Malnutrition and chemotherapy : implications for nursing practice

Background: Malnutrition before and during chemotherapy is associated with poor treatment outcomes. The risk of cancer-related malnutrition is exacerbated by common nutrition impact symptoms during chemotherapy, such as nausea, diarrhoea and mucositis. Aim of presentation: To describe the prevalence of malnutrition/ malnutrition risk in two samples of patients treated in a quaternary-level chemotherapy unit. Research design: Cross sectional survey. Sample 1: Patients ≥ 65 years prior to chemotherapy treatment (n=175). Instrument: Nurse-administered Malnutrition Screening Tool to screen for malnutrition risk and body mass index (BMI). Sample 2: Patients ≥ 18 years receiving chemotherapy (n=121). Instrument: Dietitian-administered Patient Generated Subjective Global Assessment to assess malnutrition, malnutrition risk and BMI. Findings Sample 1: 93/175 (53%) of older patients were at risk of malnutrition prior to chemotherapy. 27 (15%) were underweight (BMI <21.9); 84 (48%) were overweight (BMI >27). Findings Sample 2: 31/121 patients (26%) were malnourished; 12 (10%) had intake-limiting nausea or vomiting; 22 (20%) reported significant weight loss; and 20 (18%) required improved nutritional symptom management during treatment. 13 participants with malnutrition/nutrition impact symptoms (35%) had no dietitian contact; the majority of these participants were overweight. Implications for nursing: Patients with, or at risk of, malnutrition before and during chemotherapy can be overlooked, particularly if they are overweight. Older patients seem particularly at risk. Nurses can easily and quickly identify risk with the regular use of the Malnutrition Screening Tool, and refer patients to expert dietetic support, to ensure optimal treatment outcomes.

A social justice framework for safeguarding student learning engagement

The set of social justice principles and the Social Justice Framework (SJF), developed as resources for the sector as part of an Australian Government Office for Learning and Teaching project, adopt a recognitive approach to social justice and emphasise full participation and contribution within democratic society (Gale, 2000; Gale & Densmore, 2000). The SJF is contained within the major deliverable of the project, which is A Good Practice Guide for Safeguarding Student Learning Engagement (Nelson & Creagh, 2013) and is focused on good practice for activities that monitor student learning engagement and identify students at risk of disengaging in their first year. Examination of the social justice literature and its application to the higher education sector produced a set of five principles: Self-determination, Rights, Access, Equity and Participation. Each principle was defined and elucidated by a rationale and implications for practice, thus completing the SJF. The framework: reflects the notions of equity and social justice; provides a strategic approach for safeguarding engagement activities; and is supported by a suite of resources for practice and practitioners. The aim of this poster session is to engage in conversations about the SJF and how it might be applied to other types of student engagement activities critical to the first year of university life, such as orientation and transition programs, teamwork activities, peer programs and other academic support initiatives.

Peer journeys : building graduate capabilities for life long learning

Students experience university as peers. Peer-to-peer interaction offers unique opportunities for fostering the academic, social and emotional wellbeing of students (Kuh, 2008). Peer programs provide a formalisation of this relationship enabling students to partake both as peer leaders and program participants. The success of such programs is reliant on the university having a reserve of motivated and trained peer leaders. From their initial experience of peer programs as participants in first year and their ongoing involvement as peer leaders, students grow their graduate capabilities and employability skills through scaffolded peer leadership and training opportunities. Universities aspire to produce graduates who are inspirational leaders, effective collaborators and competent professionals ready to participate in the global community (DEEWR, 2012; Shook & Keup, 2012). This poster describes a model which scaffolds the development of peer leaders’ graduate capabilities using a university-wide supporting framework to grow a range of peer-to-peer initiatives across a variety of coordinated peer programs underpinned by a social justice framework (Gidley, Hampson, Wheller & Bereded-Samuel, 2010; Nelson & Creagh, 2012).

Student's experiences with traditional bullying and cyberbullying : findings from a Romanian sample

The field of cyberbullying is relatively new and there is no universal consensus on its definition, measurement and intervention. Authors agree that bullying has entered into the digital domain and professionals require the skills to help identify and prevent these behaviours. Ninety two students were surveyed to determine their experience with different types of bullying behaviors (face-to-face, cyberbullying or both), as bully, victim or witness. Our objective was to explore the association between those types of bullying and anxiety. The results suggest a significant association between face-to-face bullying and anxiety. Similarly, there was significant association between experiencing both types of bullying and anxiety. Further studies are required with larger and more diverse samples in order to verify current findings and to test for additional associations.

