The challenges of conducting a nurse-led intervention in a randomized controlled trial with vulnerable participants

This paper discusses the challenges encountered by researchers while conducting a randomized controlled trial (RCT) testing the efficacy of a healthy lifestyle educational and exercise intervention for people with serious mental illness. RCTs, even though considered the “gold standard” of research designs, are still prone to risks of potential bias and threats to their validity. Based on researcher reflexivity, the combination of reflection and action, during the conduct of the study, this paper outlines a number of challenges faced by the researchers. These included managing the need of participants to tell their story and be heard, reluctance of participants to remain in allocated groups, participant literacy, dual role of the nurse nurse-researcher, and reporting the benefits of nonstatistical results of a quantitative research project. Recommendations for conducting future behaviour intervention studies of this type include the incorporation of a reflexive component for the nurse nurse-researcher, highlighting the importance of taking a reflexive stance in both qualitative and quantitative research designs

If You Knew the End of the Story, Would you Still Want to Hear It?: The Importance of Narrative Time for Mental Health Care

The origins of this paper lie in our experiences of having heard too many stories with the same outcome or ending in the field of inquiry and practice described as “Aboriginal Mental Health.” This paper was written in an attempt to make sense of these experiences. It does so by focussing on another type of outcome or story ending in mental health care/research contexts more widely known as [Recovery]. Not to be confused with the term recovery as it is used in addiction studies, the concept of [Recovery] currently underpinning mental health care policies and reform is at once a philosophy, a practice orientation, and a guiding value and principle. This paper emerged from a range of discussions about [Recovery] as a practice orientation and a particular type of story-ending told by those who receive and provide Aboriginal mental health care in North Queensland. Poetic inquiry was used as a way to respond to the questions that arose from these discussions. In the research projects and discussions that foreground and underpin this paper, the use of poetic reasoning and writing, evolved from using poetry as a reflective tool, to a being used as a method of data collection, data construction, analysis and interpretation (even though none of these words appropriately inscribe these aspects of research within Arts informed research practices). It is also posited as an aesthetic and ethical way of (re)presenting the results of inquiring. This paper (re)presents and unpacks a particular generated poem to demonstrate the approach (as it is and was) used. As an arts-informed approach to social inquiry and to writing, the purpose of this text is to open or introduce an awkward pause in an ongoing dialogue or conversation about Aboriginal people in mental health care and to amplify the Aboriginal voices informing the development of this text

Terminology used to describe health care teams: an integrative review of the literature

Purpose: Health systems around the world are struggling to meet the needs of aging populations and increasing numbers of clients with complex health conditions. Faced with multiple health system challenges, governments are advocating for team-based approaches to health care. Key descriptors used to describe health care teams include "interprofessional," "multiprofessional," "interdisciplinary," and "multidisciplinary." Until now there has been no review of the use of terminology relating to health care teams. The purpose of this integrative review is to provide a descriptive analysis of terminology used to describe health care teams. Methods: An integrative review of the literature was conducted because it allows for the inclusion of literature related to studies using diverse methodologies. The authors searched the literature using the terms interprofessional, multiprofessional, interdisciplinary, and multidisciplinary combined with “health teams” and “health care teams.” Refining strategies included a requirement that journal articles define the term used to describe health care teams and include a list of health care team members. The literature selection process resulted in the inclusion of 17 journal articles in this review. Results: Multidisciplinary is more frequently used than other terminology to describe health care teams. The findings in this review relate to frequency of terminology usage, justifications for use of specific terminology, commonalities and patterns related to country of origin of research studies and health care areas, ways in which terminology is used, structure of team membership, and perspectives of definitions used. Conclusion: Stakeholders across the health care continuum share responsibility for developing and consistently using terminology that is both common and meaningful. Notwithstanding some congruence in terminology usage, this review highlights inconsistencies in the literature and suggests that broad debate among policy makers, clinicians, educators, researchers, and consumers is still required to reach useful consensus

Outsiders in the experts' world: a grounded theory study of consumers and the social world of health care

This article presents findings from a grounded theory study, which investigated interactions between health professionals and consumers. The authors used Corbin and Strauss's evolved version of grounded theory, which is underpinned by symbolic interactionism. The study sample included 23 consumers and nine health professionals. Data collection methods included demographic questionnaires, interviews, consumer diaries, digital storytelling, observations, and field notes. Data analysis was conducted using essential grounded theory methods. The resultant grounded theory consists of five categories: (a) Unexpected entrance, (b) Learning a new role, (c) Establishing a presence, (d) Confronting the dichotomy of "us and them," and (e) Tailored care. Findings suggest that despite consumers and health professionals' roles, consumers are outsiders in the social world of health care. Progress toward empowered consumers who are in control of their health and health care is slow and care that is truly consumer-centered is still the exception not the rule

Complexity, safety and challenges: Emergency responders’ experience of people affected by methamphetamines

