40 years of cancer nursing in Australia : the emergence of a specialty

Over the past 40 years, the nature and scope of cancer nursing practice has been shaped to a large extent by scientific and medical advances, as well as by social, economic and political factors. Nurses’ role in cancer care has evolved from being predominantly functional and dependent in its approach to being a specialty with clearly defined standards of practice underpinned by a growing evidence base and an agreed set of professional performance capabilities. The unique contribution that nurses make to minimising the effects of cancer on a person’s life and improving the patient experience is now well established and Australian cancer nurses are recognised as leaders in the field internationally. Nurses have achieved improved outcomes for people affected by cancer as part of a multidisciplinary team. By being active participants in the Clinical Oncological Society of Australia for at least 30 of the organisation’s 40 year history, Australian cancer nurses have been provided unique opportunities for professional development and inter-professional collaboration. To meet future challenges in delivering quality cancer care, cancer nurses will need to be full partners with consumers and with other health professionals in redesigning health care systems that are more responsive to changes in social, demographic, scientific and technological contexts.

Development of the palliative care needs assessment tool (PC-NAT) for use by multi-disciplinary health professionals

Needs assessment strategies can facilitate prioritisation of resources. To develop a needs assessment tool for use with advanced cancer patients and caregivers, to prompt early intervation. A convenience sample of 103 health professionals viewed three videotaped consultations involving a simulated patient, his/her caregiver and a health professional, completed the Palliative Care Needs Assessment Tool (PC-NAT) and provided feedback on clarity, content and acceptability of the PC-NAT. Face and content validity, acceptability and feasibility of the PC-NAT were confirmed. Kappa scores indicated adequate inter-rater reliability for the majority of domains; the patient spirituality domain and the caregiver physical and family and relationship domains had low reliability. The PC-NAT can be used by health professionals with a range of clinical expertise to identify individuals' needs, thereby enabling early intervention. Further psychometric testing and an evaluation to assess the impact of the systematic use of the PC-NAT on quality of life, unmet needs and service utilisation of patients and caregivers are underway.

What should I say?: Qualitative findings on dilemmas in palliative care nursing

The nursing literature suggests that talking and listening to patients about issues associated with death and dying, is both important and difficult, and may be improved with training. This discussion presents the results of recent nursing research to confirm, and elaborate on, this theme. In this research participants touched on many central issues in communicating with patients that included articulating a sense of discomfort and inadequacy about the whole process, detailing the innumerable blocks to open communication [e.g., interference, denial, unrealistic optimism, resistance, collusion and anger] and sharing their sense of success and failure. The insights of nurses who participated in this research testify to the ongoing need to prioritize the development of nursing skills and support in this challenging but important area.

Mediating conflict and control : practice challenges for nurses working in palliative care

A work-based professional development program was offered to a group of registered nurses working in palliative care. The goal of the program was to improve skills in psychosocial care (Yates et al., 1996). Participants were encouraged to reflect critically on their practice experience within a group setting. The focus of the group discussion and reflection were shared practice incidents. Each participant was given the opportunity to identify and describe an incident from their professional practice that presented a challenging issue within palliative nursing. This paper explores the themes of conflict and control, evident within the collection of fifteen practice incidents and discusses the nurses role as mediator. The concepts of patient advocacy and professional autonomy are challenged through the nurses experience of providing care within a hierarchical and bureaucratic health service. The outcome of reflection for the organization is most effective when shared experience and collective action (rather than individual practice) are the focus.

Exploring empathy as a variable in the evaluation of professional development programmes for palliative care nurses

Research indicates that empathy, a quality regarded as fundamentally important to nursing practice, is a teachable skill. Because empathic nurse-patient relationships are particularly important in the care of the terminally ill, this has direct relevance to the professional development of palliative care nurses. This article discusses the place of empathy as a criterion variable in the evaluation of a professional development program for palliative care nurses introduced at the Centre for Mental Health Nursing Research at Queensland University of Technology, Brisbane, Australia. A modified version of the Staff-Patient Interaction Response Scale (SPIRS) was used as a pre- and postintervention measure to assess the expressed empathy of the participating nurses. The modifications to SPIR and its coding system to make it suitable for palliative care nursing, and the mechanisms for improving and evaluating the reliability of this instrument will be discussed. The full description of this particular modification of SPIRS for palliative care research is provided as an example of how this instrument could be used in projects for which nurses undertake the difficult task of providing compassionate care to the terminally ill.

