The AJRH: 20 years on

They know us and our history, so we are lucky really as that means our hospital and health practitioners can give us really good treatment. Their farm is going downhill fast as their eldest child has been in hospital now for six months. The whole family is in Perth as the child is dying. A couple of weeks ago the father went back to the farm but that was just so difficult. . . . The cost of living in the city and the cost of hospital parking along with their absence from their family business has been disastrous for this family. A nurse was recruited to this rural mining town. When she got there she found she could earn $150 000 a year driving a truck, so she resigned from the hospital and went and worked in the mine

Nurses rate readiness for discharge higher than patients do, and nurses scores predict readmission or ED utilisation after discharge better than patient self-assessment

This paper reports on a substudy within a larger study. Specifically this paper addresses the perception of the registered nurse and patient with regard to: (A) their readiness to be discharged and (B) the postdischarged utilisation of emergency departments (EDs) or their readmission in four linked Magnet designated hospitals in the USA

Quality of life in women during and after treatment for breast cancer: A systematic review of qualitative evidence

EXECUTIVE SUMMARY: Background Breast cancer is the most common cancer in women. With increasing numbers of women surviving breast cancer, there is a need to move beyond the traditional ways of evaluating clinical outcomes and include patient-based outcomes such as the quality of life.Objectives To integrate and summarise the best evidence related to the quality of life of women diagnosed with breast cancer during and up to ten years after treatment for breast cancer. INCLUSION CRITERIA: Types of participants: Adult women (over the age of 18 years) diagnosed with breast cancer who are or have received treatment for breast cancer in the last ten years (i.e. surgery, chemotherapy, radiation therapy and/or hormonal therapy). PHENOMENA OF INTEREST: The quality of life of women diagnosed with breast cancer during and up to ten years after treatment. CONTEXT: Women with breast cancer from both developed and developing countries.Types of studies: Studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory and ethnography, action research and feminist research.Search strategy The search sought to find both published and unpublished studies between 1990 and 2010, limited to the English language. Eleven electronic databases were searched including CINAHL, PubMed, Scopus and PsycArticles.Methodological quality Methodological quality was assessed independently by two reviewers using a standardised critical appraisal instrument from the Joanna Briggs Institute.Data extraction Qualitative data were extracted from the included studies using a standardised data extraction tool from the Joanna Briggs Institute. RESULTS: A total of 42 findings from seven qualitative studies were extracted and rated as unequivocal or credible. Eleven categories were produced. Three synthesised findings were generated based on the meta-aggregation of the categories: (1) "effective care for patients will be achieved if clinicians are aware of the impact of breast cancer and its treatment on the physical and psychosocial domains of women's quality of life"; (2) "for effective patient-centred care, clinicians must be cognisant of the ways breast cancer and its treatment modalities affect social relationships"; (3) "clinicians should be aware that women use religion and spirituality to cope with breast cancer treatment and improve their quality of life". CONCLUSIONS: This review concludes that the breast cancer diagnosis and its treatment can have a significant effect on several domains of women's quality of life. Healthcare providers caring for patients need to be well informed about each individual woman's physical and psychosocial concerns and be cognisant that any attempt to offer support must be targeted to meet the specific challenges faced by each individual woman. IMPLICATIONS FOR PRACTICE: Support and guidance could be provided by healthcare providers through the use of counselling services, psycho-education and organisation of support groups. Elements of counselling and psycho-education should include, when appropriate, joint sessions with the woman's spouse/partner. As spirituality emerged as a coping mechanism, it is important that women be able to nurture their spiritual relationship in an environment which is supportive. IMPLICATIONS FOR RESEARCH: The lack of studies within the Asian context indicates that further research is warranted to examine the impact of breast cancer and its treatment on the quality of life of women from diverse multi-ethnic populations. Further research into self-help strategies to improve the psychosocial well-being of women with breast cancer is warranted.It is noted that when faced with adversity, women seek comfort in religion and spirituality and a study into the relationship between spirituality and quality of life, as well as the effect of culture and religion on the quality of life, is warranted

