Providing education and support for rural palliative care nurses in Western Australia: An intervention study

Rural palliative care nurses (RPCNs) in Western Australia (WA) are a small population, who have embraced the specialist palliative care role since the first palliative care service in rural WA began in 1990. However, there are some challenges involved with being a specialist nurse in a generalist health care setting. fu particular, there is a suggestion in the literature that RPCNs may be professionally isolated, may be prone to burnout, and may therefore experience decreased job satisfaction and may consider leaving the palliative care field

Rural palliative care nursing: A modified grounded theory study

This paper presents the findings of a study of rural palliative care nurses in Western Australia. The numbers of rural centres in Western Australia offering palliative care services are increasing; however at present there is little empirical data available about the roles of the nurses involved. This study was undertaken to begin to correct this deficit. The study examines basic social processes associated with the role of rural palliative care nurses and identities issues that affect the nurses’ professional practice. A modified grounded theory approach was used to form a conceptual framework that describes rural palliative care nursing. Theoretical sampling techniques were used to identify the six palliative care nurses working in rural Western Australia who participated in this study. Data was generated using in depth interview and participant observation techniques. Constant comparative analysis of the data was employed to allow concepts to emerge from the data. The central theme that developed from the data Living Palliative Care describes the all-consuming nature of the rural palliative care nurses’ role. Three related categories, Wearing Many Huts, Being the Expert and Surviving in Palliative Care are also discussed. This research has explored issues that rural palliative care nurses feel are relevant to their professional practice and it describes the basic social processes inherent in the rural palliative care nurse’s role. Recommendations for nursing research, education, administration and clinical practice are presented

Nurses' perceptions of caring for dying patients in an open critical care unit: a descriptive exploratory study

Background: Nurses in critical care areas play a vital part in providing end-of-life care and recognise that an ideal death should be peaceful, dignified, and comfortable. However, environmental restrictions in critical care units can make a peaceful death unachievable and can havea profoundly negative impact on end-of-life care.Purpose: To describe the provision of end-of-life care in an open high-dependency unit.Method: A descriptive exploratory approach was used involving semi-structured interviews with a purposive sample of five registered nurses working in the high-dependency area at a major teaching hospital. The interviews were audio taped and transcribed. Thematic analysis was used to code the data and identify themes.Results: Three themes emerged from the data. The core theme was ‘the nurse as protector’. The two other themes were ‘conflict of care’ and ‘peace and quiet’. Within these themes, characteristics of an ideal death were identified and barriers to providing an ideal death were acknowledged.Conclusion: This study illustrates nurses’ perceptions of caring for dying patients in an open critical care unit. This environment influences the development of the nursing role as protector and presents barriers to achieving an ideal death

Understanding Nursing Assistants' Experiences of Caring for Older People in Pain: The Australian Experience

This study examined the experiences of nursing assistants (NAs), who have worked with older people in residential aged care facilities (RACFs) who are in pain, to ascertain the role that NAs play in the pain management process. A descriptive, exploratory qualitative approach was used to examine NAs' experiences. Six NAs employed in three RACFs in regional Western Australia participated in the study. In-depth interviews focusing on the NAs experiences of caring for older people in pain were conducted. This study provided an understanding of the care needs of older residents in pain and illuminated the role of NAs in the pain management process. The central role that NAs play in RACFs was highlighted, as were the responsibilities associated with pain management. Nursing assistants may be responsible for initiating and implementing pain management treatments for older residents. This is outside the scope of practice for NAs; therefore, it is imperative that the preparation of NAs give them adequate knowledge to perform this role. As well, it may be timely to consider regulation of this large group of workers who are performing clinical tasks in RACFs

Identifying type 2 diabetes risk classification systems and recommendations for review of podiatric care in an Australian Aboriginal health clinic

Background - There are several risk classification systems developed to facilitate diabetic foot assessments and prioritise diabetes patients for foot prevention services according to risk factors. Utilisation of both The University of Texas Diabetic Foot Risk Classification System (UTDFRCS) and The National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes), allows guidance for the podiatrist in terms of review timeframes for future assessments and treatment. The aim of this clinical audit was to classify Aboriginal type 2 diabetes subjects’ risk status according to UTDFRCS and identify if evidence based standards are being met for podiatry services at the Albury-Wodonga Aboriginal Health Service in New South Wales, Australia. Methods - A retrospective clinical audit over a twenty six month period was undertaken at the Albury-Wodonga Aboriginal Health Service, New South Wales. This is a primary health care facility that started podiatry services in August 2011. The primary variables of interest were the UTDFRCS for each subject and whether those participants met or did not meet the National Evidence-Based Guideline for review appointment timeframes. Other variables of interest include age, gender, duration of diabetes, occasions of visits and cancelled and failure to attend appointments to the podiatry service over the data collection period. Results - There was excellent overall adherence (94 %) of this sample population (n = 729) to the National Evidence-Based Guideline for podiatric review timeframes according to their risk status. Males were reported to be less likely to comply with the review timeframes compared to women. There was no association between risk status and age (OR = 1.04, p = 0.11), duration of diabetes (OR = 1.03, p = 0.71) or gender (OR = 0.77, p = 0.67). Conclusions - Regular foot examinations aid in stratifying patients according to risk status, guiding podiatry interventions to reduce the likelihood of ulceration and amputation. This primary health care setting has achieved podiatric evidence based standards for Aboriginal people with type 2 diabetes, demonstrated by acceptable timeframes for review appointments

