Phenomenon of ordinariness in nursing

This phenomenological research aimed to illuminate the nature and effects of ordinariness in nursing and to discover whether the phenomenon enhanced the nursing encounter. The researcher worked as a participant observer with six registered nurses in a Professorial Nursing Unit. Following each interaction, the researcher wrote her impressions in a personal-professional journal and audiotaped conversations with the respective nurses and patients to gain their impressions. Using a theoretical framework of the phenomenological concepts of lived experience, Dasein, Being-in-the-world and fusion of horizons as an underpinning methodology, an initial hermeneutical analysis and interpretation of the impressions generated qualities and activities indicative of the aspects of the phenomenon of ordinariness in nursing. The second phase of the analysis and interpretation sought to illuminate the nature of the phenomenon itself. Eight actualities of the nature of the phenomenon emerged: 'allowingness,' 'straightforwardness,' 'self-likeness,' 'homeliness,' 'favourableness,' 'intuneness,' 'lightheartedness' and 'connectedness.' These actualities were described in relation to the phenomenon of interest. The effects of the phenomenon were the creative potential to enhance the nursing encounter and included many and various effects of facilitation, fair play, familiarity, family, favouring, feelings, fun and friendship. The research found that nurses and patients shared a common sense of humanity, which enhanced the nursing encounter. Within the context of caring, the nurses were ordinary people, perceived as being extraordinarily effective, by the very ways in which their humanness shone through their knowledge and skills, to make their whole being with patients something more than just professional helping. The shared sense of ordinariness between nurses and patients made them as one in then- humanness and created a special place, in which the relative strangeness of the experience of being in a health care setting, could be made familiar and manageable.

Nursing work and nursing knowledge : exploring the work of women's health nurses, patterns of power and praxis

The majority of women's health nurses in this study work in generalist community health centres. They have developed their praxis within the philosophy and policies of the broader women's health movement and primary health care principles in Australia. The fundamental assumption underlying this study is that women's health nurses possess a unique body of knowledge and clinical wisdom that has not been previously documented and explored. The epistemological base from which these nurses' operate offers important insights into the substantive issues that create and continually shape the practice world of nurses and their clients. Whether this represents a (re)construction of the dominant forms of health care service delivery for women is examined in this study. The study specifically aims at exploring the practice issues and experience of women's health service provision by women's health nurses in the context of the provision of cervical cancer screening services. In mapping this particular group of nurses practice, it sets out to examine the professional and theoretical issues in contemporary nursing and women's health care. In critically analysing the powerful discourses that shape and reshape nursing work, the study raises the concern that previous analyses of pursing work tend to universalise the structural and social subordination of nurses and nursing knowledge. This universalism is most often based on examples of midwifery and nursing work in hospital settings, and subsequently, because of these conceptualisations, all of nursing is too often deemed as a dependent occupation, with little agency, and is analysed as always in relation to medicine, to hospitals, to other knowledge forms. Denoting certain discourses as dominant proposes a relationship of power and knowledge and the thesis argues that all work relations and practices in health are structured by certain power/knowledge relations. This analysis reveals that there IX are many competing and complimentary power/knowledge relations that structure nursing, but that nursing, and in particular women's health nurses, also challenge the power/knowledge relations around them. Through examining theories of power and knowledge the analysis, argues that theoretical eclecticism is necessary to address the complex and varied nature of nursing work. In particular it identifies that postmodern and radical feminist theorising provide the most appropriate framework to further analyse and interpret the work of women's health nurses. Fundamental to the position argued in this thesis is a feminist perspective. This position creates important theoretical and methodological links throughout the whole study. Feminist methodology was employed to guide the design, the collection and the analysis. Intrinsic to this process was the use of the 'voices' of women's health nurses as the basis for theorising. The 'voices' of these nurses are highlighted in the chapters as italicised bold script. A constant companion along the way in examining women's health nurses' work, was the reflexivity with feminist research processes, the theoretical discussions and their 'voices'. Capturing and analysing descriptive accounts of nursing praxis is seen in this thesis as providing a way to theorise about nursing work. This methodology is able to demonstrate the knowledge forms embedded in clinical nursing praxis. Three conceptual threads emerge throughout the discussions: one focuses on nursing praxis as a distinct process, with its own distinct epistemological base rather than in relation to 'other' knowledge forms; another describes the medical restriction and opposition as experienced by this group of nurses, but also of their resistance to medical opposition. The third theme apparent from the interviews, and which was conceptualised as beyond resistance, was the description of the alternative discourses evident in nursing work, and this focused on notions of being a professional and on autonomous nursing praxis. This study concludes that rather than accepting the totalising discourses about nursing there are examples within nursing of resistance—both ideologically and X in practice—to these dominant discourses. Women's health nurses represent an important model of women's health service delivery, an analysis of which can contribute to critically reflecting on the 'paradigm of oppression' cited in nursing and about nursing more generally. Reflecting on women's health service delivery also has relevance in today's policy environment, where structural shifts in Commonwealth/State funding arrangements in community based care, may undermine women's health programs. In summary this study identifies three important propositions for nursing: • nursing praxis can reconstruct traditional models of health care; • nursing praxis is powerful and able to 'resist' dominant discourses; and • nursing praxis can be transformative. Joining feminist perspectives and alternative analyses of power provides a pluralistic and emancipatory politics for viewing, describing and analysing 'other' nursing work. At the micro sites of power and knowledge relations—in the everyday practice worlds of nurses, of negotiation and renegotiation, of work on the margins and at the centre—women's health nurses' praxis operates as a positive, productive and reconstructive force in health care.

