95% of participants considering bereavement follow-up visits as consistent with their role, 53% found the visits difficult for reasons such as the nurse or client not understanding the purpose, the CN's excessive personal identification with the client's situation, the emotional intensity of visits, and lack of confidence or skills despite prior training. The nature and quality of the CN's prior relationship with the bereaved family was an important determinant of the visits' success. Results highlight the value of bereavement support visits, while identifying professional development needs. Managing emotionally intense episodes should receive priority in preparing CN's for this challenging role