School of Nursing

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This collection contains Honours, Masters and Ph.D by coursework theses from University of Adelaide postgraduate students within the School of Nursing. The material has been approved as making a significant contribution to knowledge.

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Open Access
Advanced Practice and the Orthopaedic Nurse: An Interpretive Study
(2000) Taylor, Anita Carol; Jones, Tina
Advanced nursing practice is a broad topic that is often misunderstood. Related terms are used interchangeably, which tends to engender a degree of confusion over what constitutes advanced practice. The relationship of advanced practice to expert and specialty practice is unclear. Health care is increasingly becoming more complex. There are greater expectations placed upon the nurse practising in this context. Therefore the role of the nurse must reflect the increasing complexity that exists within a contemporary health system. Advanced practice provides an opportunity to debate and acknowledge how nursing practice must reflect modern trends. This study will assist in conceptualising advanced practice in terms of the nature and scope of advanced orthopaedic nurse practice. This study aimed to uncover the meaning of the lived experiences of advanced orthopaedic nurse practitioners, thereby engaging orthopaedic nurses within the debate. The methodology employed in this study was Hermeneutic Phenomenology, informed by Heidegger and van Manen. Seven expert orthopaedic nurse practitioners were asked to describe an experience in which they believed they performed at an advanced level. Concepts and themes emerged from the narratives. Themes included: having knowledge, being in and outside the role, being an advocate and being in control. Controversy and confusion dominates the debate over what constitutes advanced practice, both here and overseas. This study highlighted that advance practice is part of a continuum that describes specialist, expert and advanced practice. It is also an important concept in contemporary nursing practice. However ongoing clarification and consistency in terminology would assist immeasurably in identifying standards of advanced practice. Once this is achieved, the impact of advanced practice on patient care can be ascertained.
Open Access
Awareness and attitudes of intensive care nurses regarding the bowel protocol for the critically ill patients.
(2013) Varghese, Rency John; Magarey, Judy; Rasmussen, Philippa; School of Nursing
Patients in the intensive care unit are critically ill and are commonly on life support systems such as mechanical ventilation medication to stabilise their haemodynamic parameters. They are usually unable to eat or drink and are fed through a nasogastric or naso-enteric tube. With the priority being resuscitation and life support, normal physiological functions and requirements can be over ridden, one of which is bowel function. There are no set guidelines nationally recognised for the management of the bowel. But most institutions have a bowel protocol in order to facilitate and promote the bowel function of these patients. Despite this, anecdotal evidence indicates bowel management is often overlooked or ignored. The aim of this study was to investigate the attitudes and awareness of the nurses working in the intensive care setting towards the bowel protocol used for the critically ill patients from the level III intensive care units of three different public hospitals (Appendix 1). A simple descriptive design in the form of an online survey was conducted for the nurses working in the intensive care unit. Data were analysed using simple descriptive statistics and qualitative data a content analysis. The findings of this study indicated that even though many of the nurses were experienced, there still remain concerns regarding bowel management with issues of lack of knowledge and awareness, lack of accountability and responsibility and poor attitudes of staff. Recommendations were made to increase education and staff awareness with regular audits and vigilant supervision. Also further studies related to this concept are recommended preferably in a different setting.
Open Access
Barriers and perceptions to medication administration error reporting among nurses in Saudi Arabia
(2016) Albukhodaah, Abdulrahman Abdullah; McLiesh, Paul Christopher; School of Nursing
Background: Medication administration errors (MAEs) are considered as a global problem which influences the safety of patients. Due to some factors MAEs are still underreported. However, MAEs have been under-researched in Saudi health settings. The reporting barriers of fear, perception of nurses towards reporting MAEs, and the process of reporting significantly contribute to failure to report. Understanding of factors that may inhibit reporting MAEs among nurses in Saudi Arabia is a primary step to improve the safety culture of hospitals. Furthermore, understanding nurses’ perception toward MAEs reporting is the initial step to increasing the reporting rate. Aims: (1) To identify factors from the literature that facilitate or hinder the reporting of medication administration errors among nurses and (2) to identify factors that nurses perceive as major contributors in the culture of reporting medication administration errors in Saudi Arabia hospitals. Methods: a questionnaire was developed consisting of four pages to examine the nurses’ perceptions and the potential barriers to the reporting of medication administration errors and an open-ended question to seek more understanding of this topic among nurses in Saudi Arabia. The questionnaire items included: demographics and background, nurses’ perceptions of reporting medication administration errors and potential barriers to reporting MAEs. Participants for this study were nurses from three hospitals in Saudi Arabia. The Statistical Package for the Social Sciences Software the IBM (SPSS) Statistics was used to analyses the quantitative data and content analysis was used to analyses the qualitative data. Results: A total of 366 nurses participated in the study with response rate 63.3%. Nurses’ perception and awareness towards the importance of medication administration error reporting were positive. The major perceived barrier was fear of the consequences after reporting. This study found only 28.6% of nurses always reported MAEs when it occurs. Nursing administration (Head Nurse, Nursing Supervisor and/or Nursing Director) was the biggest concern affecting nurses’ willingness to report MAEs. Making the work environment, a non-blame environment may encourage a greater reporting of MAEs. Conclusions: Most nurses in Saudi Arabia’s hospitals believed that MAEs must be reported. However, fear of blame or the possibility of legal action and administration factors lead to underreporting. Implications for nursing management: Nursing administration should work towards establishing a blame free culture and support the safety culture to encourage reporting.
