The lived experience of being a sole mother in Taiwan

Aim: To explore the lived experience of being a sole mother in Taiwan Background: The number of sole mothers in Taiwan has increased by 55 % in the last decade due to changes in the social and economic status of women (e.g. earlier divorce, the development of national policies for the protection of women, the rise of feminism, and changing work practices which have seen an increase in the number of women in the workforce) (Taiwan Department of Statistics, 2010). Issues confronting sole mothers as part of daily living involve inability to cope with daily life stressors, little social support, experiencing feelings of helplessness and hopelessness, and lack of self-confidence to assume responsibility for the physical and mental health needs of themselves and their children (Cairney, 2007; Loxton, Mooney & Young, 2006; Samuels-Dennis, 2006; Waldron et al., 1996). Although there have been a number of studies conducted concerning what it means to be a sole mother, few Taiwanese studies have been undertaken. In light of the absence of research on this topic from a Taiwanese perspective, this study was undertaken. Design:A descriptive phenomenological approach was used for this study. Methods: In-depth audio-taped interviews were conducted with 15 sole Taiwanese mothers. The audiotapes were later transcribed, translated into English, and then back translated into Chinese to ensure accuracy of participants‘ information. Colaizzi‘s phenomenological approach to analysis with one additional step (eight steps in all) informed the analytical process. Findings: The process of analysis identified six central themes: 1. Enduring the burdensome, 2. Survival means living day-by-day, 3. Living in the shadows of insomnia, depression and suicidal thoughts, 4. Living with rejection and social isolation, 5. Living with uncertainty, and 6. Transcending difficult times through being resilient. Conclusion: For the participants of this study, the lived world of Taiwanese sole mothers was replete with daily difficulties marked by isolation, loneliness, social disapproval and rejection. Feelings of sadness and dejection were their daily companions. However, amid their myriad hardships, the participants found strength and solace in their children and close friends. Rather than succumb to the pressures of being a sole mother, the participants forged new paths spurred on by their own hopes and dreams for a better future. The findings of this study have the potential to make significant contributions to extant knowledge concerning the lived experiences of sole mothers in Taiwan.

Relationships between preventive activities, psychosocial factors and recurrence of venous leg ulcers : a prospective study

Aim To identify relationships between preventive activities, psychosocial factors and leg ulcer recurrence in patients with chronic venous leg ulcers. Background Chronic venous leg ulcers are slow to heal and frequently recur, resulting in years of suffering and intensive use of health care resources. Methods A prospective longitudinal study was undertaken with a sample of 80 patients with a venous leg ulcer recruited when their ulcer healed. Data were collected from 2006–2009 from medical records on demographics, medical history and ulcer history; and from self-report questionnaires on physical activity, nutrition, preventive activities and psychosocial measures. Follow-up data were collected via questionnaires every three months for 12 months after healing. Median time to recurrence was calculated using the Kaplan-Meier method. A Cox proportional-hazards regression model was used to adjust for potential confounders and determine effects of preventive strategies and psychosocial factors on recurrence. Results: There were 35 recurrences in a sample of 80 participants. Median time to recurrence was 27 weeks. After adjustment for potential confounders, a Cox proportional hazards regression model found that at least an hour/day of leg elevation, six or more days/week in Class 2 (20–25mmHg) or 3 (30–40mmHg) compression hosiery, higher social support scale scores and higher General Self-Efficacy scores remained significantly associated (p<0.05) with a lower risk of recurrence, while male gender and a history of DVT remained significant risk factors for recurrence. Conclusion Results indicate that leg elevation, compression hosiery, high levels of self-efficacy and strong social support will help prevent recurrence.

Development and pilot test of a peer-support based Cardiac-Diabetes Self-Management program : a study protocol

Background: People with cardiac disease and type 2 diabetes have higher hospital readmission rates (22%)compared to those without diabetes (6%). Self-management is an effective approach to achieve better health outcomes; however there is a lack of specifically designed programs for patients with these dual conditions. This project aims to extend the development and pilot test of a Cardiac-Diabetes Self-Management Program incorporating user-friendly technologies and the preparation of lay personnel to provide follow-up support. Methods/Design: A randomised controlled trial will be used to explore the feasibility and acceptability of the Cardiac-Diabetes Self-Management Program incorporating DVD case studies and trained peers to provide follow-up support by telephone and text-messaging. A total of 30 cardiac patients with type 2 diabetes will be randomised, either to the usual care group, or to the intervention group. Participants in the intervention group will received the Cardiac-Diabetes Self-Management Program in addition to their usual care. The intervention consists of three faceto- face sessions as well as telephone and text-messaging follow up. The face-to-face sessions will be provided by a trained Research Nurse, commencing in the Coronary Care Unit, and continuing after discharge by trained peers. Peers will follow up patients for up to one month after discharge using text messages and telephone support. Data collection will be conducted at baseline (Time 1) and at one month (Time 2). The primary outcomes include self-efficacy, self-care behaviour and knowledge, measured by well established reliable tools. Discussion: This paper presents the study protocol of a randomised controlled trial to pilot evaluates a Cardiac- Diabetes Self-Management program, and the feasibility of incorporating peers in the follow-ups. Results of this study will provide directions for using such mode in delivering a self-management program for patients with both cardiac condition and diabetes. Furthermore, it will provide valuable information of refinement of the intervention program.