Providing care to methamphetamine‐related callout events in the prehospital environment is often complex and resource‐intensive, requiring staff to manage agitation and violence‐related side effects of methamphetamines. In Australia, emergency responders are increasingly required to attend events related to methamphetamines, even though reports suggest methamphetamine use across Australia has declined. The aim of the study was to explore Australian police and paramedic experiences attending methamphetamine‐related events. A qualitative descriptive phenomenology design was employed using semi‐structured interviews with employed police (10) and paramedics (8) from Australia. Data were analyzed using thematic analysis. Participants described the complexities associated with providing prehospital care to people affected by methamphetamines. Participants described associated domestic/family violence, increased levels of violence, challenges with communication, and responder emotional and psychological distress and physical injury. Violence associated with methamphetamine use is a critical factor in prehospital care. Workplace violence and family/domestic violence are important issues that require further research to ensure families and staff are well supported and have the services they need to continue responding to people affected by methamphetamine use

Applying a simulation based teaching strategy to promote professional skills development amongst first year nursing students

This presentation will provide an overview of how a teaching team addressed the degree of 'reality shock' experienced amongst first year nursing students via the development of an innovative teaching strategy that embedded simulation into its curriculum. In 2013, Professional Experience Workshops (PEWs) were introduced to the undergraduate nursing curriculum. These workshops combined previously siloed theory based tutorial classes with clinical skills laboratories, thereby, overtly linking theory to practice with the view to minimise the 'reality shock' experienced by students whilst on clinical placement (Mills, West, Langtree, Usher, Henry, Chamberlain-Salaun & Mason, 2014). Despite this positive initiative, feedback from students following their first clinical placement revealed 'reality shock' was not necessarily lessened. Upon reflection about why this issue prevailed, it was discovered by the teaching team that a key component in creating the realism of a dynamic, pressured clinical environment was lacking in the PEWs: students were rarely required to 'think and act on their feet' (Houghton, Casey, Shaw & Murphy, 2013). Furthermore, resilience-building professional skills such as prioritisation, delegation, advocacy and teamwork were not necessarily being developed within the students

The potential of virtual healthcare technologies to reduce healthcare services’ carbon footprint

The COVID-19 pandemic demonstrated the potential to reduce our carbon footprint especially by reducing travel. We aim to describe healthcare and health education services’ contribution to the global climate emergency and identify the need for increased use of virtual health service delivery and undergraduate/postgraduate education to help reduce the impact of health service and health education delivery on the environment. Health care services, as one of the largest contributors to carbon emissions, must take steps to rapidly reduce their carbon footprint. Health services have unfortunately paid little attention to this issue until recently. Virtual healthcare and education have a valuable role in transition to a net carbon-zero outcome. Given the increasing use of and satisfaction with virtual health services such as telehealth, and the increase in virtual education opportunities, it is important that a concerted effort is undertaken to increase their use across health services and education in the future

Potential challenges of using narrative inquiry with at-risk young people

Aim: To present an overview of several challenges that arose when conducting narrative research with at-risk young people. Background: Being identified as 'at-risk' places an individual in danger of future negative outcomes. Conducting qualitative research such as narrative inquiry with 'at-risk' individuals has the potential for challenges to arise for participants and/or researchers. Discussion: Five main challenges identified and discussed were trauma disclosure, pre-existing relationships, insider/outsider perspective, power relationships and researcher and participant emotional safety. Conclusions: It is imperative that potential challenges be identified prior to the commencement of studies and plans made to address the challenges. Implication for practice: Difficulties can arise with any type of research involving vulnerable participants; hence as researchers we must always plan to ensure these challenges are managed appropriately

Obstructive sleep apnoea (OSA) in regional and remote Indigenous Australians

Background: Despite Aboriginal and Torres Strait Islander people having increased risk factors for OSA (diabetes, obesity) and high levels of comorbid associated conditions (chronic non-communicable diseases), there are currently no published data relating to the nature of sleep related breathing disorders affecting Indigenous adults. Aims/Objectives: The aim of this study was to compare the use of sleep diagnostic tests, the risks, and cofactors, and outcomes of the care of Indigenous and non-indigenous Australian adults in regional and remote Australia in whom sleep related breathing disorders have been diagnosed. Methods: A retrospective cohort study of 200 sequential subjects: 100 Aboriginal and/or Torres Strait Islander people and 100 non-Indigenous Australians in northern Queensland and Central Australia. Results: Results showed overall Indigenous Australians were 1.8 times more likely to have a positive diagnostic sleep study performed compared with non-indigenous patients, 1.6 times less likely in central Australia and 3.4 times more likely in far north Queensland. All regional and remote residents accessed diagnostic sleep studies at a rate less than Australia overall (31/100,000/y compared with 575/100,000/y). Discussion: Appropriate and more accessible diagnostic and treatment sleep services are required in regional and remote Australia. Further research is required to validate appropriate screening tools and pathways of care especially for Aboriginal and Torres Strait Islander peoples

COVID-19: Resilience and the Nursing Workforce

As we write this editorial, the world is battling the deadly COVID-19 pandemic. Nurses across the world have been in the front line for many weeks now. Over the course of the pandemic we have seen nurses from all corners of the globe continue to provide the very best of care possible, while in many settings, struggling with issues such as a lack of staff and adequate personal protective equipment (PPE), and dealing with previously unseen levels of critical illness and death