Round the bend : a history of psychiatric nursing in Victoria

This feature length documentary explores the development of psychiatric nursing from the early colonial beginnings in 1848 through to the post-institutional present. The film commences with a montage of photos, film and narrative that documents the period until 1930s.

The period from the 1930s to the present is described chronologically in oral histories provided by personal interviews with psychiatric nurses. The interviews include a number of key psychiatric nurse leaders who were instrumental in bringing about significant changes to nursing practice and education, and were also at the forefront of leading major reforms to service delivery in Victoria such as the community mental health movement.

The oral histories provide an account of the history of this unique area specialty of nursing. At times confronting and challenging, the film also highlights the significant contribution of psychiatric nursing to the development of humanistic, person-centered philosophies of care in mental health. The narratives are woven together with photographs and film footage of historical artifacts and institutions.

'We just do the dirty work': dealing with incontinence, courtesy stigma and the low occupational status of carework in long-term aged care facilities.

AIMS AND OBJECTIVES: To systematically examine, describe and explain how continence care was determined, delivered and communicated in Australian long aged care facilities. BACKGROUND: Incontinence is a highly stigmatising condition that affects a disproportionally large number of people living in long-term aged care facilities. Its day-to-day management is mainly undertaken by careworkers. We conducted a Grounded theory study to explore how continence care was determined, delivered and communicated in long-term aged care facilities. This paper presents one finding, i.e. how careworkers in long-term aged care facilities deal with the stigma, devaluation and the aesthetically unpleasant aspects of their work. DESIGN: Grounded theory. METHODS: Eighty-eight hours of field observations in two long-term aged care facilities in Australia. In addition, in-depth interviews with 18 nurses and careworkers who had experience of providing, supervising or assessment of continence care in any long-term aged care facility in Australia. RESULTS: Occupational exposure to incontinence contributes to the low occupational status of carework in long-term aged care facilities, and continence care is a symbolic marker for inequalities within the facility, the nursing profession and society at large. Careworkers' affective and behavioural responses are characterised by: (1) accommodating the context; (2) dissociating oneself; (3) distancing oneself and (4) attempting to elevate one's role status. CONCLUSION: The theory extends current understandings about the links between incontinence, continence care, courtesy stigma, emotional labour and the low occupational status of carework in long-term aged care facilities. RELEVANCE TO CLINICAL PRACTICE: This study provides insights into the ways in which tacit beliefs and values about incontinence, cleanliness and contamination may affect the social organisation and delivery of care in long-term aged care facilities. Nurse leaders should challenge the stigma and devaluation of carework and careworkers, and reframe carework as 'dignity work'.

An exploration of the role and scope of the Clinical nurse consultant (CNC) in a metropolitan health service

Introduction

Clinical nurse consultants have been a part of the nursing workforce for some time however a lack of clarity regarding this role has led to significant variations in health service expectations, workloads and scope for the Clinical nurse consultants working within this metropolitan health service.

Aim

The aim of this study was to explore the role of the CNC as it is perceived by them, in the context of this health service.

Method

A qualitative approach was used for this study. Following ethics approval a single audio-taped focus group was undertaken to gather data. Guiding questions were used to elicit responses from the group, moderated by the co-investigators. The focus group was transcribed verbatim. Each researcher independently analysed the narrative data, using coding and clustering the data to develop primary and sub-themes.

Results

Whilst each participant experiences their role individually, there were four themes derived from comments expressed by the participants: ‘Diversity and conflict’, ‘Leaders but powerless’, ‘Support systems’ and ‘The portfolio holder role’.

Conclusion

The role of the Clinical nurse consultant is complex and diverse. The variability in the role suggests that organisational consensus of the role, scope and purpose of the CNC position has not been actualised, resulting in a lack of support systems, and an underutilisation of the Clinical nurse consultants as leaders, where they can challenge existing practice and guide future directions in care delivery.

Is creativity a matter for cultural leaders?