Open Access
A difficult path to walk: Critical Care Nurses’ lived experience of crucial conversations: perspectives from one Australian team
(2017) Besic, Nihada; Perry, Josephine; Millington, Sindy; School of Nursing
This practice inquiry reports the lived experience of Crucial Conversations by a small group of critical care nurses in a South Australian quaternary hospital’s critical care unit. Crucial Conversations are high stakes, highly emotional dialogues, where opinions and understanding greatly differ. Executed well, these discourses result in increased collaboration, meaningful solutions to challenging issues and improved team performance. Literature reveals other systems in place for quality improvements in unit performance that include TeamSTEPPS and Safety Learning System (SLS) reporting, however, the unique conflict resolution strategies with reflective events has not been adequately covered. Crucial Conversations are one form of a structured resolution process, which addresses this gap. Research regarding the lived experience of Crucial Conversations is an important piece missing from the literature. Using van Manen’s hermeneutic phenomenological methods, ‘Too hot to handle’, ‘Anticipatory responding’ and ‘Moving from who is right to what is right’ emerged as themes of the critical care nurses’ lived experience of Crucial Conversations. The inquiry findings give complementary views to previous research, add to the body of knowledge related to Crucial Conversations and bring attention to the importance of improving professional relationships on all levels. The study findings lend themselves to a process of implementing Crucial Conversations into the critical care setting. The value of this research lies in the implementation of multidisciplinary strategies for effective ongoing working relationships.
Open Access
The Effect of a Breath Alcohol Level Measurement on Length of Stay and Clinical Management of Acutely Intoxicated Patients in an Emergency Department
(2018) Mooney, Kelly Jane; School of Nursing
Background Alcohol use and misuse is a common occurrence in Australian society with one in seven Emergency Department Presentations being alcohol related. Despite substantial literature on the treatment and management of acute alcohol intoxication there is no consistency in the approach to treatment and diagnosis. With a lack of literature on the use of breath alcohol level measurement as a diagnostic tool and the focus of Australian Emergency Departments being length of stay, this study compares them alongside the additional interventions provided throughout the patient journey in the Emergency Department. Method A retrospective study of patient case notes from the calendar year 2016 was conducted. Five hundred and ninety episodes of care met the inclusion criteria and data was collected from the patient case notes and the Emergency Department computer system. This data included identifying treatment provided, breath alcohol levels, length of stay and demographic data. The data was analysed and then interpreted. Results Results revealed that having a breath alcohol level measurement affected length of stay and interventions in the Emergency Department but the value of that breath alcohol level did not influence length of stay or the interventions provided. This indicates that utilising a breath alcohol measurement for determining whether a person is intoxicated affects patient journey through the Emergency Department, however utilising it to determine how intoxicated a patient is, is unlikely to change their Emergency Department journey.Conclusion This study provides evidence on current practice in an Australian Emergency Department. It showed there was a lack of consistency in approach to treatment of acute alcohol intoxication and suggests some implications to clinical practice for Emergency Department clinicians, and examples of where future research would be beneficial.
Open Access
An evaluation of mental health services in the Whyalla Hospital Accident and Emergency Department: a comparison of a new and old model of care.
(2011) Papoulis, Debra; Wilson, Anne; School of Nursing
In January 2009 the first Mental Health Nurse Practitioner positions were rolled out in country South Australia, as a result of ongoing mental health reform at both commonwealth and state levels. This thesis reports on research comparing the practice model of a new Mental Health Nurse Practitioner Service, utilising a Mental Health Consultation Liaison model of care and an older, established, in reach General Practitioner model, of mental health service delivery in a regional accident and emergency department in South Australia. The new Mental Health Nurse Practitioner Service is provided by a Mental Health Nurse Practitioner (Candidate), who secured a position with Country Health SA when they were rolled out in 2009. To answer the research question ‘Does the Mental Health Nurse Practitioner Service improve mental health service delivery in the Accident and Emergency Department of the Whyalla Hospital?’ a comparative descriptive study design utilising an empirical and analytical approach was employed. The study compares waiting times, admission rates and re-presentations to the accident and emergency department within 28 days of the original presentation. It also compares the incidence of consultation with other health professionals and the referral to community based mental health services taking place from the Accident and Emergency Department for the two models. The results of the study are presented and represent significant statistical differences between the two models of care. The major findings of the study conclude engagement with the Mental Health Nurse Practitioner (Candidate) provides an opportunity for specialised comprehensive mental health assessment, timely therapeutic engagement and early intervention commenced in the Accident and Emergency Department. The high rate of consultation liaison from the Accident and Emergency Department as well as referral to community based mental health services is consistent with enhanced care coordination.