Communication and the casualisation of nursing : a critical ethnography

The contemporary working environment is being rapidly reshaped by technological, industrial and political forces. Increased global competitiveness and an emphasis on productivity have led to the appearance of alternative methods of employment, such as part-time, casual and itinerant work, allowing greater flexibility. This allows for the development of a core permanent staff and the simultaneous utilisation of casual staff according to business needs. Flexible workers across industries are generally referred to as the non-standard workforce and full-time permanent workers as the standard workforce. Even though labour flexibility favours the employer, increased opportunity for flexible work has been embraced by women for many reasons, including the gender struggle for greater economic independence and social equality. Consequently, the largely female nursing industry, both nationally and internationally, has been caught up in this wave of change. This ageing workforce has been at the forefront of the push for flexibility with recent figures showing almost half the nursing workforce is employed in non-standard capacity. In part, this has allowed women to fulfil caring roles outside their work, to ease off nearing retirement and to supplement the family income. More significantly, however, flexibility has developed as an economic management initiative, as a strategy for cost constraint. The result has been the development of a dual workforce and as suggested by Pocock, Buchanan and Campbell (2004), associated deep-seated resentment and the marginalisation of part-time and casual workers by their full-time colleagues and managers. Additionally, as nursing currently faces serious recruitment and retention problems there is urgent need to understand the factors which are underlying present discontent in the nursing profession. There is an identified gap in nursing knowledge surrounding the issues relating to recruitment and retention. Communication involves speaking, listening, reading and writing and is an interactive process which is central to the lives of humans. Workplace communication refers to human interaction, information technology, and multimedia and print. It is the means to relationship building between workers, management, and their external environment and is critical to organisational effectiveness. Communication and language are integral to nursing performance (Hall, 2005), in twenty-four hour service however increasing fragmentation due to part-time and casual work in the nursing industry means that effective communication management has become increasingly difficult. More broadly it is known that disruption to communication systems impacts negatively on consumer outcomes. Because of this gap in understanding how nurses view their contemporary nursing world, an interpretative ethnographic study which progressed to a critical ethnographic study, based on the conceptual framework of constructionism and interpretativism was used. The study site was a division within an acute health care facility, and the relationship between increasing casualisation of the nursing workforce and the experiences of communication of standard and non-standard nurses was explored. For this study, full-time standard nurses were those employed to work in a specific unit for forty hours per week. Non-standard nurses were those employed part-time in specific units or those nurses employed to work as relief pool nurses for shift short falls where needed. Nurses employed by external agencies, but required to fill in for shifts at the facility were excluded from this research. This study involved an analysis of observational, interview and focus group data of standard and non-standard nurses within this facility. Three analytical findings - the organisation of nursing work; constructing the casual nurse as other; and the function of space, situate communication within a broader discussion about non-standard work and organisational culture. The study results suggest that a significant culture of marginalisation exists for nurses who work in a non-standard capacity and that this affects communication for nurses and has implications for the quality of patient care. The discussion draws on the seven elements of marginalisation described by Hall, Stephen and Melius (1994). The arguments propose that these elements underpin a culture which supports remnants of the historically gendered stereotype "the good nurse" and these cultural values contribute to practices and behaviour which marginalise all nurses, particularly those who work less than full-time. Gender inequality is argued to be at the heart of marginalising practices because of long standing subordination of nurses by the powerful medical profession, paralleling historical subordination of women in society. This has denied nurses adequate representation and voice in decision making. The new knowledge emanating from this study extends current knowledge of factors surrounding recruitment and retention and as such contributes to an understanding of the current and complex nursing environment.

Nursing practice environment, quality of care and morale of hospital nurses in Japan

The purpose of this study was to describe Japanese hospital nurses’ perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan.

Toward an in-depth understanding of cardiovascular interventional nursing : a qualitative study into nursing within the cardiac catheterisation laboratory setting

Introduction: Nursing in the cardiac catheterisation laboratory (CCL) varies globally in terms of scope and deployment. In the US, all allied staff are cross-trained into all CCL roles. The Australian and New Zealand experience has legislative frameworks that reserves specific functions to nurses. Yet, the nursing role within the CCL is poorly researched and defined. Aim: This study sought to gain deeper understanding of the perceived role of CCL nurses in Australia and New Zealand. Method: A descriptive qualitative study using semi-structured in-depth interviews was used. A cross-sectional sample of 23 senior clinical nurses or nursing managers representing 16 CCLs across Australia and New Zealand was obtained. Data were digitally recorded and transcribed verbatim prior to analysis by three researchers. Results: Five major themes emerged from the data. These themes were: 1. The CCL is a unique environment; 2. CCL nursing is a unique and advanced cardiac nursing discipline; 3. The recruitment attributes for CCL nurses are advanced; 4. Education needs to be standardised; and 5. The evidence to support practice is poor. Discussion: The CCL environment is a dynamic, deeply interdisciplinary setting with CCL nursing seen to be a unique advanced practice role. Yet the time has come for a scope of practice, educational standards, guidelines and competencies was expressed by the participants. Conclusion: Nursing in the CCL is an advanced practice role working within a complex interdisciplinary environment. Further work is required to define the role of CCL nurses together with the evidence-base for their practice.