A climate of change in the arts in the 1990s, including a growing recognition of the need for creative management, has raised the issue of how not-for-profit art museum directors use creativity in their managerial role. Traditionally, the prime function of art museums has been to gather, preserve and study objects. The perception of directors as keepers of collections and creativity as residing in the object has evolved. Creativity is increasingly seen as residing in the managers of organizations. A survey of Australian and New Zealand art museum directors revealed six strategic responses to change, indicating the extent to which they used creativity in their leadership role: economic emphasis, market orientation, audience development, collaboration, accessibility and community relations. The question this paper poses is whether the change in the director's role has overturned the traditional view of creativity as focused on the art work rather than on management initiatives. The proposed answer is that it has been not so much overturned as extended: directors now balance the development and preservation of creative art works with creative management of the art museum as a market-facing organization.

Administering the global trap : the role of educational leaders

This article begins with an analysis of Martin and Schumann’s thesis that globalization is (a) enhancing the power of corporations and undermining the sovereignty of nation states and (b) in the process consuming social capital at an alarming rate, thus producing a loss of social cohesion. Globalization is then discussed in terms of the transformations of technology, finance, production and culture, and Gray’s account of differing relationships between markets and cultures in differing forms of capitalism is introduced. The Third Way is then analysed as a specific attempt to resolve cultural contradictions and its limitations are set out. As a possible way forward Amartya Sen’s account of ‘development as freedom’ is outlined and the implications for the role of educational leaders are discussed.

`Zealotry or nostalgic regret`? women leaders in technical and further education in Australia : agents of change, entrepreneurial educators or corporate citizens?

Education has been restructured in many Western post-industrial nation states during the 1990s. The Australian Technical and Further Education sector (TAFE) has been particularly susceptible to discourses of responsiveness to the market and the new entrepreneuralism. This article explores how women have been repositioned in contradictory and ambiguous ways as the new entrepreneurial middle managers by existing and emergent discourses that circulated in and through TAFE organizations. In turn, it points to how discourses of change management and client responsiveness took on particular readings within specific institutional and professional cultures of the eight Technical and Further Education institutions (TAFEs). At the same time, the restructuring that arose from the corporatization of TAFE, in a highly gendered process, through the twin strategies of marketization and the new managerialism produced new possibilities for individual women educators who moved up into middle management. Yet these individual women were positioned within highly masculinist 'neo-corporate bureaucratic cultures' that co-opted their passion for the capacity of education to make a difference and incorporated these new entrepeneurial work identities.

Complementary therapies or 'luxury' therapies? A nurse's experience in the use of complementary therapies in nursing practice

Complementary therapies have an increasing popularity. This case study explores the experience of a nurse who practises complementary therapies within the health care system where there is a still a widespread of skepticism within the medical profession. It is considered by the nurse that it is a 'luxury' to include these therapies in nursing practice.

Nurse academics meeting the challenges of scholarship and research

This research study explored nurse academics' perceptions and experiences of scholarship and research. Interviews were carried out with 20 nurse academics in four Australian states. A grounded theory approach was used to explore issues they faced. The paper discusses how academics engaged in research and scholarship integrate it into their work practices. The participants spoke of problems encountered, such as the difficulty of gaining higher degrees whilst undertaking additional research. They indicated they felt under significant pressure to publish. The organisational structures that a small number of institutions put in place to facilitate the development of a scholarly research culture are illustrated.

Community leaders' views of the purposes of science in the compulsory years of schooling

Accepting that scientific literacy is the primary purpose of science in the compulsory years of schooling leads to the question 'What does scientific literacy mean in a particular community?' This paper reports a study designed to provide some insight into that question. Data were gathered through interviews with a sample of community leaders, in the state of Victoria, Australia, about their views of the purposes of school science.

The data reveal that, although most of those interviewed had no formal post-school science education, their life experiences provided them with useful insights into the question raised. The wisdom of such people could make an important contribution during the initial stages of curriculum development in science.

As people successful in their own fields, the study participants were lifelong learners. Consequently, their responses suggest that a primary focus of school science must be to provide students with a framework that will enable them to continue learning beyond schooling. This is not just a matter of knowledge or skills, but of feeling comfortable with science.

The methods used provide a useful example of how views about education can be gathered from thoughtful, non-expert community members. In this instance, they allowed a reconceptualization of the purposes of school science. These community leaders argued for an education for 'science in life' rather than an education about science.