Open Access
Exploring the meaning of low self-esteem that is inherent in depression, an interpretive phenomenological study.
(2014) Fisher, Katie Louise; Wilson, Anne; Crouch, Rosanne; Foley, David C.; Green, Cheryl; School of Nursing
The purpose of this research was to explore the lived experience of low self esteem inherent in depression for participants who directly accessed mental health care in a rural mental health service in the South East Region of South Australia. Five participants were interviewed. Data was collected from interviews in which participants reflected on the connection of low self esteem often inherent in depression in nine domains of life and how this had impacted on the participant’s day to day life. Data was collected using a phenomenological methodology, and the data was analysed using Colaizzi’s7 step method. Meaning was aggregated into themes using the structure of cognitive behavioural therapy to explore the interaction of cognition, behaviour, physiology and affect. Results illustrated a significant negative experience of low self esteem in depression with associated thoughts and behaviours. These thoughts and behaviours maintained suffering and distress in all domains of life except spirituality and to a lesser degree citizenship. Participant’s experience of the mental health service was generally viewed as worthwhile. This research confirms the value of psychological interventions by skilled health professionals. The subjective experience of low self esteem appeared to have become a part of life, not dissimilar to an addiction whereby people do not know how to live without it. The experience of low self esteem in depression for the participants was a long battle and gaining new insights through contact with mental health services may be viewed as too little too late. The research demonstrated the long term benefits of a co-ordinated approach to early interventions within the primary and secondary education system. With the estimated rates of depression on the rise there is a challenge for mental health professionals at the grass roots level to disseminate vital information to young people about the complexity of the mind. Understanding the experience of low self esteem in depression during our formative years may abort these negative experiences before they become entrenched and gain a psychological hold, which may develop into the formation of unhelpful habitual thoughts and unhelpful habitual behaviours, and loss of life through suicide.
Open Access
The Factors Associated With the Occurrence of Medication Errors in the Ministry of Health Hospitals in Saudi Arabia: A Cross-Sectional Study of Nurses
(2017) AL Qrishah, Mohammad Hassan; Donnelly, Francis Patrick; Wiechula, Richard John; School of Nursing
Aim: to investigate the factors associated with occurrence of medication errors (ME) in Ministry of Health hospitals in Saudi Arabia. Objective: To investigate nurses’ views on factors that contribute to medication errors. Methods: A cross-sectional descriptive survey was undertaken. A convenient sample of 152 nurses from three hospitals was obtained. Respondents were asked to determine factors associated with the occurrence of medication errors Results: A total of 152 of 300 (50.7%) questionnaires were returned. Exactly half of the respondents had been involved in medication errors once or more during their nursing career, with 26.97% (n= 41) having reported one or more medication errors at some point in their nursing career. A significant number (n= 131 86%) of respondents identified that unclear writing or illegible medication orders or prescriptions was the most significant factor in ME. Other highly significant factors contributing to errors included poor communication between nurses and physicians (n= 118, m=3.99), similarity in the name of medications (n= 114, m=3.92), similarity in the appearance of medications (n= 114, m=3.91), interruptions while preparing or administering medications (n= 101, m=3.71) , stressful working environments (n= 105, m=3.66), and a lack of medication safety education programs (n= 94, m=3.55). Conclusion: There are a range of factors that contribute to ME, of those the most significant is unclear or illegible medication orders or prescriptions. This study has identified a range of other factors in Saudi Arabian hospitals leading to medication errors, further research could be directed to the appropriate strategies to reduce them.
Open Access
Factors for perioperative nurse retention: an inquiry into the lived experience of perioperative nurses.