Action research: Changing nursing practice

This article describes action research as a methodology and gives two examples of its application to nursing and health services research. Action research is cyclical in nature and involves the development, evaluation and redefining of an action plan using four basic steps: planning, action, observation and reflection. These cycles of action continue until the research group is satisfied that its objectives have been met. Data generation and analysis are iterative processes that occur continuously throughout the project, which is usually time-limited. Factors that should be taken into account to ensure success include: engaging the community, consideration of 'insider' versus 'outsider' perspectives, competing agendas, expectations not being met and the integrity of the research methodology

Ethical challenges in the conduct of qualitative research

The three themed papers in this edition identify particular issues in the ethical conduct of qualitative research. Some concerns are common to all three papers and other concerns raise queries related to the conduct of the authors’ own research. This commentary will focus on three of these issues: gaining access and recruitment, informed consent and the relationship between the researcher and participant

Buddhism and medical futility

Religious faith and medicine combine harmoniously in Buddhist views, each in its own way helping Buddhists enjoy a more fruitful existence. Health care providers need to understand the spiritual needs of patients in order to provide better care, especially for the terminally ill. Using a recently reported case to guide the reader, this paper examines the issue of medical futility from a Buddhist perspective. Important concepts discussed include compassion, suffering, and the significance of the mind. Compassion from a health professional is essential, and if medical treatment can decrease suffering without altering the clarity of the mind, then a treatment should not be considered futile. Suffering from illness and death, moreover, is considered by Buddhists a normal part of life and is everchanging. Sickness, old age, birth, and death are integral parts of human life. Suffering is experienced due to the lack of a harmonious state of body, speech, and mind. Buddhists do not believe that the mind is located in the brain, and, for Buddhists, there are ways suffering can be overcome through the control of one’s mind

Queensland nursing staffs' perceptions of the preparation for practice of registered and enrolled nurses

Introduction: In Australia, unlike other countries, programmes which lead to registration as a registered or enrolled nurse (called “entry to practice” programmes) are carried out solely in the tertiary sector. In Australian nursing and the wider community, there continues to be a debate over the place of preparation and the “work readiness” of graduates. Background: Despite several opinion papers on the preparation of registered nurses, there is a dearth of published research on the perceptions of the clinical nursing workforce on the suitability of the current preparation for practice models. Methods: Data were collected from approximately 3000 nurses in Queensland, Australia in 2007 and 2010. The aim of these studies was to ascertain issues around nursing work. This paper reports on qualitative data that were collected as part of that larger survey. Specifically this paper provides the thematic analysis of one open-ended question: “what are the five key issues and strategies that you see could improve nursing and nursing work?” as it was apparent when we undertook thematic analysis of this question that there was a major theme around the preparation of nurses for the nursing workforce. We therefore carried out a more detailed thematic analysis around this major theme. Results: The major sub-themes that we identified from comments on the preparation of the nursing workforce were: perceptions of lack of clinical exposure and the need to increase the amount of clinical hours; the design of the curriculum, the place of preparation (solely within industry or a great focus on industry), financial consideration (students to be paid for theirwork); and in 2007 only, the need for students to have better time management. Discussion: The findings suggest that a majority of respondents believed there should be changes to the entry to practice preparation for nurses. The major focus of these comments was the perception of insufficient clinical experience and inappropriate curriculum content. Thus, graduates are not “work ready”. Conclusion: The attitude of clinical nurses, who work closely with student nurses, influences the workplace experience of student nurses. It is apparent from the statements of respondents in this study, that there is a need for stronger industry/academic partnerships, particularly around the design and implementation of the entry-to-practice curriculum

Nurses’ perceptions of the barriers in effective communication with inpatient cancer adults in Singapore