A trial of nurse practitioner scope of practice

Aims. The aim of this paper is to report a trial to investigate the feasibility of the nurse practitioner role in local health service delivery and to provide information about the educational and legislative requirements for nurse practitioner practice.

Background. Nurse practitioners have been shown to offer a beneficial service and fill a gap in health care provision. However, the lack of publications describing, critiquing, or defending the way that existing nurse practitioner roles have been developed may lead to a lack of clarity in comparing the nurse practitioner scope of practice internationally. In Australia, credible exploratory research is needed to realize the potential of nurse practitioners to bridge the divide of inequitable distribution of health services. A trial of nurse practitioner services in the Australian Capital Territory provided an excellent opportunity to investigate these scope and continuity issues.

Methods. This was an observational analytic study using multiple data sources. Four models of nurse practitioner service were chosen from a competitive field of applications that were evaluated according to efficacy, feasibility, and sustainability across specified selection criteria. Each model in the trial included a clinical support team, with the nurse practitioner candidate 'working-into-the-role' and collecting demographic, clinical practice, patient outcome, and health service and consumer survey data over a 10 month period.

Findings. The trial identified the broad potential of the nurse practitioner role, its breadth and limitations, and its impact on selected health services in the Australian Capital Territory. Data from individual models were compared highlighting generic elements, and formed the basis for the development of the scope of practice for the Australian Capital Territory nurse practitioner models.

Conclusions. This study has validated a research-based, iterative process for initial development of nurse practitioner scope of practice for any Australian specialization. Importantly, the study concluded with the scope of practice as a finding, rather than commencing with it a priori. Although general areas of health care need and under-servicing were identified at the outset, the process tested both the expansion and parameters of the roles.

A historical review of the nurse practitioner role in Australia

Internationally, the nurse practitioner role has been shown to be cost-effective, safe, and instrumental in improving patient outcomes. The nurse practitioner role in Australia is in its infancy. Major stakeholders such as the nurses' boards and state departments of health throughout Australia were contacted to identify major policies and discussion papers. Database searches were conducted in CINAHL and EBSCOhost. Disparity between states exists in all facets of the nurse practitioner role, especially in definition of the role, scope of practice, educational qualifications, and specialized functions. Access to Medicare funding is unobtainable, resulting in inequity of access to health services for disadvantaged communities. The State Nurse Practitioner Taskforce Reports highlight the disparity between the role of nurse practitioner in each State of Australia and has led to fragmentation of the role at a national level. There is a need for consistency, which could be achieved if it were coordinated by a national nursing body with a voice in national health policy development and implementation

Emergency nurse practitioner care and emergency department patient flow: case-control study

Objective: The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care. Methods: A case–control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care. Results: There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS. Conclusion: Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes.

Development, reliability and validity of an instrument measuring the attitudes and knowledge of emergency department staff regarding the emergency nurse practitioner role

Introduction: The Emergency Department (ED) at The Northern Hospital is currently participating in the Victorian Department of Human Services funded Emergency Nurse Practitioner Project. This project aims to develop, implement and evaluate the Emergency Nurse Practitioner role in Victorian EDs. This led to a need to develop a specific data collection tool called The Northern Emergency Nurse Practitioner Staff Survey to examine the knowledge and attitudes of ED medical and nursing staff. This paper describes the development of The Northern Emergency Nurse Practitioner Staff Survey and presents the results of reliability and validity studies. Method: Twenty-five items were developed and piloted on a sample of 58 ED medical and nursing staff. Content and face validity were established by expert panel review. Reliability was established by tests of unidimensionality, exploratory factor analysis and internal consistency. Results: Four items were discarded because of low item to total correlation. Exploratory factor analysis of the remaining items revealed five factors with eigenvalues >1 and acceptable correlation coefficients that explained 76.7% of the variance. Cronbach’s coefficent α for these items was 0.926 indicating a high degree of internal consistency. The factors were titled to reflect the content domain of the items in each factor and the factors arranged in a logical sequence to form the final version of The Northern Emergency Nurse Practitioner Survey.