(2013) Mewett, Sharon Ann; Perry, Josephine; Kitson, Alison Lydia; School of Nursing
Background: Current literature concludes that a global nursing shortage has a profound impact on the workplace, consumers of healthcare, on recruitment, professional development, job satisfaction and retention. In Australia, as in worldwide, the specialty of perioperative nursing has been identified as one of the key areas suffering these issues. Objective: The purpose of this study was to investigate nurse recruitment, retention and job satisfaction within the specialty of perioperative nursing. Method: A total of 8 registered nurses (RN’s) currently practicing in the perioperative field, located at an outer metropolitan healthcare facility, participated in the study. The design that was used for the study was an interpretive hermeneutic phenomenological method that was informed by van Manen (1990). Instruments with auditable reliability and validity were used for data collection. The sample’s characteristics reported in this thesis, were similar to the demographic characteristics described in recent Australian Institute of Health and Welfare reports and were of sufficient scale and scope to provide a reliable and thorough picture of the phenomena of recruitment, job satisfaction and retention among perioperative nurses. Results: Through taped interviews and subsequent analysis to detect patterns and themes, the study findings demonstrated that South Australian perioperative nurses are experiencing moderate to high levels of dissatisfaction in the workplace. Furthermore, many of the participants’ additional comments locate the major source of their dissatisfaction as organisational and professional issues. Findings also indicated an intention to remain working in nursing and in particular the perioperative specialty, only in regards to the proximity of work to home and general convenience. Conclusions: The results of this study provide an interpretive description of, and some personal perspectives of SA perioperative nurses’ current job satisfaction and their intention to leave the specialty. These findings have ramifications for management in the development of strategies aimed at improving the job satisfaction, and ultimately the retention of nurses within the specialty of perioperative nursing.
Open Access
Factors that assist undergraduate nursing students to cope with the experience of their first clinical placement
(2016) AlShahrani, Yousef Mohammed; Cusack, Lynette; Rasmussen, Philippa
Background: Nursing schools prepare nurses for their future career, therefore academic nursing programs need to be well-developed and structured with both theoretical and practical components to ensure they graduate competent nurses. Clinical placement is an essential component in nursing education that integrates theoretical knowledge with clinical nursing skills which cannot be gained by classroom education alone. The first clinical placement can be an extremely stressful experience for some undergraduate nursing students which may lead to negative consequences for students, the profession, healthcare settings or patients. Objectives: The aim of this study was to identify factors that enable a positive experience of the first clinical placement for first year undergraduate nursing students. This aim was achieved by adopting three research objectives including: identifying factors from the literature that were facilitators or barriers to first clinical placement for first year undergraduate nursing students; identifying a framework in which to explore and discuss how first year undergraduate nursing students coped with their experience of their first clinical placement and identifying coping strategies first year undergraduate nursing students used to overcome any barriers or to prevent negative experience of their first clinical placement. Significance of the study: Results of this research will offer academics in nursing schools further insight regarding coping strategies of nursing students in their first clinical placement, which in turn, will assist in supporting these students to cope with the experience of their first clinical placement, continue with their studies and enter the nursing profession. Method: This study adopted a concurrent mixed method design and was conducted using an online questionnaire that involved both quantitative and qualitative questions. Adaptation and content validity was assessed by piloting the questionnaire in order to ensure that the tool was understandable, relevant and well-designed. The study participants were all first year undergraduate nursing students at a higher education facility in South Australia. There were no ethical considerations or risks associated with this study. Findings: There were fifty-eight first year nursing students of one hundred and fifty-four that responded to the questionnaire. The majority of participants were female, aged less than twenty years old, local students with no previous work experience as healthcare professionals. Most participants had a level of anxiety ranging from moderately to extremely anxious about their first clinical placement due to several reasons. These reasons included being worried about making mistakes that could harm patients, providing direct care and speaking to patients for the first time. Some participants were also worried about being assessed by nursing staff and clinical lecturers, as well as inadvertently breaking the rules of clinical placement institutions. Factors that assisted participants to cope with their anxiety and have a positive experience of the first clinical placement included supportive clinical lecturers and nursing staff, co-operative patients, adequate preparation before the clinical placement, effective communication between nursing schools and clinical institutions, and constructive feedback from nursing staff and clinical lecturers. Participants developed different strategies that assisted them to cope with their first clinical placement, including talking to different people about the experience of the first clinical placement, adopting positive attitudes, asking nursing staff questions, providing help to nursing staff and asking for help if unsure about their competence in their nursing task. Conclusion: There are a range of strategies that can be put into place by the nursing students, clinical lecturers and nursing staff that will enable nursing students to cope well with their first clinical placement and to have a positive experience. The research shows that preparation for the first clinical placement is very important for all concerned. Once on placement, then support and encouragement by clinical lecturers and nursing staff is critical in building the nursing students’ confidence in the new work environment. It is also essential that nursing students are provided with opportunities to reflect and debrief with colleagues and with friends and family about their experiences during their first clinical placement, being mindful of patient confidentiality. This study confirms the findings of other research of the importance of using a range of supportive approaches for nursing students undertaking their first clinical placement to enable them to have a positive experience that will boost their confidence as they commence their career in nursing.
Open Access
Graduates’ perspectives of attributes assessed during structured oral assessment for the selection of undergraduate nursing students at the University of Adelaide.