Nursing and being nursed from patients' perspectives : an ethnographic study

The research was commenced to understand why patients submissively accept compliance in the nursing relationship. To understand this phenomenon, an anthropological perspective about nursing was sought through ethnographic processes, utilising The Ethnographic Research Cycle and The Developmental Research Sequence as detailed by James Spradley (1980). Ethnographic methods of fieldwork and participant observation were undertaken over a three month period in a district nursing service in a rural area of Victoria, Australia. There are three over arching aims. The first is to record information at risk of being lost, hence the ethnography is an archival record describing insiders' perspectives of nursing practice. Description brings into view broad contextual issues that shape nursing practice, the daily routines and cultural norms of nursing, whilst also giving voice to patients' experiences about being nursed. The early part of the thesis is descriptive of the mundanity of nursing practice and of being a patient as these interactions are of fundamental significance in giving meaning to people's lives. Secondly the inquiry seeks to capture the meaning patients attach to nursing. Further description continued to uncover perspectives of nursing that were layered to present an integrated whole that still acknowledges the integrity of individuals and structures that make up that whole. As the cultural picture gained detail, the expected norms of being a nurse and a patient became evident, revealing how culture gives shape to nursing and being nursed. Notions of time and space were found to be constructs of being a patient which shape the illness experience. They are not necessarily within a patient's control, nonetheless, there is a norm and deviation from this norm has consequences for patients. Thirdly, the ethnography conveys the expected behaviour for a person who becomes a patient, to make known the implicit meanings, norms of behaviour and unwritten rules that a patient needs to understand as they pass through various stages of the health care system. In conclusion, the ethnography consistently reveals the underlying conflict between what nurses believe they do and the meaning attached to the experience of being nursed. For example, some nurses practice with patients' values as central to practice; others believe they care, yet observation and patient conversations suggest that they do not. The ethnography revealed that society expects nurses to elicit and reinforce compliance. Similarly, the power of culture shapes the experience of patients as the desire to be accepted, as a personal need, and as a means of having their nursing needs met, means that patients will invariably be passively compliant. The consequence is that nurses have a dominant power differential over patients, therefore, if nursing is to continue to describe practice as humanistic and caring, they ought to actively seek to be aware of patients' values and be motivated to accept these as central to practice.

Notion of impaired practice in nursing : a radical feminist perspective

In this radical feminist investigation of impaired practice in nursing it is argued that prejudicial and discriminatory attitudes and behaviours deriving from racism, ageism and lesbian phobia constitute impaired practice in nursing. The author's vision is that society, of which nursing would be a part, would truly care for all, regardless of race, age or sexuality.

Clinical nurse research consultant : a clinical and academic role to advance practice and the discipline of nursing

Aims:  This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role. Background:  Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians. Data sources:  International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant. Discussion:  The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus. Implications for nursing:  Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support. Conclusion:  The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing.

