A study of post diagnosis breast cancer concerns for women living in rural and remote Queensland. Part I : Personal concerns

The findings presented in this paper are part of a research project designed to provide a preliminary indication of the support needs of postdiagnosis women with breast cancer in remote and isolated areas in Queensland. This discussion will present data that focuses on the women’s expressed personal concerns. For participants in this research a diagnosis of breast cancer involves a confrontation with their own mortality and the possibility of a reduced life span. This is a definite life crisis, creating shock and needing considerable adjustment. Along with these generic issues the participants also articulated significant issues in relation to their experience as women in a rural setting. These concerns centred around worries about how their partner and families cope during their absences for treatment, the additional burden on the family of having to cope with running the property or farm during the participant’s absence or illness, added financial strain brought about by the cost of travel for treatment, maintenance of properties during absences, and problems created by time off from properties or self-employment. These findings accord with other reports of health and welfare services for rural Australian and the generic literature on psycho-oncology studies of breast cancer.

A study of postdiagnosis breast cancer concerns for women living in rural and remote Queensland. Part II : support issues

This paper presents the recent findings from a study on the postdiagnosis support needs of women with breast cancer living in rural and remote Queensland. The findings presented in this discussion focus on support needs from the perspective of the women experiencing breast cancer as well as health service providers. The tyranny of distance imposes unique hardships, such as separation from family and friends, during a time of great vulnerability for treatment, the need to travel long distances for support and follow-up services, and extra financial burdens, which can combine to cause strains on the marital relationship and family cohesion. Positive indications are, however, that the rural communities operate on strong, informal networks of support. This network of family, friends and community can, and does, play an active role in the provision of emotional and practical support.

The Large Allen Cognitive Level Screen as an indicator for medication adherence among adults accessing community mental health services

Background: Medication remains the cornerstone treatment for mental illness. Cognition is one of the strongest predictors of non-adherence. The aim of this preliminary investigation was to examine the association between the Large Allen Cognitive Level Screen (LACLS) and medication adherence among a small sample of mental health service users to determine whether the LACLS has potential as a screening tool for capacity to manage medication regimens. Method: Demographic and clinical information was collected from a small sample of people who had recently accessed community mental health services. Participants then completed the LACLS and the Medication Adherence Rating Scale (MARS) at a single time point. The strength of association between the LACLS and MARS was examined using Spearman rank-order correlation. Results: A strong positive correlation between the LACLS and medication adherence (r = 0.71, p = 0.01) was evident. No participants reported the use of medication aids despite evidence of impaired cognitive functioning. Conclusion: This investigation has provided the first empirical evidence indicating that the LACLS may have utility as a screening instrument for capacity to manage medication adherence among this population. While promising, this finding should be interpreted with caveats given its preliminary nature.

Do nursing interventions targeting concurrent symptoms hold promise for managing fatigue in patients with advanced cancer?

TO THE EDITOR: It was with great interest that I read two recent articles by de Raaf et al1, and Bruera et al2. These authors are to be congratulated for completing two of the very few high quality randomized trials that evaluate complex interventions for managing fatigue in patients with advanced cancer. de Raaf et al conducted a non-blinded RCT with 152 patients with advanced cancer and reported significant reduction of fatigue in patients who received a nurse-led monitoring and protocol-guided treatment of physical symptoms compared with those who received usual care1. Patients who received this intervention experienced a significant improvement over time in general fatigue, at one-month follow-up and two-month follow-up. Another recent RCT conducted with 141 patients with advanced cancer by Bruera et al2 did not find any benefits of a nursing telephone intervention that involved systematic symptom assessment/management, medication review, psychosocial support and patient education in fatigue reduction, compared to those who received a control telephone intervention conducted by a non-professional...