Aim. This study investigated the factors affecting effective communication between Singaporean registered nurses and inpatient oncology adults. Background. In oncology nursing, where conversations entail emotionally loaded topics and patients’ receptivity is greatly affected by their life-threatening disease and its trajectory, effective communication is crucial. Design. This is a qualitative study situated within the interpretivism paradigm. Method. Ten registered nurses from the oncology wards of a major teaching hospital in Singapore were interviewed. Data were transcribed verbatim and thematically analysed. Conclusion. Factors that influenced effective nurse–patient communication were found in the characteristics of the patient, the nurse and the environment. While there are common factors influencing communication in all contexts of practice, this study has suggested that a multicultural community such as Singapore presents special challenges in the oncology inpatient setting. Language barriers are significant, particularly between overseas trained nurses and patients who cannot converse in English. Cultural taboos also increase nurses’ discomfort when discussing sensitive topics. Additionally, the government’s promotion of Singapore as a medical ‘hub’ increases the cultural and ethnic mix of inpatients. A particular concerning finding is Singapore society’s poor perception of and lack of respect for nurses, which is partly contributed by Singapore’s ‘user-pays’ health system and lowly-paid foreign nurses. Relevance to clinical practice. Nurses should be mindful of how patients’ disease trajectory and psychological state affect communication. Nurses should also take patients’ cultural background into consideration when approaching sensitive topics. Language and cultural induction classes should also be made available, especially for overseas trained nurses working in Singapore. Nursing Associations in Singapore need to work on programmes that will increase the prestige of nursing. Further research involving a more representative sample is warranted to understand how Singapore’s ‘user-pays’ health care system affects effective nurse–patient communication

A systematic review on the factors affecting effective communication between registered nurses and oncology adult patients in an inpatient setting

BACKGROUND: Effective nurse-patient communication is essential in the development of therapeutic relationships and meeting the cognitive and affective needs of oncology patients. However, the emotional load in cancer nursing has made communication additionally challenging. OBJECTIVE: This review aimed to establish the best available evidence regarding the factors affecting effective communication between registered nurses and adult oncology patients in inpatient setting. INCLUSION CRITERIA: Types of participants This review considered studies that included registered nurses and inpatient oncology adults who were more than 21 years of age. This review considered studies carried out in inpatient settings, regardless of ward specialty, whilst active or palliative cancer treatments were administered.Phenomena of interest This review considered the factors affecting effective communication between registered nurses and inpatient oncology adults.Types of studies This review considered both quantitative (randomized controlled trials, non-randomized controlled trials, before and after studies, cohort observational, descriptive survey and mixed method studies) and qualitative (including, but not limited to, phenomenology, grounded theory and ethnography) research studies on the factors affecting effective communication between registered nurses and inpatient oncology adults.Search strategy The search strategy aimed to find studies published in English language and not limited by year of publication. A three-step search strategy was utilized in each component of this review. The grey literature was not included in this review. DATA EXTRACTION: Quantitative data were extracted using standardized data extraction tools adapted from the Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Qualitative data were extracted using the standardized data extraction tool from the Joanna Briggs Institute-Qualitative Assessment and Review Instrument (JBI-QARI). DATA ANALYSIS: Quantitative data were presented in a narrative summary. Qualitative findings were categorised using JBI-QARI tool to generate synthesised findings. RESULTS: One quantitative, two mixed method and four qualitative studies were included in this review. Combined findings of the narrative summary and meta-synthesis identified promoting and inhibiting factors in the characteristics of nurses, patients, and the environment. Promoting factors in nurses included genuineness, competency and supportive facilitation skills. However, the role of post-basic training in improving communication remained inconsistent. In patients, active participation in their own care and information-seeking behaviour promoted nurse-patient communication. Conversely, inhibiting factors in nurses included task orientation, fear of own death and low self-awareness of own verbal behaviours. Nurses also communicated less effectively during psychological assessments and emotionally-charged situations. For patients, their unwillingness to discuss the disease/feelings, their preference to seek emotional support from family and friends and the use of implicit cues inhibited effective communication. Environmentally, a supportive ward environment increased the use of facilitative behaviour in nurses, whereas the existence of conflict among staff increased the use of blocking behaviours. Cultural norms in the Chinese society also inhibited nurse-patient communication. CONCLUSION: Within the constraints of the study and the few quality papers available, it appears that personal characteristics of patients and nurses are the key influencing factors of effective nurse-patient communication in the oncology setting. Very little evidence exists on the role of environment in effective nurse-patient communication, particularly within an Asian setting. IMPLICATIONS FOR PRACTICE: Using evidence from the quantitative component of the review, nurses need to focus on the mental health status of patients admitted with a recurrence of cancer. Education programs can be implemented to inform nurses about the challenges in communication and develop strategies to counter these obstacles. Using evidence from the qualitative component of the review, nurses should build rapport and encourage active patient participation in their care in order to enhance patient disclosure. Nurses should also be mindful of patients' psychological readiness to communicate and respect their preference as to whom they wish to share their thoughts/emotions with. Institutions need to design ward structures (ward culture and nurses' workload) that support and/or encourage nurses to be person-oriented and take responsibility for providing holistic care to patients. Both the quantitative and qualitative components of the review indicated the need to improve nurses' communication skills and their receptivity to patient cues. IMPLICATIONS FOR RESEARCH: An explorative descriptive study on the effect of the Asian culture on the effective communication in the oncology setting is required to add to the small amount of knowledge in this area. Descriptive or mixed method studies to ascertain the effect of the patient's age and place within the oncology treatment cycle are also warranted. The lack of evidence on the effectiveness of post-basic communication courses would be best gathered by a descriptive study, followed by a before-and-after randomised controlled trial to test different education programs