Design of a professional development programme for palliative care nurses (Part Two)

Yates et al (1996) provided a review of the literature on educational approaches to improving psychosocial care of terminally ill patients and their families and suggested that there was an urgent need for innovation in this area. A programme of professional development currently being offered to 181 palliative care nurses in Queensland, Australia, was also described. This paper presents research in progress evaluating this programme which involves use of a quasi-experimental pre-post test design. It also includes process and outcome measures to assess effectiveness in improving the participant's ability to provide psychosocial care to patients and families. Research examining the effectiveness of various educational programmes on care of the dying has offered equivocal results (Yates et al 1996). Degner and Gow (1988a) noted that the inconsistencies found in research into death education result from inadequate study designs, variations in the conceptualisation and measurement of the outcomes of the programmes and flaws in data analysis. Such studies have often lacked a theoretical basis, few have employed well-controlled experimental designs, and the programme outcomes have generally been limited to the participant's 'death anxiety', or other death attitudes which have been variously defined and measured. Whilst Degner and Gow (1988b) have reported that undergraduate nursing students who participated in a care of the dying educational programme demonstrated more 'approach caring' behaviours than a control group, the impact of education programmes on patient care has rarely been examined. Failure to link education to nursing practice and subsequent clinical outcomes has, however, been seen as a major limitation of nursing knowledge in this area (Degner et al 1991). This paper describes an approach to researching the effectiveness of professional development programmes for palliative care nurses.

Improving psychosocial care: a professional development programme

Despite the numerous reports of difficulties experienced by health care providers in providing psychosocial care to terminally ill patients and their families, few studies have yet been undertaken to examine the effectiveness of different educational approaches to addressing these issues. The aim of this paper is to describe a programme of professional development for palliative care nurses, which is currently being offered to 181 registered nurses in Queensland, Australia. The programme is based on an action learning model and is designed to facilitate processes of reflection and peer consultation. In Part One of this paper, a review of this literature is presented to provide the background and rationale for the programme design. Details of the research programme developed to evaluate the programme will be presented in Part Two of this paper, which is to be published in the next issue of this Journal. Surveys of health professionals suggest that the demands of working with terminally ill patients are associated with a great deal of stress (Beaton and Degner 1990, Seale 1992, Vachon 1995), and emotional burden, as they are confronted with their patients' physical and emotional suffering over extended periods of time (Ullrich and Fitzgerald 1990). Key areas of concern (Lyons 1988, Bramwell 1989, Seale 1992, Copp and Dunn 1993, Wilkinson 1995) include: * Handling questions and conversations with dying patients. * Dealing with ethical and moral issues. * Handling emotions. * Giving hope. * Providing spiritual care and bereavement support. * Confronting team communication problems.

Pain : the views of elderly people living in long term residential care settings

While an individual's beliefs and attitudes have long been considered important factors in how people respond to pain, few studies have attempted to provide in-depth descriptions of the nature of such pain beliefs and attitudes The aim of this research was to investigate the views of pain and pain management practices held by elderly people living in long-term residential care settings Ten 60–90 minute focus group interviews, each involving around five elderly people, were conducted in four large, long-term residential care settings in Brisbane, Australia Categories of beliefs and attitudes regarding pain were identified following analysis of the verbatim transcripts of these interviews Findings suggest that many elderly people living in long-term residential care settings may have become resigned to pain, that they are ambivalent about the benefit of any action for their pain and that they may be reluctant to express their pain Implications of these beliefs and attitudes are discussed

Constructions of children's needs in informal kinship care in rural China

Kinship care is the oldest form of alternative child care in the world. Recent years have witnessed a significant increase in the number of children being placed in kinship care across Western countries. However, in contrast to rapid knowledge advances about formal kinship care, far less is known about the needs of children in informal kinship care, especially in Asian contexts. This thesis and the study upon which it is formed sought to redress this knowledge gap. Qualitative approach was adopted to explore social constructions of children in informal kinship care in rural China. Parents in China seeking work in cities have left behind around 58 million rural children, mostly with relatives and without the involvement of the state. The present study examined caregivers’ and school personnel’s understandings of these school-age children’s needs through semi-structured interviews with 23 kin caregivers and five school personnel in Shijiapu Town, Jilin Province, China. The central question that guided the whole study is: What are the needs of children in informal kinship care in rural Jilin Province, China? Interpretative Phenomenological Analysis was used to categorise and interpret the qualitative data. Based on participants’ constructions, this study developed a need model with eight themes. They are: (1) emotional needs and mental health, (2) relationships, (3) empowerment and agency, (4) safety, (5) education, (6) basic care, (7) physical health, and (8) personal development. These needs are grounded in the Chinese context, and therefore a good understanding of Chinese culture is essential to address them. The first four needs particularly capture children’s separations from their parents, and the rest are more general, and can be applied to most Chinese children. To meet the most important need for children left behind, namely education, these caregivers determined that others needs sometimes have to be compromised. Children left behind are a vulnerable group in contemporary rural China, and their diverse needs are attended to by several groups. This study found that as children’s closest kin while their parents are away, caregivers play a vital role in salving the children’s emotional loss. Caregivers’ love and familial obligations strongly motivate them to care for these children, and sensitivity to social stigma makes them strive to show their love and care to compensate for perceived differences between these children and their peers. Caregivers’ efforts to make children happy, however, were sometimes criticised by some school personnel, who see this as spoiling. The conflicting viewpoint between caregivers and school personnel indicate their different roles and perceptions in children’s lives, and the latter influence these children in a more authoritative way. Informal kinship care has several advantages of addressing children’s needs, especially their needs for emotional bonds with family. Community-based kin networks provide children with both emotional and material support. However, these advantages sometimes are restricted by caregivers’ child rearing capacity. Having developed a model of the needs of children left behind in China, this study suggests that caregivers, school personnel and government social services work in harmony to be child-centred and meet these children’s diverse needs. The unmet needs of children left behind mainly result from unbalanced development between urban and rural China, therefore, it is imperative to enhance state policies and programs that improve wellbeing for this growing part of China’s people.