Are we there yet? Early years reform in Queensland : stakeholder perspectives on the introduction of funded preschool programs in long day care services

Australian educators are currently engaging with wide-ranging, national early childhood reform that is reshaping early childhood education and care. The Australian reform agenda reflects many of the early childhood policy directions championed by bodies such as the Organisation for Economic Cooperation and Development and the United Nations Children's Education Fund, and is based on the dual discourse of (i) starting strong and (ii) investing in the early years. However, despite its traction in policy rhetoric and policy there is little empirical evidence of how reform is being played out. This paper reports on research undertaken in collaboration with the Queensland Office for Early Childhood Education and Care to generate sector feedback on one element of the reform agenda, the implementation of universal preschool in Queensland. The study aimed to determine the efficacy of the new policy in supporting the provision of 'approved preschool programs' within long day care services. Drawing together the views and experiences of a range of stakeholders, including peak organisations, service providers, directors, preschool teachers and government policy officers, it provides a situated case study of the implementation of universal preschool, and offers empirical evidence of how this policy is being played out at the local level. The paper identifies the opportunities and challenges in implementing universal preschool in Queensland that may have bearing on early childhood reform in Australia as well as other countries. Discussion of key findings is set within an overview of the ECEC policy agenda in Australia, with a particular focus on the commitment to universal preschool. Les éducateurs australiens s’engagent présentement dans une vaste réforme nationale de la petite enfance qui remodèle l'éducation et l’accueil de la petite enfance. Le programme de la réforme australienne reflète plusieurs des orientations en politique de la petite enfance soutenues par des organismes comme l'Organisation de coopération et de développement économiques (OCDE) et le Fonds des Nations Unies pour les enfants (UNICEF). Il s’appuie sur le double discours de (i) un bon départ et de (ii) l’investissement dans les premières années. Cependant, en dépit de son attrait en rhétorique de politique et en politique il y a peu de données empiriques sur la façon dont la réforme se déroule. Cet article rend compte de la recherche entreprise en collaboration avec le bureau de l'éducation et l’accueil à la petite enfance du Queensland afin d’obtenir une rétroaction du secteur sur un élément de la réforme, la mise sur pied du préscolaire universel dans le Queensland. L'étude visait à déterminer l'efficacité de la nouvelle politique pour soutenir la disposition «programmes préscolaires approuvés» dans les services de garde à temps plein. En regroupant les perspectives et les expériences d'une gamme d’intervenants, y compris d’importantes organisations, des prestataires de service, des directeurs, des enseignants du préscolaire et des fonctionnaires de politique gouvernementale, elle constitue une étude de cas localisée de l'exécution la mise sur pied du préscolaire universel, et fournit des données empiriques sur la façon dont cette politique se met en place au niveau local. L’article identifie les opportunités et les défis liés à l’implantation du préscolaire universel au Queensland, qui pourraient avoir une portée sur la réforme de petite enfance en Australie ainsi que dans d'autres pays. La discussion des principaux résultats est faite en lien avec un aperçu global de la politique d'éducation et d’accueil de la petite enfance en Australie, avec un accent particulier sur l'engagement envers le préscolaire universel. Los educadores australianos actualmente están involucrados en una amplia reforma de la educación temprana nacional que está revolucionando la educación preescolar y los servicios de cuidado. El programa de reforma Australiana refleja muchas de las direcciones políticas relacionadas con la infancia temprana incitadas por organismos como la Organización de Cooperación y Desarrollo Económicos y el Fondo Educacional Infantil de las Naciones Unidas, y se basa en el doble discurso de (i) empezando fuertemente e (ii) invertir en los primeros años. Sin embargo, a pesar de su política de tracción en retórica y política, hay pocos datos empíricos de cómo la reforma se está llevando a cabo. Este documento informa sobre las investigaciones llevadas a cabo en colaboración con la Oficina de Queensland de Educación tempana y cuidados, para generar comentarios del sector, sobre uno de los elementos de la agenda de reforma, la aplicación del preescolar universal en Queensland. El estudio tiene como objetivo determinar la eficacia de la nueva política para apoyar la prestación de "programas preescolares aprovados" dentro se los servicios de guardería y cuidado. Reuniendo los puntos de vista y las experiencias de una serie de interesados, entre ellos algunas organizaciones cumbre, proveedores de servicios, los directores, los maestros preescolares y oficiales de política y gobierno, se logra un estudio simulado de la implementación del preescolar universal, y ofrece evidencia empírica de cómo esta política se está llevando a cabo en el plano local. El documento identifica las oportunidades y desafíos en la implementación del preescolar universal en Queensland, que puede repercutir en la reforma de la indancia temprana en Australia, así como en otros países. La discusión de los resultados claves se encuentra en el interior de una visión de la agenda política de ECEC en Australia, con un enfoque particular en el compromiso con el preescolar universal.