Challenging the handover : recommendations for research and practice

Communicating nursing care during the patient's total hospital stay is a difficult task to achieve within the context of high patient turnover, a lack of overlap time between shifts, and time constraints. Clear and accurate communication is pivotal to delivering high quality care and should be the gold standard in any clinical setting. Handover is a commonly used communication medium that requires review and critique. This study was conducted in five acute care settings at a major teaching hospital. Using a grounded theory approach, it explored the use of three types of handover techniques (verbal in the office, tape-recorded, and bedside handovers). Data were obtained from semi-structured interviews with nurses and participant field observations. Textual data were managed using NUD-IST. Transcripts were critically reviewed and major themes identified from the three types of handovers that illustrated their strengths and weaknesses. The findings of this study revealed that handover is more than just a forum for communicating patient care. It is also used as a place where nurses can debrief, clarify information and update knowledge. Overall, each type of handover had particular strengths and limitations; however, no one type of handover was appraised as being more effective. Achieving the multiple goals of handover presents researchers and clinicians with a challenging task. It is necessary to explore more creative ways of conducting the handover of patient care, so that an important aspect of nursing practice does not get classified as just another ritual.

Rural nursing and health care reforms : building a social model

This article explores recent shifts in health-care policy and the implications for rural nursing in Australia. Health-care reforms have resulted in the implementation of a 'market forces' ideology, creating tensions between economic imperatives and the need for equity and greater access in rural service delivery. New models of health-service delivery have been developed that have significant implications for the way rural health care is defined, practised and received. The issues surrounding the context of rural nursing practice and service delivery are discussed.

Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice

Postoperative pulmonary complications are the most frequent and significant contributor to morbidity, mortality, and costs associated with hospitalization. Interestingly, despite the prevalence of these complications in cardiac surgical patients, recognition, diagnosis, and management of this problem vary widely. In addition, little information is available on the continuum between routine postoperative pulmonary dysfunction and postoperative pulmonary complications. The course of events from pulmonary dysfunction associated with surgery to discharge from the hospital in cardiac patients is largely unexplored. In the absence of evidence-based practice guidelines for the care of cardiac surgical patients with postoperative pulmonary dysfunction, an understanding of the path ophysiological basis of the development of postoperative pulmonary complications is fundamental to enable clinicians to assess the value of current management interventions. Previous research on postoperative pulmonary dysfunction in adults undergoing cardiac surgery is reviewed, with an emphasis on the pathogenesis of this problem, implications for clinical nursing practice, and possibilities for future research.

Best practice in stabilisation of oral endotracheal tubes : a systematic review

Mechanical ventilation of patients in intensive care units is common practice. Artificial airways are utilised to facilitate ventilation and the endotracheal tube (ETT) is most commonly used for this purpose. The ETT must be stabilised to optimise ventilation and avoid displacement or unplanned extubation. Tube movement is a major factor in causing airway trauma. A destabilised tube can cause fatal complications. A systematic review was conducted to identify and analyse the best available evidence on ETT stabilisation to determine which stabilisation method resulted in reduced tube displacement and the least amount of unplanned or accidental extubations. The types of stabilisations included one or a combination of the following methods: twill or cotton tape, adhesive tape, gauze, or a manufactured device. All relevant randomised controlled and quasi-experimental studies of ETT stabilisation practices, identified through electronic and hand searching, were assessed for inclusion in the study. One published randomised controlled trial and six published quasi-experimental studies met the inclusion and exclusion criteria and were retrieved. Data were extracted independently by two reviewers. Results of the systematic review showed that no single method of ETT stabilisation could be identified as superior for minimising tube displacement and unplanned or accidental extubations. Rigorous randomised controlled trials with clearly identified and described ETT stabilisation methods are required to establish best practice. In addition, comparative research to evaluate cost effectiveness and nursing time requirements would also be of significant benefit to critical care nursing practice.

Defining the scope of practice of the emergency nurse practitioner role in a metropolitan emergency department