Let the journey begin : cultivating student identity and a sense of belonging through a formal academic welcome

Queensland University of Technology [QUT] Caboolture campus is a satellite campus co-located with Brisbane North Institute of TAFE. Building a sense of belonging on-campus continues to be challenging, with anecdotal evidence suggesting that QUT Caboolture students feel like second-class students, isolated from the prestige and excitement of the city campuses. A student identity and fostering a sense of belonging are fundamental to on-campus engagement and have been linked to retention (Field & Morgan-Klein, 2010). A formal welcome ceremony, including an academic procession in full regalia, was a new inclusion for QUT Caboolture’s 2013 Orientation Day. The ritual was intended to be a temporal mark for students to recognise their personal transition and emerging identity as a university student. Cultural capital is one ingredient in a complex mix of interactions and relationships to build a sense of identity. (Ecclestone, Biesta & Hughes, 2010). Fostering a sense of belonging and a connection to the campus and its staff was also anticipated. Students responded positively to the event, reporting feelings of excitement, inspiration and being welcomed into the university culture. The ceremony marked the beginning of the students’ journey together as QUT Caboolture students.

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.

Supporting transition to law school and student well-being : the role of professional legal identity

The empirically established decline in law student well being during the first year of law school is a red-flagged imprimatur for first year curriculum change. This article suggests that by engaging law students with the concept of a positive professional identity, student engagement and intrinsic motivation will increase because they are working towards a career goal that has meaning and purpose. Law school is a time of professional transformation and the legal academy can take steps to ensure that this transformation is inculcated with positive messages. Literature from the fields of law and psychology is analysed in this article, to explain how a positive conception of the legal profession (and a student’s future role within it) can increase a student’s psychological well-being – at law school and beyond.

Valuing student and community voices in the university : action research as a framework for community service-learning

The Community Service-learning Lab (the Lab) was initiated as a university-wide service-learning experience at an Australian university. The Lab engages students, academics, and key community organisations in interdisciplinary action research projects to support student learning and to explore complex and ongoing problems nominated by the community partners. The current study uses feedback from the first offering of the Lab and focuses on exploring student experiences of the service learning project using an action research framework. Student reflections on this experience have revealed some positive outcomes of the Lab such as an appreciation for positive and strengths-based change. These outcomes are corroborated by collected reflections from community partners and academics. The students also identified challenges balancing the requirements for assessment and their goals to serve the community partner’s needs. This feedback has provided vital information for the academic team, highlighting the difficulties in balancing the agenda of the academic framework and the desire to give students authentic experiences.

Transition to law school and law student well-being : The importance of professional legal identity

The empirically established decline in law student well-being during the first year of law school is a red-flagged imprimatur for first year curriculum change. This article suggests that by engaging law students with the concept of a positive professional identity, student engagement and intrinsic motivation will increase because they are working towards a career goal that has meaning and purpose. Law school is a time of professional transformation and the legal academy can take steps to ensure that this transformation is inculcated with positive messages. Literature from the fields of law and psychology is analysed in this article, to explain how a positive conception of the legal profession (and a student’s future role within it) can increase a student’s psychological well-being – at law school and beyond.

Time to change consumer involvement in nursing research

The experiences of people affected by cancer are at the very heart of nursing research efforts. Because much of our work is focused on understanding how to improve experiences and outcomes for people with cancer, it is easy for us to believe that our research is inherently "person centered" and thus collaborative. Let's reflect on what truly collaborative approaches to cancer nursing research could be like, and how we measure up to such goals. Collaboration between people affected by cancer (consumers) and nurses in research is much more than providing a voice for individuals as participants in a research study. Today, research governing bodies in many countries require us to seek a different kind of consumer participation, where consumers and researchers work in partnership with one another to shape decisions about research priorities, policies, and practices.1 Most granting bodies now require explanations of how consumer and community participation will occur within a study. Ethical imperatives and the concept of patient advocacy also require that we give more considered attention to what is meant by consumer involvement.2 Consumers provide perspective on what will be relevant, acceptable, feasible, and sensitive research, having lived the experience of cancer. As a result, they offer practical insights that can ensure the successful conduct and better outcomes from research. Some granting bodies now even allocate a proportion of final score or assign a "public value" weighting for a grant, to recognize the importance of consumer involvement and reflect the quality of patient involvement in all stages of the research process.3