Promoting the consumer voice in palliative care: exploring the possibility of using consumer impact statements

BACKGROUND: It can be difficult to engage consumers in health decision making. This is particularly so in the area of palliative care, where consumers are very unwell and are unlikely to become involved in long-term programmes that promote consumer input. This paper explores the possibility of using ‘Consumer Impact Statements’ to facilitate the inclusion of the viewpoint of people at the end of life in the process of policy and decision making, particularly in the area of subsidy of pharmaceuticals used in palliative care. SEARCH STRATEGY: A broad search was conducted to find information about the use of impact statements in any health field. The health literature and grey literature were searched to explore the use of Consumer Impact Statements to date. RESULTS: No papers were found describing the use of Consumer Impact Statements in the palliative care setting. Health impact assessment is used in the areas of environmental health and community health. Impact statements are less commonly used in other areas of health, especially policy development, and no formal description of a Consumer Impact Statement was found. DISCUSSION: There is considerable scope for developing the use of Consumer Impact Statements to promote the consumer viewpoint in health decision making, because it will allow people who are otherwise unlikely to contribute to the public debate to have their views heard by decision makers. CONCLUSION: The use of Consumer Impact Statements is particularly suited to palliative care, given that consumers are often otherwise unable to contribute to the public debate

Staying just one step ahead: providing care for patients with motor neurone disease

Introduction: There is limited information about the experiences and educational needs of health professionals who may be required to provide care for people with Motor Neurone Disease(MND) especially in the later stages of the disease. The aim of this study was to determine the experiences of, and need for, education of these health professionals. Methods: Interviews and focus groups were conducted with 31 health professionals with some experience in providing palliative care for people with MND. Thematic content analysis was used to identify common themes. Results: A key theme, Just One Step Ahead, emerged, that describes the central capability health professionals identified as necessary to help individuals plan and prepare for disease and lifestyle changes just before they arise. Two subthemes also emerged: Expertise in MND and Bespoke Communication. Expertise in MND described the required understanding of the disease and the particular individual’s version of the disease to allow the health professional to plan, advise, support and anticipate the needs of the person living with MND. Bespoke Communication was the facility to tailor care messages sensitively and effectively to the range of people involved in care (patients, family, healthcare team members).Conclusions: Care of people with MND requires up-to-date expertise about the disease and skilled communication abilities to manage complexity and change. Timely and focused education and specialist MND support for care providers are essential to tailored and responsive care and a widely available education programme has been developed to address these needs

Australian health care providers' views on opt-out HIV testing

Background: Opt-out HIV testing is a novel concept in Australia. In the opt-out approach, health care providers (HCPs) routinely test patients for HIV unless they explicitly decline or defer. Opt-out HIV testing is only performed with the patients' consent, but pre-test counselling is abbreviated. Australian national testing guidelines do not currently recommend opt-out HIV testing for the general population. Non-traditional approaches to HIV testing (such as opt-out) could identify HIV infections and facilitate earlier treatment, which is particularly important now that HIV is a chronic, manageable disease. Our aim was to explore HCPs' attitudes toward opt-out HIV testing in an Australian context, to further understanding of its acceptability and feasibility. Methods: In this qualitative study, we used purposeful sampling to recruit HCPs who were likely to have experience with HIV testing in Western Australia. We interviewed them using a semi-structured guide and used content analysis as per Graneheim to code the data. Codes were then merged into subcategories and finally themes that unified the underlying concepts. We refined these themes through discussion among the research team. Results: Twenty four HCPs participated. Eleven participants had a questioning attitude toward opt-out HIV testing, while eleven favoured the approach. The remaining two participants had more nuanced perspectives that incorporated some characteristics of the questioning and favouring attitudes. Participants' views about opt-out HIV testing largely fell into two contrasting themes: normalisation and routinisation versus exceptionalism; and a need for proof versus openness to new approaches. Conclusion: Most HCPs in this study had dichotomous attitudes toward opt-out HIV testing, reflecting contrasting analytical styles. While some HCPs viewed it favourably, with the perceived benefits outweighing the perceived costs, others preferred to have evidence of efficacy and cost-effectiveness