An investigation of the lived experiences of Intensive Care Paramedics

Intensive Care Paramedics (ICPs) attend to only the most clinically challenging of emergency medical cases, often working in a chaotic and frenetic atmosphere. They are regularly exposed to human tragedy and with that, the potential to experience traumatic events is not uncommon. There is very little known about the well-being of ICPs; how they cope with the demands of their role, or about their mental health in general. Nineteen experienced ICPs (4 female, 15 male) participated in a semi-structured interview. Themes were extracted from the data using an Interpretive Phenomenological Analysis approach. All participants discussed a work-related event they attended that traumatized them, usually experienced in the earlier parts of their career. Some spoke of an immediate overwhelming of their capacity to cope and others of a gradual onset of traumatic stress when reflecting on the event at a later time. More than half of the participants described events that involved children as the most difficult. Data revealed four superordinate themes: Social Support, Cognitive Coping, Proactive Coping, and Long Term Effects. Each superordinate theme comprised a number of constituent themes which are presented in this paper and exemplified with participant quotes. Although ongoing distress was described by some participants, all of the ICPs interviewed discussed positive aspects of their job; things that made the role worthwhile and fulfilling. This research highlights the important factors involved in coping with, and growing from, the extraordinary events that ICPs face. Results have implications for employing organizations and staff support services as well as for paramedics more broadly as they learn to cope with events inherent in their career. Findings indicate that positive adaptation and personal growth as a result of exposure to extremely high levels of potentially traumatic experiences is not only possible, but highly probable.

Study protocol : establishing good relationships between patients and health care providers while providing cardiac care. Exploring how patient-clinician engagement contributes to health disparities between indigenous and non-indigenous Australians in South Australia

Abstract Background: Studies that compare Indigenous Australian and non-Indigenous patients who experience a cardiac event or chest pain are inconclusive about the reasons for the differences in-hospital and survival rates. The advances in diagnostic accuracy, medication and specialised workforce has contributed to a lower case fatality and lengthen survival rates however this is not evident in the Indigenous Australian population. A possible driver contributing to this disparity may be the impact of patient-clinician interface during key interactions during the health care process. Methods/Design: This study will apply an Indigenous framework to describe the interaction between Indigenous patients and clinicians during the continuum of cardiac health care, i.e. from acute admission, secondary and rehabilitative care. Adopting an Indigenous framework is more aligned with Indigenous realities, knowledge, intellects, histories and experiences. A triple layered designed focus group will be employed to discuss patient-clinician engagement. Focus groups will be arranged by geographic clusters i.e. metropolitan and a regional centre. Patient informants will be identified by Indigenous status (i.e. Indigenous and non-Indigenous) and the focus groups will be convened separately. The health care provider focus groups will be convened on an organisational basis i.e. state health providers and Aboriginal Community Controlled Health Services. Yarning will be used as a research method to facilitate discussion. Yarning is in congruence with the oral traditions that are still a reality in day-to-day Indigenous lives. Discussion: This study is nestled in a larger research program that explores the drivers to the disparity of care and health outcomes for Indigenous and non-Indigenous Australians who experience an acute cardiac admission. A focus on health status, risk factors and clinical interventions may camouflage critical issues within a patient-clinician exchange. This approach may provide a way forward to reduce the appalling health disadvantage experienced within the Indigenous Australian communities. Keywords: Patient-clinician engagement, Qualitative, Cardiovascular disease, Focus groups, Indigenous

The rise of government in Early Childhood Education and Care following the Child Care Act 1972 : the lasting legacy of the 1990s in setting the reform agenda for ECEC in Australia

Less than twenty years on from the proclamation of the Child Care Act 1972, and introduction of funding for not-for-profit child care centres, a series of market-driven public policies paved the way for the emergence of Australia’s current ECEC quasi-market. Seeking to respond to increasing demand for work-related child care in the 1990s, and to manage associated costs, a succession of Australian Governments turned to market theory and New Public Management (NPM) principles to inform ECEC policy. Reflecting on an era of high policy activity within ECEC, this paper examines a series of policy events and texts that set the course for the reform agenda that was to ensue in ECEC.