This study examined the emergency nurse practitioner candidate (ENPC) scope of practice in a Victorian emergency department (ED). The emergency nurse practitioner (ENP) role is relatively new in Victoria and the scope of the ENP(C) practice is yet to be defined. International research literature regarding the ENP role has focused on outcomes such as patient satisfaction, waiting times and/or ED length of stay, accuracy and adequacy of documentation, use of radiography, and patient education, health promotion and communication issues. A prospective exploratory design was used to conduct this cohort study. There were 476 ENPC-managed patients between 14 July 2004 and 31 March 2005 with an average age of 29 years. The majority (77.2%) of ENPC-managed patients were discharged from the ED. The majority of the ENPC time was devoted to clinical practice (55%) and development of clinical practice guidelines (25%). Of patients managed by the ENPC, 49.6% required medications, 51% required diagnostic imaging and 8.6% required pathology testing during their ED stay. The most common discharge referrals were made to local medical officers (73.5%) and the most common referrals made for patients requiring admission were made to the plastic surgery (37.3%) and orthopaedic (35.5%) units. Extensions to the current scope of emergency nursing practice are pivotal to effective management of specific patient groups by ENP. The ENP model of care is an important strategy for the management of increased service demands in Victoria; however, little is known about the scope of the ENPC practice and many outcomes of the ENP care are yet to be defined. Further research to better understand the relationships between ENP outcomes is required if the contribution that ENPs make to emergency care is to be accurately quantified.

Nursing education and graduates : profiles for 1999 and 2000, with projections for 2001

An analysis of DEST statistical data on nursing education had suggested that there were issues with the classification of undergraduate data and new initiatives, such as combined degrees, which were poorly captured. This project had two distinct aims. First, to explore and map exhaustively the range of undergraduate programs offered by tertiary education providers across Australia leading to an initial qualification and entry into nursing practice. Second, to explore and map in detail specialist nursing education courses offered by tertiary and other education providers across Australia. This research was funded under the Evaluations and Investigations Programme (EIP).

Nursing educations and graduates : profiles for 2001 and projections for 2002

The present study was commissioned for the National Review of Nursing Education. This is the second of two national studies commissioned to map in detail nursing education programs and to profile and make future projections regarding graduates from undergraduate and postgraduate nursing education courses in Australia.

The first study was undertaken in 2001 by Deakin University School of Nursing under the auspices of the 2001 Evaluation Investigations Project titled "Nursing Education and Graduates: Profiles for 1999, and 2000 with projections for 2001". This project sought data on nursing education within Australia in order to improve the accuracy of nursing education databases and to strengthen the ability of DETYA to provide advice on workforce planning. Issues that arose from that project included differences in data sets for undergraduate nursing courses in Australia and the complex process of attempting to tease out and accurately quantify postgraduate specialty courses when a trend towards postgraduate generic courses was evident. Approximately 26% of postgraduate domestic student enrolment data were reported utilising a generic nursing course category.

The purpose of this study was, therefore, twofold. Firstly, this study validated and extended the existing database developed in the previous study mapping in detail the full range of undergraduate programs offered by tertiary education providers across Australia that lead to an initial qualification and entry into nursing practice.

New data about the following was sought:

* Undergraduate nursing degrees (both three-year and four-year courses);
* Double/combined nursing degrees;
* Courses offered by private universities;
* Four-year bachelor degrees that concurrently provide both initial nurse registration and preparation for specialty nursing practice;
* Courses that facilitate ‘fast-tracking’ of students for initial nurse registration with previous tertiary or nursing studies,
* Hours and configuration of clinical experience in undergraduate nursing courses.

The career development year : responding to the emergency nursing shortage in Australia

Background: The Career Development Year (CDY) is a 12 month supported entry program at one health care service in Victoria, Australia. The program targets Division One Registered Nurses with little or no emergency nursing experience. The intent of CDY is to improve recruitment to, and retention in, emergency nursing by educational and experiential preparation for emergency nursing practice.

Method: This study used a retrospective exploratory design to examine recruitment and retention of emergency nurses recruited via CDY (n = 72) and compare these findings with recruitment and retention data for a cohort of non-CDY participants (n = 15). CDY data was collected by self-report questionnaires. Descriptive statistics, correlations and inferential statistics were calculated using SPSS.

Results: CDY was found to promote recruitment of novice nurses to emergency nursing, with almost half the respondents (n = 25, 48.1%) reporting they would not have entered emergency nursing were it not for the supported entry program. Further, comparison with non-CDY participants revealed that CDY promoted retention within emergency nursing, with both short-term (n = 47, 90.4% vs. n = 8, 53.4%) and long-term retention doubling (n = 50, 96.1% vs. n = 7, 46.6%) following the introduction of CDY.

Conclusion: CDY was a valuable recruitment tool and successful retention strategy in the ED. Future research using a larger sample may demonstrate potential applicability to other clinical areas.