Prevalence and correlates of sleep disturbance in post-menopausal Australian women : the Healthy Aging of Women (HOW) study

Background: Sleep disturbance in midlife women has been studied extensively, although less is known about sleep after menopause. This study examined the relative impact of socio-demographics, modifiable lifestyle factors, and health status on sleep disturbance in post-menopausal women from Queensland, Australia. Methods: The longitudinal Healthy Aging of Women (HOW) study examines health-related quality of life (HRQOL measured by SF-12©), chronic illness, modifiable lifestyle factors such as physical activity, alcohol consumption, smoking, and sleep disturbance (General Sleep Disturbance Scale, GSDS ≥ 43 represent poor sleep) in midlife and older women from low and high socio-economic, rural and urban areas of South-East Queensland, Australia. This paper presents cross-sectional data from the 322 women, aged 60-70 years, participating in the HOW study in 2011. Results: For women in this study, sleep disturbance was relatively common, with 23% (n = 83) reporting poor sleeping (GSDS ≥ 43). Sleep disturbance scores were strongly correlated with being unemployed or on a disability support pension (β = 18.69, P < 0.01), sedentary lifestyle (β = 23.84, P < 0.01), and lower mental (β = -0.60, P <0.01) and physical health-related quality of life scores (β = -0.32, P = 0.01), and these variables explained almost one third of variance in sleep disturbance scores (ηρ² = 29%). Conclusions: Multivariable analysis revealed that sleep disturbance was correlated with physical and mental health-related quality of life, disability, and sedentary lifestyle, but not other lifestyle and socio-demographic characteristics. It may be however, that modifiable lifestyle factors may indirectly impact on sleep by influencing health status.

Consumer acceptance of m-wellbeing services : a social marketing perspective

Purpose This study aims to employ the Model of Goal-Directed Behaviour (MGB) to examine the consumer acceptance of technology-based self-service (TBSS) for a credence service instrumental to a social goal. Credence services are increasingly delivered via self-service technology and in social marketing, the achievement of social goals can be contingent on consumer acceptance of these services. However, little is known about the determinants of acceptance and extant marketing literature fails to account for emotional and goal influences which are likely to be important. Design/methodology/approach The authors interviewed 30 young adults with self-reported stress, anxiety or depression as potential users of a self-help mental health service delivered via mobile phone. The data were analysed deductively and inductively with the assistance of NVivo. Findings The findings generally support using the MGB to enhance understanding of consumers' acceptance of TBSS. The paper also found evidence of the importance of maintenance self-efficacy, the self-evaluation of the ability to continue using the service, and a previously ignored element of consumer level competition that arises between alternatives that achieve the same goal. Originality/value This study is the first to examine factors that influence consumers' acceptance of TBSS for credence services aimed at achieving a social goal. It builds on understanding of consumer decision making in social marketing, particularly the influence of self-efficacy and competition. It also contributes to attitudinal research by providing initial evidence for deepening and broadening the MGB in the context of TBSSs.

Evaluating patient presentations for care delivered by emergency nurse practitioners : a retrospective analysis of 12 months

Background The delivery of quality patient care in the emergency department (ED) is emerging as one of the most important service indicators to be measured in health services today. The emergency nurse practitioner role was implemented as a service innovation in a Emergency & Trauma Centre (ETC), Melbourne, Australia, in July 2004 .The primary aim of the role was intended to enhance healthcare services, improve the efficiency and timely delivery of high quality care to patients. Aim To conduct a retrospective study of patient presentations at the ETC to obtain a profile of the characteristics of patients managed by emergency nurse practitioners. Specifically the objectives of the study were to: 1) examine the demographics of the patient population 2) evaluate data on emergency department service indicators for this patient cohort Method All patients presenting to the ETC from January 01 2011 to December 31 2011 and managed by emergency nurse practitioners were included in the review. Data collection included baseline demographics, waiting times to be seen, length of stay, emergency department discharge diagnoses and referral patterns. Data were extracted and imported directly from the emergency department Patient Information System (Cerner log), for the specified time frame. Results A total of 5212 patients were reviewed in the study period. The median age of patients was 35 years and 61% of patients were male. The most common discharge diagnosis was open wounds to hand/wrist. Waiting times to be seen by the emergency nurse practitioner were 14 minutes and length of stay for patients with a discharge disposition of home were 122 minutes. Conclusions This study has provided information on patient baseline characteristics and performance on important service indicators for this patient sample that will inform further research to evaluate specific outcomes of the emergency nurse practitioner service.