A qualitative systematic review on the experiences of self-management in community-dwelling older women living with chronic illnesses

BACKGROUND: With the risk of chronic conditions increasing with age, older women are likely to have co-morbid chronic conditions. In addition, they may have to contend with socioeconomic issues unique to their gender which can challenge their self-management. OBJECTIVE: The aim of the systematic review was to determine the best available evidence related to the experiences of self-management among community-dwelling older women with chronic conditions, specifically non-communicable illnesses which include cardiovascular disease, chronic respiratory diseases, diabetes mellitus and arthritis. INCLUSION CRITERIA: Types of participants included all older women with the following characteristics: aged sixty-five years and above; living in their own community dwellings; community setting rural, suburban or urban; living alone or with others; having co-morbidities and having chronic illnesses for a minimum of one year. Phenomenon of interest was experiences of self-management among community-dwelling older women with chronic conditions. Interpretive studies were considered in the review, which included but were not limited to designs like phenomenology, grounded theory, action research, feminist research and ethnography. SEARCH STRATEGY: The search strategy aimed to uncover both published and unpublished studies, in English language only, and was unrestricted by time. The databases searched included CINAHL, MEDLINE, PsycINFO (Ovid), Scopus, Embase, Science Direct, Sociological Abstracts, Social Sciences Citation Index (Web of Science), Proquest and Google Scholar. Preliminary keywords were drawn from the topic of the systematic review. METHODOLOGICAL QUALITY: Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute Qualitative Assessment and Review Instrument QARI Critical Appraisal Checklist for Interpretive & Critical Research was used to appraise the methodological quality of all papers. DATA COLLECTION: Qualitative data were extracted from papers included in the review using standardized data extraction tools developed by the Joanna Briggs Institute. DATA SYNTHESIS: Qualitative research findings were synthesized using the Joanna Briggs Institute-Qualitative Assessment and Review Instrument. RESULTS: 88 findings from six studies were aggregated into 22 categories, and then into five synthesized findings. The five synthesized findings are: (i) losing control over a failing body, (ii) maintaining control, (iii) developing self-expertise, (iv) re-defining health, and (v) relying on social support. CONCLUSIONS: For these women, self-management involves reclaiming and maintaining their sense of control over their bodies, which is constantly threatened by their chronic illnesses. In addition, they redefine their meaning of health in the context of illness to maintain their emotional well-being in spite of their illness.Healthcare providers can assist their older female patients in maintaining their sense of control through effective symptom management and practical strategies to manage daily life. Because social support is crucial to self-management by older women, healthcare providers should include, where relevant, family members and other loved ones in patient education. Healthcare providers should also endeavour to build and maintain a positive relationship with their patients through effective communication as the provider-patient relationship is a strong influence on an older woman's experience in self-management.Further research is warranted in older women of other cultural backgrounds as the majority of reviewed studies focused on Caucasians in the United States