Legislative hegemony and nurse practitioner practice in rural and remote Australia

Nurse practitioners were introduced into Australia in 1990 to improve access to health care in isolated communities where medical doctors are scarce. The slow uptake of nurse practitioners in these areas has largely been the result of legislation not affording them access to provider numbers through the Medicare Australia Act 1973. This has denied nurse practitioners the opportunity to become primary care providers because they cannot prescribe medications and order diagnostic tests at rebated costs. Recently this Act changed, making provision for nurse practitioners. Ironically the enactment of the new legislation still prevents nurse practitioners from practicing effectively. This paper describes the discursive practices in legislation, driven by traditional power brokers, which perpetuate the traditional role of nurses as care givers and fails to support the evolution of nurse practitioners as care providers. These continued practices effectively prevent nurse practitioners from working to their potential, despite government reassurance under recent health care reform in Australia

The changing world of nurses – the global village

Editorial in nursing co-ordination of care

Exploring the potential of nurses in the delivery of care for people living with chronic conditions

People living with one or more chronic conditions is becoming an everyday occurrence. According to a recent report by the World Health Organization (WHO, 2013), 65% of all global deaths are attributable to chronic illness, with nearly 40% of those deaths being in people between the ages of 30 and 70 years old

A protocol for exploring patients' and support peoples' experiences after prolonged critical illness

Background: Improved survival of critically ill people has increased the number of patients who experience an extended stay in intensive care units (ICU). Evidence suggests the complexities, vulnerabilities, and traumas created by critical illness are substantial for both patients and their support people with a number experiencing devastating impairments across multiple domains of health and function including physical, mental, cognitive, and social health. However, research on survivors predominantly focuses on those who have experienced a relatively short length of stay; only a limited number of studies seek to explore the experiences of survivors and their support people who have had a prolonged stay in intensive care. Aims: To describe the experiences of survivors of prolonged critical illness (invasively mechanically ventilated in ICU for ≥eight days) and their support people during the first 12 months following hospital discharge in New Zealand. Study design: This research will be a multi-centre study recruiting from three intensive care units in New Zealand. A narrative inquiry methodology will be used to interview 6–8 former long stay patients and 6–8 support people of a former long stay patient. Each participant will be interviewed at 3-, 6-, 9-, and 12-months following hospital discharge. Data will be collected via narrative inquiry interviews. Data analysis will combine two theoretical frameworks: the Clandinin and Connelly narrative inquiry three-dimensional space and the Fairclough situation, discourse and context framework. Results: The phenomenon of investigation will be experiences after prolonged critical illness explored longitudinally across the first-year post-hospital discharge. Relevance to clinical practice: This protocol provides a methodological framework for exploring the lived experiences of survivors of prolonged critical illness and their support people. Data analysis will support understanding of the human journey of ICU survivorship and add to the body of knowledge on how to support post-ICU recovery in this population. The barriers and enablers of survivorship at the micro, meso, and macro levels of the health service will also be illuminated

Lost voices: Using a case study to illustrate narrative inquiry: Research brief

Introduction: In this study, we tested the feasibility of using a narrative inquiry - three-dimensional space inquiry to elicit the experiences of an adult family member who shared her journey of care and advocacy for her husband situated in a dementia care unit. Background: The voices of family members are rarely heard in relation to their experiences about being included in or making decisions about their loved one's care. Shared decision-making has been an important patient- centred approach to nursing care since the 1990s; however, it is often not a reality in aged care facilities. Method: An interview was conducted with one adult family member using the three-dimension space that is inspired by narrative theorists to analyse the narrative. Results: Three themes were identified in the responses: communication between staff and family, staffing in the dementia care unit, and loss of voice and shared decision making. Conclusion: Results of this study indicate that narrative inquiry supports the telling of personal experiences around a problem and then using that information to raise awareness of those issues that are not always heard but which are essential for change in health care policy and practice

Nurse practitioners in aged care settings: A study of general practitioners’ and registered nurses’ views