Organisational change stressor and nursing job satisfaction : the mediating effect of coping strategies

Aim To examine the mediating effect of coping strategies on the consequences of nursing and non-nursing (administrative) stressors on the job satisfaction of nurses during change management. Background Organisational change can result in an increase in nursing and nonnursing- related stressors, which can have a negative impact on the job satisfaction of nurses employed in health-care organisations. Method Matched data were collected in 2009 via an online survey at two timepoints (six months apart). Results Partial least squares path analysis revealed a significant causal relationship between Time 1 administrative and role stressors and an increase in nursing-specific stressors in Time 2. A significant relationship was also identified between job-specific nursing stressors and the adoption of effective coping strategies to deal with increased levels of change-induced stress and strain and the likelihood of reporting higher levels of job satisfaction in Time 2. Conclusions The effectiveness of coping strategies is critical in helping nurses to deal with the negative consequences of organisational change. Implications for nursing management This study shows that there is a causal relationship between change, non-nursing stressors and job satisfaction. Senior management should implement strategies aimed at reducing nursing and nonnursing stress during change in order to enhance the job satisfaction of nurses. Keywords: Australia, change management, job satisfaction, nursing and non-nursing stressors, public and non-profit sector

Inside the research incubator : a case study of an intensive undergraduate research experience for nursing and midwifery students

Undergraduate research experiences are an increasing component of nursing and midwifery degrees. The Summer Research Scholarship Programme (SRSP) is a tertiary education initiative in Australia to provide an intensive undergraduate research experience. Between 2009 and 2010, six students and four academic faculty mentors in School of Nursing and Midwifery participated in an inaugural SRSP. This study explores the experiences of both students and faculty mentors to determine how this undergraduate research experience impacted student learning and interest in research. A qualitative case study approach was used to explore the research experiences of undergraduate student and faculty participants in an inaugural undergraduate research programme. Based on the results of two surveys four main themes were identified: (1) acquisition of research skills, (2) expectations, (3) academic engagement, and (4) continued interest in research. An intensive undergraduate research experience is a valuable component of student learning that has the capacity to contribute to immediate and longer-term learning and research outcomes.

Person centred nursing care in radiation oncology : a case study

Purpose The aim of this case study is to describe clinical staff perceptions of implementing a person-centred model of nursing in an outpatient radiotherapy treatment department, using a Primary Nursing/Collaborative Practice framework. The questions are: 1) what are the nursing and radiotherapy staff perspectives of the changed model of care, 2) what factors impacted on aspects of the evolving model?, and 3) how was interdisciplinary collaboration influenced by the new model? Methods An instrumental case study addressed the multiple perspectives of several radiotherapy health professionals, within a qualitative approach, to assess the new model of nursing care. Interview data were obtained from thirteen clinical staff over a six month period approximately one year after the model was implemented. Results The new model supports nurses to work more closely with the individual patient, with some perceived positive patient outcomes. Nurses reported increased satisfaction with their work, more autonomy and responsibility, and improved working relationships with medical staff. They also became more aware of the holistic approach to support positive patient outcomes. However, this study acknowledged that education was required for nurses to provide holistic care, especially in the context of complex interdisciplinary relationships. Conclusions A person-centred nursing approach in radiotherapy represents a radical change to the functional approach, providing some benefits for patients. However, the challenges of providing holistic care in the context of complex interdisciplinary relationships are evident, and this study acknowledges the importance of a team approach to addressing changes in practice in the future.