(2009) Rochmawati, Erna; Wilson, Anne; McCann, Robert; School of Population Health and Clinical Practice : Nursing
A reliable student selection in nursing education programs is important to select the most suitable candidates not only as students but also as likely to pursue a career in nursing. In the last several years, the student selection of Bachelor of Nursing degrees have not been based solely on an academic performance, but also on a structured oral assessment. Although several evaluations of structured oral assessment have been undertaken, no reviewed study of structured oral assessment from the perspectives of the graduates nurse has been found. Evidence to improve processes of structured oral assesment is limited. In order to conduct a better structured oral assessment, further investigation in the structured oral assessment from graduate nurses perspectives is necessary. Therefore, this multi-method descriptive study aimed to explore graduates’ perceptions of the attributes explored during the structured oral assessment. Required attributes for successful completion of the Bachelor of nursing, and undertaking a career as a registered nurse were also explored. Thirty five Bachelor of Nursing graduates were invited to participate in this study, in which participants completed self-administered postal questionnaires. A semi-structured interview was conducted after a quantitative data collection. Quantitative data was analysed utilising simple descriptive statistics, while qualitative data utilising content analysis. Results indicated that the structured oral assessment was an excellent method in student selection, and questions being asked in the structured oral assessment were viewed as appropriate, suitable and relevant. Findings of this study illustrated attributes which were viewed important for successful completion of pre-registered nurse education and undertaking a career as nurses. From this study, two new findings were revealed, including integrity and the mentorship between younger and more mature students. Recommendations from this study include improving teaching and learning methods, and supporting mutual relationships among pre-registered nurse students. Further studies related to refinement of the questionnaire, and replications of this study at broad level are also recommended.
Open Access
How mental health clinicians assess and manage the risk of violence from mental health consumers: a descriptive exploratory research investigation
(2016) Smit, Jacqueline Teresa; Cusack, Lynette; School of Nursing
The advent of deinstitutionalisation has increased the number of mental health consumers in the community. Consequently, community mental health clinicians (CMHC) now play an increasingly important role in caring for mental health consumers, which raises the question of how CMHCs maintain their safety. The overall aim of the research was to improve the safety of CMHCs when caring for mental health consumers. In light of this question, a literature search was conducted to investigate how CMHCs assess and manage the risk of violence from mental health consumers in the community. The literature search provided background information about deinstitutionalisation but also revealed there was a paucity of research about the subject of risk assessment and management by CMHCs. This research was conducted to gain an understanding of the strategies of risk assessment and management in community mental health. A descriptive exploratory qualitative research methodology was selected. The research was conducted in a community mental health centre in a metropolitan region of South Australia. Individual interviews of eleven CMHCs provided data, which was thematically analysed and interpreted. The main themes that emerged were: preparing to meet the consumer; intervention strategies for safety; and organisational management. There were several strategies that were consistently upheld by CMHCs such as gaining information about a consumer; appraisal of the environment; careful attention to exit strategies; and appropriate interaction with the consumer according to their mental state. Concurrently, the research findings raised awareness of the need for improvement in certain areas relating to: communication within the team; training requirements for CMHCs; and awareness of the policies and procedures and Work Health and Safety Standards. This research has also highlighted new areas of interest for future research.
Open Access
‘I know the difference it has made in people’s lives’: Perceptions of Rural South Australian Nurses Extending Their Role to Administer Chemotherapy.
(2014) Alnasser, Qasem; Cameron, Kate; Prouse, Janette; School of Nursing
Nurses in rural Australia are currently administering chemotherapy in centres where this was not previously the case. This has resulted from an Australian Government and metropolitan residents in Australia. One initiative has been education of rural health care professionals who work with cancer patients. In South Australia (SA) a State-wide Chemotherapy Education and Assessment Program was implemented using the Antineoplastic Drug Administration Course (ADAC) developed by the Cancer Institute of New South Wales (NSW). This research project explored the perceptions of nurses working in level-one rural centres administering low risk chemotherapy protocols in SA. Critical social theory was used to explore the hidden constraints, conscientize and empower participants. Through individual interviews a dialectic process was developed to collect the data from eight participants who were rural registered nurses working in low risk chemotherapy centres. The data analysis revealed four main categories of findings. These were; 1) role extension, preparedness and self-confidence; 2) chemotherapy services in rural areas; 3) power relationship, referrals and sustainability; and 4) communication with other cancer settings and professionals. These four categories represent the participants’ perceptions of their role and the provision of chemotherapy services in rural areas. Participants valued the service highly but identified areas that they find problematic including maintenance of knowledge and skills. It was also perceived that rural nurses do not have input into the referral process and fear that the service is being underutilised due to low referral rates from metropolitan centres. Based on the findings, literature review and current knowledge of cancer education some recommendations were suggested. These recommendations included, developing an education module for rural cancer chemotherapy practice, implementation of an annual re-credential course and clinical rotation to a higher chemotherapy administration service, a more explicit patient referral process would help to identify patients eligible for chemotherapy treatment in low risk centres, upgrade of centres to enable them to manage medium risk level treatments would increase the volume and familiarity of nurses administering treatments, and lastly, use of telehealth communication for education and communication.
