Environmental, structural and process barriers in breast cancer screening for women with physical disability : a qualitative study

Breast cancer is the most common cancer in women internationally and is responsible for the deaths of thousands of women annually. Early detection of breast cancer is integral to ensure early intervention which increases survival rates and health outcomes for women. Despite the availability of breast cancer screening (BCS), previous research has identified that women with physical disability are less likely to access BCS and when they do, they encounter substantial barriers to these services. This paper presents the environmental, systemic and process barriers that women with physical disability face in undertaking BCS in New South Wales, Australia. A qualitative design was used to collect data via in-depth interviews which were audio-recorded, transcribed verbatim and thematically analysed. Twelve women with physical disability participated in interviews to share their experiences of BCS. Findings revealed that participants had both negative and positive experiences during BCS and are presented in the following four themes: Needing better access, Feeling like the machines aren't made for people like me; Experiencing health workers as being clinical and detached and; Facilitating and improving the experience of breast screening. Participants encountered substantial difficulties with the inflexibility of the diagnostic equipment. Further some conveyed that negative experiences of the procedure and interactions with staff while accessing mammography would deter them from returning for BCS. Informed and individualised care is required to enhance the experience of women with physical disability and thus increase uptake rates of this service

Barriers to breast cancer screening in Australia : experiences of women with physical disabilities

Aims and objectives: To explore the experiences of breast cancer screening for women with physical disabilities. Background: Despite women with disabilities having the same or greater risk of having breast cancer than women without disabilities, they are less likely to uptake breast cancer screening services. Design: Qualitative descriptive study. Methods: Twelve women with physical disabilities were recruited for the purpose of this study. Data were collected via semi-structured face to face or telephone interviews. Interviews were transcribed and data were analysed thematically. Results: Overwhelmingly, participants conveyed that their breast screening experiences were negative. The following four themes describe the experiences of breast cancer screening for women with physical disabilities: feeling I'm not in control; being ignored and not listened to; being helpless, alone and afraid and experiencing pain, torture and humiliation. Conclusions: Women with physical disabilities experience substantial barriers to breast cancer screening. This research highlights that the attitudes and poor communication skills of health professionals served as a deterrent to future screening for participants. Relevance to clinical practice: By exploring experiences of women with physical disabilities of breast cancer screening, nurses and other health-care professionals can use this to develop and implement optimal approaches, such as collaborative models of care which empower women with disabilities

Understanding the ageing process

The term ‘ageing’ conjures a range of perceptions and misconceptions in the minds of people of all ages. This chapter provides an overview of existing knowledge about ageing and the ageing process. Contemporary issues impacting on the older person in Australia are introduced and sequentially explored to allow insight into the lives of everyday ageing Australians, the challenges they encounter as they age and how nurses may positively influence their lives. The chapter begins with a brief account of our understanding of ageing. An overview of the demographic characteristics of the ageing population in Australia is then profiled, enabling a broader picture to emerge of the ageing community we serve. The impact of ageing at an individual, community and national level is then presented through the examination of contemporary attitudes towards ageing. Ageing theories are then introduced, presenting background information about the biological and psychosocial perspectives as to why and how we age. Moving from the 'big picture' of ageing, we present the physical changes and processes that may occur within the various body systems as we age. Myriad psychosocial changes may also be encountered with ageing and these are described and discussed. Everyone will experience physical and psychosocial changes as they grow older. The impact of these changes on each individual and their engagement with the activities of daily life is unique

Older persons' experiences of their own decision making about their care : a systematic review of qualitative evidence protocol

Review question/objective: The overall objective of this systematic review is to identify and synthesize the best available qualitative evidence of how older persons go about making decisions regarding their own health care. Background: Decision making refers to a person considering a range of options pertaining to their health care and selecting from these the course of action or belief they wish to adopt. Health care decision making for older adults is influenced by a range of factors such as their right to making choices, their capacity for decision making, cultural perspectives and beliefs, financial circumstance, and access to health information and services. Older people have the right to make choices regarding their health care. Their choices relate to whether or not they will seek, accept, refuse or discontinue health care. The right to make these choices is enshrined in law. This arises from the ethical principles of autonomy and self-determination. A corollary to this principle is the requirement for health professionals to obtain informed consent for patient care. This assumes that adults have the capacity to give informed consent, that is, they understand the benefits and risks associated with the proposed care and alternate options available to them. Health care decisions requiring informed consent may include treatments, advance care planning and issues regarding end of life care. A diminished decision making capacity refers to a person’s impaired ability to make an informed choice or consent about their health care. Their capacity may be diminished due to: impaired cognition, communication, or understanding of the decision they may be making and the implications of that decision. Adults can lose their decision making capacity necessitating others to make decisions on their behalf. This is known as surrogate decision making. Commonly this may occur as people age or as a consequence of chronic illness or co-morbidities. As people age and their circumstances change, they are required to make increasingly complex decisions about their health care. Older adults experience higher rates of co-morbidities further influencing the likelihood of needing to make decisions regarding their health care. Given ageing is a risk factor for dementia, the prevalence of dementia will increase and the capacity for decision making of these adults will diminish. Decision making may also be influenced by the older persons’ personal attitudes and characteristics about assuming responsibility for their health and health care decisions, as well as their social, economic and health circumstances. Health care decision making in older adults is a global issue scantily addressed in literature. There is a paucity of research on older persons’ experiences of decision making about their care. Following a review of databases listed in the search strategy, no systematic reviews on this topic were identified. Therefore it is important to conduct a systematic review of older persons’ experiences of their decision making about their own health care. The findings from this systematic review may be used to inform health care policy makers, health care providers and health care practice, so as to best understand and support older people in their decision making about their health care