Background: This paper draws on a 2015 study in New Zealand that examined perceptions of registered nurses (RNs) and general practitioners (GPs) regarding the role of Nurse Practitioners (NPs) in long-term aged care facilities (LTACF). Aim: To explore the attitudes of RNs and GPs regarding the role of NPs in LTACFs. Design: A descriptive, mixed methods design with a survey and invitation to interview was used. RNs and GPs who provided hospital-level care were invited to participate. Findings: The findings showed RNs and GPs are open to considering the NP role in aged care. However, there remains a lack of understanding of what NPs do. Conclusions: This study suggests a shift in attitude towards accepting the NP role by RNs and GP working in LTACFs. © 2018 Informa UK Limited, trading as Taylor & Francis Group

The discursive practices of nurse practitioner legislation in Australia

Aim. The aim of this paper was to examine the nurse practitioner legislative framework in Australia from a critical social theory perspective. Background. National regulation for nurses and midwives has superseded all previous state legislation with effect from July 2010. The aim of this change was to streamline regulation processes across all health professionals requiring regulation, in order to eliminate diverse state-based regulatory policies that were identified as hindering transferability of the workforce across Australia. This paper explores the changes with reference to nurse practitioners. Since their introduction to Australia different legislative practices between states have presented difficult endorsement procedures which have affected employment. Data sources. Information for the paper is drawn from a doctoral study which examined the politics of advancing nursing in Australia, with particular reference to the discourses of nurse practitioners. This is augmented by more recent legislative documents and policies, as well as media reports, to examine the process of change in legislation and the unfolding discourses on employment and practice. Implications to nursing. Nurse practitioner endorsement may be more complicated, defeating the original premise of transferability of a skilled workforce across state jurisdictions. Conclusion. This paper exposes the influence that powerful discourses can have on a major change to professional practice. © 2011 Blackwell Publishing Ltd

Providing woman-centred care in complex pregnancy situations

Objective: Midwifery philosophy and practice is grounded in providing woman-centred care. The available evidence was reviewed to better understand how to provide Woman-centred midwifery care in complex pregnancy situations. Complexity in this context is defined as psychosocial or biomedical risk factors that place the mother and/or her baby at increased risk for adverse outcomes. Design: A comprehensive integrative review was undertaken to identify peer reviewed research in English over the last 5 years. The quality of the studies was assessed using the Critical Appraisal Skills Programme Tool. Setting/Participants: Published studies which discussed enablers and barriers to woman-centred care for pregnant women with complex needs. 13 papers met the inclusion criteria for this review. Findings: This review identifies that Organisational and Professional power differentials create barriers to woman-centred care and provoke professional boundary tensions. For a woman with a complex pregnancy, this places her at risk for ‘falling through the gaps’ between maternity services, models of care and health providers. Key conclusions: Women, birth and midwifery care are still largely constrained within a biomedical model of maternity care. Whilst barriers to woman-centred care have been identified, for women with complexity in pregnancy there appear to be few solutions when care requires multi-specialist input and crossing the boundaries and silos of healthcare

Obstacles that prevent nurse practitioners in New Zealand fulfilling their roles

The nurse practitioner (NP) position has not been embraced as eagerly as other new health practitioner roles in New Zealand (NZ), and there is little research about the role in the country. A study was carried out to find out more about the contribution NPs are making to primary health care, regardless of healthcare setting. Using a mixed-methods approach, the study mapped the contributions of NPs against indicators from a results-based model for primary health care developed by Watson et al (2009). The findings demonstrate that NPs are essential to maintaining the population’s health in a cost-constrained healthcare environment and highlight the need for national policymakers and local decision makers to give the role a higher profile and to provide more resources and support

Nurse navigators and person-centred care; delivered but not valued?

© 2021 John Wiley & Sons Ltd Positioning the individual at the centre of care (person-centred care [PCC]) is essential to improving outcomes for people living with multiple chronic conditions. However, research also suggests that this is structurally challenging because health systems continue to adopt long-standing, episodic care encounters. One strategy to provide a more cohesive, individualised approach to care is the implementation of the nurse navigator role. Current research shows that although PCC is a focus of navigation, such care may be hindered by the rigid, systematised health services providing siloed specialist care. In this paper, we utilised a case study method to investigate the experiences of a nurse navigator and patient. The nurse navigator and the patient participated in individual interviews, the transcripts of which were analysed using critical discourse analysis. Findings from a larger research project suggest that traditional measures (hospital avoidance, emergency department usage) which work as the service objectives of the nurse navigator service have the potential to stifle the delivery of PCC. The analysis from this case study supports the broader findings and further highlights the need for improved alignment between service objectives and the health and well-being of the individuals utilising the services