Open Access
Interdisciplinary health team’s experience in mobilising postoperative orthopaedic patients with altered mental status in a private hospital setting: a phenomenological study
(2016) Decoyna, Jovie Ann Alawas; McLiesh, Paul; Salamon, Yvette Michelle; School of Nursing
Achievement of patients’ pre-morbid functional level or improvement of their functional ability is a major postoperative goal for orthopaedic surgical patients. A change in a patient’s mental state has a multifactorial aetiology which can impact patient outcomes and influence the delivery of care. Patient mobilisation is a role shared by both nurses and physiotherapists. Mobilising orthopaedic patients with altered mental status require both professional groups to work in close collaboration. The study aims to enhance the understanding of the experience of nurses and physiotherapists in mobilising postoperative orthopaedic patients who have altered mental status using the hermeneutic phenomenological research methodology. It also seeks to explore the differences/ similarities of their experience, describe any challenges encountered, interpret and give meaning to their experience, contribute to literature, and impact health practices. Three nurses and three physiotherapists were recruited through purposive sampling. Data was analysed using Burnard’s 14 stages of thematic content analysis. Four main categories emerged from the study: altruism, interprofessional specialist practice, patient dynamics and challenges. The findings of this study demonstrated that nurses and physiotherapists experience numerous challenges from both patient and resources related factors that influence the mobilisation of this patient group with the potential to impact the relationship between the two professional groups. Nurses and physiotherapists maintain a symbiotic relationship; their interprofessional collaboration enables achievement of mobilisation goals and their experience of the phenomenon is comparable. Patient and staff safety takes precedence over mobilisation. Participants believe that safety risks can be mitigated by having adequate resources, competence, and teamwork. The study recommends an evaluation of the resources and strategies required to ensure that this patient group are mobilised optimally to improve patient outcomes and experience.
Open Access
An investigation of palliative care nurses' perceptions and views of an extended hours community nursing service at the Northern Adelaide Palliative Service.
(2014) Grigson, Jane Maree; Cameron, Kate; Harvey, Gillian; School of Nursing
Background Palliative care as a health specialty has undergone dramatic growth across the globe since the 1960’s. With this growth has come an array of service models, providing palliative care in a variety of ways. The situation in Australia is no different, and the inequity of access to palliative care has been noted at both a commonwealth and state government level. Purpose This study investigated the perceptions and views of the nurses into an extended hour’s community nursing service at Northern Adelaide Palliative Service. The data obtained was intended to identify if there was any perceived need for a change in service delivery and any potential benefits to the current client group. Methods This is a mixed method study, combining the collection of qualitative data from the current nursing staff and an analysis of the after-hours telephone calls to the service. Nursing staff were interviewed individually using a semi-structured approach. Telephone data reviewed was information already collected by Northern Adelaide Palliative Service, and all data was de-identified prior to review. Results Data gathered from the interviews revealed that whilst there was support for the concept of an extended hour’s community service in general, this support did not translate to the local setting. A lack of consensus existed between current nurses of Northern Adelaide Palliative Care Service in relation to both the need for an extended hour’s service and the potential benefits to the current client group. The telephone data identified that nearly a third of all calls received could have been responded to by a nurse, with the majority of these calls being received after eight in the morning until ten at night. Conclusion Overall the data obtained is not convincing in indicating either a desire or need for an extended hours community nursing service at Northern Adelaide Palliative Service. Despite this the management and care of the palliative patient in the after-hours period continues to be an area of concern. It would be beneficial to collect additional data from all users of the service to obtain their view on the effectiveness and accessibility of the service.
Open Access
"It's busy .... but I love it": the experience of nurses providing abortion care in a specialist setting.
(2013) Coombe, Brigid Ann; Cusack, Lynette; Hetzel, Sue; School of Nursing
Aim: This is a report of a study to understand the subjective experience of nurses whose role it is to provide nursing care for women seeking abortion services in a specialist clinic. Background: Abortion is a very commonly provided health service in Australia but remains morally and politically controversial and associated with judgment and stigma. Nurses are integral to the provision of abortion services for women. Research attention to the subjective experience of nurses providing abortion care in specialist abortion services has been limited, particularly in Australia. Methods: A qualitative research design, informed by feminist research principles was developed to explore the experience of nurses caring for women in a gendered and marginalised area of health care. A small sample of nurses, working in a specialist clinic in SA, participated in an in depth interview with the researcher, and a workshop to validate initial thematic data analysis. Results: Nurses choose to work in a specialist abortion clinic for a range of reasons. A commitment to self-determination in health care decision-making facilitates the nurses’ work in the contested environment of abortion. Four themes emerged from the data analysis. The participants’ experience was revealed, through their voices, in the themes of: with woman, finding balance, relating with care and intention and silences. Conclusion: Providing abortion care for women in a specialist setting is a rewarding and challenging experience for nurses. Doing important work that directly helps women is rewarding for nurses who have a wide scope of practice with organisational and team supports. This study confirms the findings of other research of the importance of supportive frameworks for nurses working in abortion care. Future research to develop supervisory and reflective frameworks should include the development of appropriate language to discuss the difficult aspects of work in the second trimester. Decriminalisation of abortion laws would enable nurses to provide woman centred care based on clinical guidelines, taking account of the complexities of women’s lives and responsibilities.