Quality of life, fatigue and activity in Australians with chronic kidney disease : a longitudinal study

Aims and objectives This study sought to determine the relationship between health related quality of life (HRQoL), fatigue and activity levels of people with anaemia secondary to chronic kidney disease (CKD) over a 12 month period following the introduction of an erythropoietin stimulating agent (ESA). Background CKD occurs in five stages and it is a complex chronic illness which severely impacts on an individual’s HRQoL, and ability to perform everyday activities. Fatigue is also a common symptom experienced by people with CKD. Design and methods Using a longitudinal repeated measures design, 28 people with CKD completed the SF-36, human activity profile and fatigue severity scale at the commencement of an ESA and then at 3, 6 and 12 months. Results Over a 12 month period, people reported a significant change in HRQoL in relation to role physical, vitality, mental health/emotional well-being and overall mental health. However activity levels did not significantly improve during that time. Both the amount of breathlessness and level of fatigue were highest at baseline and declined over time. Both fatigue and breathlessness were correlated with less reported general health over time. Conclusion Renal nurses, in dialysis units and CKD outpatient clinics, have repeated and frequent contact with people with CKD over long periods of time, and are in an ideal position to routinely assess fatigue and activity levels and to institute timely interventions. Early detection would enable timely nursing interventions to optimise HRQoL and independent activity. Relevance to Clinical Practice Drawing on rehabilitation nursing interventions could assist renal nurses to minimize the burden of fatigue and its impact on simple everyday activities and a person’s quality of life. These interventions are important for people who are living at home and could assist in lowering the burden on home support services.

Chronic kidney disease in Saudi Arabia : a nursing perspective

Chronic kidney disease (CKD) is a major health problem in Saudi Arabia. The number of people requiring kidney replacement therapy in Saudi Arabia is growing, which poses challenges for health professionals and increases the burden on the health care system. However, there is a paucity of nursing literature about CKD in the Middle Eastern region, including Saudi Arabia. The purpose of this review is to describe the epidemiology, risk factors, treatment modalities and the implications for nursing practice of CKD in Saudi Arabia. Improving nurses’ knowledge and awareness about CKD and the risk factors in Saudi Arabia will help them to determine high risk groups and provide early management to delay progression of the disease.

Young women's recent experience of labour and birth care in Queensland

Background Young parenthood continues to be an issue of concern in terms of clinical and psychosocial outcomes for mothers and their babies, with higher rates of medical complications such as preterm labour and hypertensive disease and a higher risk of depression. The aim of this study was to investigate how young age impacts on women's experience of intrapartum care. Methods Secondary analysis of data collected in a population based survey of women who had recently given birth in Queensland, comparing clinical and interpersonal aspects of the intrapartum maternity care experience for 237 eligible women aged 15–20 years and 6534 aged more than 20 years. Descriptive and multivariate analyses were undertaken. Results In the univariate analysis a number of variables were significantly associated with clinical aspects of labour and birth and perceptions of care: young women were more likely to birth in a public facility, to travel for birth and to live in less economically advantaged areas, to have a normal vaginal birth and to have one carer through labour. They were also less likely to report being treated with respect and kindness and talked to in a way they could understand. In logistic regression models, after adjustment for parity, other socio-demographic factors and mode of birth, younger mothers were still more likely to birth in a public facility, to travel for birth, to be more critical about interpersonal and aspects of care and the hospital or birth centre environment. Conclusion This study shows how experience of care during labour and birth is different for young women. Young women reported poorer quality interpersonal care which may well reflect an inferior care experience and stereotyping by health professionals, indicating a need for more effective staff engagement with young women at this time.

User-centred study on quality of mobile video services

Mobile video, as an emerging market and a promising research field, has attracted much attention from both industry and researchers. Considering the quality of user-experience as the crux of mobile video services, this chapter aims to provide a guide to user-centered studies of mobile video quality. This will benefit future research in better understanding user needs and experiences, designing effective research, and providing solid solutions to improve the quality of mobile video. This chapter is organized in three main parts: (1) a review of recent user studies from the perspectives of research focuses, user study methods, and data analysis methods; (2) an example of conducting a user study of mobile video research, together with the discussion on a series of relative issues, such as participants, materials and devices, study procedure, and analysis results, and; (3) a conclusion with an open discussion about challenges and opportunities in mobile video related research, and associated potential future improvements.