Graduate nurses' experiences of reporting clinical incidents : what we don't know

In NSW, healthcare providers are required to manage the notification of incidents by being open about failures and while there is an upward trend of reporting by nurses, the Clinical Excellence Commission have indicated incident reports are fragmented and incomplete. [...]known failure mechanisms may go undetected and the gravity of not knowing how and why incidents occur has led to harmful outcomes for patients (CEC 2019). Increased awareness related to how undergraduate students can be taught to define, identify and understand the processes involved in navigating reporting systems in order to maintain quality and safety for consumers within healthcare organisations

The experience of sessional teachers in nursing : a qualitative study

Background: Worldwide, there is a growing reliance on sessional teachers in universities. This trend is reflected in an undergraduate nursing program in a large Australian metropolitan university where a significant proportion of contact hours is staffed by sessional teachers, yet little is known about what type of support is needed for sessional teachers to optimise their capacity to contribute to the academic program. Objectives: To describe the experiences of sessional teachers in a Bachelor of Nursing program in an Australian university. Design: This is an exploratory qualitative study; fifteen sessional teachers were interviewed using semi-structured questions to explore their experiences of teaching. Setting: This study was conducted in a large metropolitan school of nursing located on three sites. Participants: A purposive sample of 15 sessional teachers was interviewed for this study. Methods: Semi-structured interviews were conducted face to face. Thematic analysis was used to identify major themes in the interview data and collaborative analysis was undertaken to ensure rigour. Results: Findings revealed that sessional teachers enjoyed teaching, were committed to their role and viewed their clinical currency as a valuable asset for teaching. However, participants also spoke about wanting a sense of belonging to the School, with most feeling they were "outsiders". Areas identified for improvement included system and process issues, micro teaching and assessment skills, classroom management and timely access to resources. Conclusion: There is a need to improve sessional teachers' sense of belonging and to provide an inclusive structure and culture to optimise their capacity to contribute to the academic program

Barriers to breast and cervical cancer screening for women with physical disability : a review

This review critically examined the barriers to breast and cervical cancer screening services for women with physical disability and discussed ways forward to change practice. When compared to the rest of the community, women with disability were less likely to use preventive health screening services for multiple reasons. Moreover, women with disability live longer than in previous years, and as age is linked to an increased risk of developing cancer, it is imperative that the barriers to screening for these women become a focus of discussion. We designed an integrative literature review to investigate this. Multiple databases were systematically searched for literature published between 2001 and 2013. Search terms used were a combination (AND/OR) of key terms. After excluding duplicates and articles not meeting the eligibility criteria, twenty-five articles were systematically and critically reviewed. Sociodemographic factors were associated with less access to preventive health screening for women with disability. The literature reviewed indicated that this was complicated further by three prominent barriers: health insurance, health care workers, and physical barriers. Sociodemographic, health insurance, health workers, and physical barriers impair access for disabled women to breast and cervical cancer screening, which are vital measures in the timely detection of breast and cervical cancers and preventable morbidity and mortality. Measures are needed to address these limiting factors for women with disability so that they can be active participants in health care, rather than being marginalized because of their disability

Measuring final-year nursing students' satisfaction with the viva assessment

This paper reports a study conducted to develop and test the psychometric properties of a brief 5-item Satisfaction with the Oral Viva Assessment Scale. The viva has been increasingly used to gauge students' learning, beyond the traditional written assessments. This assessment approach may pose additional challenges to various student groups. Using a prospective, correlational design, this study surveyed 275 final year nursing students about their satisfaction with the viva as an assessment approach. The survey was administered to those who attended a revision session in an undergraduate high dependency unit. Descriptive and inferential statistical analyses, as well as exploratory and confirmatory factor analyses of the scale were computed. Exploratory factor analysis yielded a one-component structure that explained 51% of the total variance, which was supported by confirmatory factor analysis (standardised factor loadings: 0.54-0.73). Internal consistency as computed by a Cronbach's alpha was 0.8. The results also revealed that those who obtained higher grades in their viva performance (OR: 2.78, 95% CI: 1.58-4.90) and English-speaking only students (OR: 1.87, 95% CI: 1.07-3.27) were more satisfied with the viva assessment. These findings support the validity and reliability of this scale, and can be used to assess students' satisfaction with the viva