Open Access
The lived experience of nursing severe burns injury patients: a phenomenological inquiry
(2009) Kornhaber, Rachel Anne; Wilson, Anne; School of Population Health and Clinical Practice : Nursing
Little nursing research has focused on nurses’ experiences of nursing severe burns injury patients. This study has provided a gateway to explore, describe and document the experience of nursing severe burns injury patients. This thereby adds to the existing body of nursing knowledge upon which the nursing care of patients with severe burns injury can be made in an informative manner with confidence. This descriptive phenomenological study describes the lived experiences of seven full time registered nurses that care for patients who have sustained a severe burns injury. The descriptive phenomenology of Husserl and the methodological interpretations of Colaizzi underpin this study. Purposeful sampling was utilised to select participants who work in a severe burns injury unit in New South Wales, Australia. The use of in-depth interviews was used to generate data about the participants’ personal and professional experiences’ of nursing severe burns injury patients. The interviews were transcribed verbatim, analysed and described using a descriptive phenomenological methodology. Twenty eight cluster themes emerged from the participants’ experiences which were further merged into nine emergent themes that depicted the experiences of nurses caring for severe burns injury patients which formed the basis of the findings reported. Participants described burns nursing as both physically and emotionally demanding yet rewarding. It was shown that burns nurses have a resilient nature with the ability to cope with the challenges of burns nursing. Participant nurses described how they emotionally detached and became hardened to the devastation of a severe burns injury. The unique bond that formed between burns nurses and their patients’ demonstrated a relationship embedded in trust and understanding that allowed the nurse to continue caring for burns patients for extended periods. Commitment and dedication were found to be fundamental elements for nursing burns patients. Participant nurses were found to feel emotionally exhausted, powerless and burnt out; however, feelings of accomplishment and motivation outweighed these negative emotions. Support and unity was identified as fundamental to burns nursing, without the support of the burns team nurse participants believed that they would not be able to care for patients with severe burns injury. The findings of this study have provided an insight into the experience of nursing severe burns injury patients. It is hoped that the findings of this study will contribute to the care of burns patients and the well being of the burns nurses who care for these patients. The paucity of available literature in the area of burns nursing concludes that more research is required into the impact of nursing severe burns injury patients.
Open Access
Nurses’ lived experience of delivering temporary epicardial cardiac pacing care: an Australian cardiothoracic intensive care finding
(2017) Han, Matilda Kyungsook; Donnelly, Francis Patrick; School of Nursing
There are many examples in literature concerning the effectiveness or complications associated with temporary epicardial pacing practice. While surrounding literature identifies elements essential to safe care and challenges faced by clinicians managing temporary epicardial pacing systems, no literature was identified about nurses’ experience in managing this practice. This study contributes to understanding of nurses’ experiences of managing temporary epicardial pacing. An interpretive phenomenological framework articulated by Heidegger was used to generate rich and descriptive data of this little known phenomenon. In-depth interviews were conducted with eight registered nurses who work in the specialist cardiothoracic intensive care and had responsibility for delivering temporary epicardial pacing care. The transcripts from the interviews were analysed using Smith’s Interpretive Phenomenology Analysis (IPA) method and to gain deeper interpretation, consideration of Benner’s five-stage skill acquisition theory was used as a lens to further examine the findings. The participants’ shared experiences revealed three major themes; ‘Risky business’, ‘Take time to own’ and ‘Zeroing in’. These themes were experienced in a variety of ways depending on the skill level of each participant. Furthermore, the interpretation of the study recognized that an internal motivation to use pacing at its optimal best, is characteristic of an expert. Strengths and limitations and implications for both clinical practice and education are discussed, and suggestions for future research are included.
Open Access
Orthopaedic nursing in the 2010s: a critical ethnography
(2012) McLiesh, Paul Christopher; Wiechula, Richard John; School of Nursing
This is a complex yet subtle story- it is a story about orthopaedic nurses, who they are, what do they do and why. Background Orthopaedic nursing is a speciality that has members in many settings and institutions throughout the world. Orthopaedic nurses identify themselves as a distinct group who share common beliefs, values and actions. Their patients have similar needs and they work in similar ways to meet those needs. Changes in nursing and changes in the surgical treatment of orthopaedic patients have impacted the way orthopaedic nurses’ deliver care. In part, this has created a threat to the speciality as some no longer see the need to have the care of orthopaedic patients delivered by specialist orthopaedic nurses. Aims This study describes the orthopaedic nursing group and makes evident the value of their roles and actions in caring for their patients. It asks if the group identifies as a speciality, how that speciality is defined and what are the essential skills needed to be considered an orthopaedic nurse. It identifies the common needs of members of the group, how those needs are meet by leaders of the group and what it is that makes them leaders of the group. Methodology A critical ethnography framework was used for this research as it best matched the aims of understanding the group and what factors influence its existence. Method The research was conducted in two phases. Participants were self-selected. The first phase used an online questionnaire that asked a series of questions about the participants’ backgrounds, their roles and activities as members of the group. Phase two consisted of six semi-structured interviews with six participants selected from phase one. Findings The orthopaedic nursing group is a complex and difficult group to define. The group and its members vary in a number of ways but share common elements. They describe an attraction to orthopaedic nursing that is based on the type of nursing and the team focussed nature of the work. Orthopaedic patients are often restricted to bed or have limited mobility. This has implications for the way their nursing care is delivered. Much of the care they require is basic nursing care but it needs to be delivered in a unique way by orthopaedic nurses. The skills and knowledge needed to deliver this care may not be overtly obvious to outsiders, or even to someone looking directly at the care being delivered but for nurses from other specialities who try to deliver that same care it becomes more obvious. It is difficult for some orthopaedic nurses to articulate the specifics of that care as they have learned to deliver that care over time from other members of the group at almost an intuitive level. Changes to the surgical management of orthopaedic patients have been the most significant issue influencing the way the group practices. Some in the group and others outside the group have seen the reduction in the requirement for specific skills such as traction as a sign that the group is no longer a specialist group and that orthopaedic patients do not need their care delivered by specialists. However the fundamentals of orthopaedic nursing remain unchanged and still need to be delivered by specialist nurses. Leadership of the group is a complex issue and is often undervalued, even by the leaders themselves. Developing teams, attracting new staff to the speciality, relationships with other disciplines and inspiring and promoting orthopaedic nursing are all responsibilities of the group but must be fostered and directed by the leaders. Conclusion Orthopaedic nursing remains a strong speciality but continues to face many challenges. While the specific skills and knowledge required by orthopaedic nurses continues to fluctuate, the fundamentals remain constant. It is vital that the group considers their current position and use this knowledge to help influence the future direction of the group. The future of the group is dependent on how it responds to external and internal changes and demands. This is how the speciality has evolved and is the best way forward to ensure success in the future.
Open Access
PACU nurses & postoperative pain : A focused ethnography
(2014) Nayar, Priya Susan; Donnelly, Francis Patrick; School of Nursing
BACKGROUND: The post-anaesthetic care unit (PACU) is the first place that patients are taken following their operation and it is here that the initial recovery from their anaesthetic and surgery happens. Accordingly a significant proportion of the PACU nurse’s time is involved with the assessment and management of pain in the postoperative patient. Despite the implementation of standardised tools such as pain rating scales and medication protocols, the assessment and management of postoperative pain varies markedly from one patient to another in the PACU. Taking this into consideration, the researcher sought to understand how PACU nurses interpret pain assessment and management of the postoperative patient. AIM: To understand the processes PACU nurses utilise when assessing pain and implementing subsequent pain management in patients following surgery. METHODOLOGY: The qualitative approach of focused ethnography was used to frame this study. Focused ethnography was considered to best portray the perspectives of PACU nurses, as a culture, regarding the assessment and management of postoperative pain. METHODS: Ten PACU nurses were recruited from the PACU of a government hospital. The experience of the participants ranged from 3 years to more than 20 years in PACU nursing. James Spradley’s ethnographic research cycle was used to frame the research process. The research design employed two methods of data collection: participant observation and individual interviews. Collected data was transcribed and thematic analysis conducted. FINDINGS: Five themes emerged reflecting the perspectives of PACU nurses on the assessment and management of postoperative pain. These themes are: With Surgery Comes Pain; The Picture Beyond The Wound; Knowing; The Individual Experience; and Bridging Surgical Care. There are many complexities involved in assessing and managing postoperative pain in the PACU. Underpinning the five themes, communication was seen to be an integral aspect of assessing and managing postoperative pain from the PACU nurse’s perspective. CONCLUSION: This study represents a population of nurses who identify strongly with working in a unique clinical environment. The findings give insight to the multi-dimensional process that PACU nurses employ to be able to provide proficient care of postoperative pain to their patients; and, this study illustrates that the PACU fosters a distinct sense of culture amongst its nurses when considering the assessment and management of pain in the postoperative patient. The significance of this research is that there is no set method of pain assessment and management the PACU that could be taught from a textbook. Postoperative pain assessment and management is a highly individualised process that continuously changes with variables that are introduced by both the PACU nurse and the patient. Further research is required to develop knowledge about this particular environment.

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