Using user-friendly telecommunications to improve cardiac and diabetes self-management programme : a pilot study

Previous studies exploring the incidence and readmission rates of cardiac patients admitted to a coronary care unit (CCU) with type 2 diabetes [1] have been undertaken by the first author. Interviews of these patients regarding their experiences in managing their everyday conditions [2] provided the basis for developing the initial cardiac–diabetes self-management programme (CDSMP) [3]. Findings from each of these previous studies highlighted the complexity of self-management for patients with both conditions and contributed to the creation of a new self-management programme, the CDSMP, based on Bandura’s (2004) self-efficacy theory [4]. From patient and staff feedback received for the CDSMP [3], it became evident that further revision of the programme was needed to improve self-management levels of patients and possibility of incorporating methods of information technology (IT). Little is known about the applicability of different methods of technology for delivering self-management programmes for patients with chronic diseases such as those with type 2 diabetes and cardiac conditions. Although there is some evidence supporting the benefits and the great potential of using IT in supporting self-management programmes, it is not strong, and further research on the use of IT in such programmes is recommended [5–7]. Therefore, this study was designed to pilot test feasibility of the CDSMP incorporating telephone and text-messaging as follow-up approaches.

Mentoring across the professions : some issues and challenges

Mentoring has been identified as a valuable learning activity for beginners and more experienced personnel across a range of professions. For example, education, nursing, medicine, law, accounting , and public administration are among those professions that have utilised mentoring programs as a way of socialising and developing the skills and competencies of new professionals. The definition of mentoring used in this paper comes from Hansford, Tennent, and Ehrich (2002, 2003) that describes mentoring as a process whereby a more experienced practitioner works with, supports, guides and provides professional development to a less experienced practitioner. Mentoring, then, is often used to develop novice or less experienced professionals at two important phases in their career: (i) during their initial university training; and (ii) after graduation from university. For example, within the field experience components of many university degrees in education, nursing, medicine, social work, and other human service programs, students are assigned workplace mentors who assist them in transferring important skills and knowledge learned at university into practical setting. For concentrated periods of time during their degree, pre-service teachers, pre-service nurses and medical students work in the field alongside a workplace mentor.

Transitioning to practice across the professions : some lessons from the teaching profession

Across the professions, there is strong interest in the transition between graduation and early stages of professional practice. Our initial literature search revealed that this period of transition is significant to professions that include nursing, vets, midwives, financial planners, lawyers, occupational therapists, doctors as well as our particular area of interest - teachers. This importance is easy to understand for in these applied fields new graduates need to be competent in applying and synthesizing their theoretical content knowledge on a daily basis, often with limited supervision and mentoring (Goetz, Tombs & Hampton, 2005). As such, this transition period is of critical importance to the individual and their feelings of competence and early profession learning. An added layer for graduates in these professions during this transition/probation period is that they are also expected to have well-developed 'soft skills' such as communication, problem solving, and teamwork (Oblinger & Verville, 1998; Rao & Sylvester, 2000) in order to be effective in their roles.

School-aged workers : industrial citizens in the making?

While the literature points to significant shifts in young peoples‟ labour market participation and the social, economic and political context in which the shift has occurred, it tells us little about how young people are socialised in the workplace, how literate they are in terms of their rights and responsibilities at work or how and via what mechanisms this literacy is acquired. Using the concept citizenship as an analytical tool, we explored these questions using data derived from 48 focus groups conducted with 216 adolescents (13-16 years of age) at 19 high schools in Australia. The findings reveal the way in which several key dimensions of industrial citizenship come to be shaped and have implications for addressing the vulnerability of youth in employment and informing policy and action.

Indigenous knowledge and effective parent / school partnerships : insights and issues from 4 school case studies

Towards the last decade of the last millennium, Indigenous knowledge has been central to scholarly debates relating to decolonising knowledge on a global level. Much of these debates were advanced by Indigenous scholars in colonised countries particularly Australia, New Zealand, Canada and the United States. Indigenous scholars argue for the location of Indigenous knowledge as the epistemological standpoint (Battiste, Bell and Findlay, 2002; Kai’a, 2005; Nakata 2002, 2007) for intellectual engagements and methodology for resisting colonial constructions of the colonised other (Rigney, 1997; Smith, 1999, 2005). However, the challenge to engage Indigenous knowledge to inform research and educational processes, in many respects, is still a contested debate in western-oriented universities and institutions of higher education. The place of Indigenous knowledge in Australian secondary and primary schools remains vague, while efforts to embed Indigenous perspectives in the curriculum continue to be made by both government and private educational providers. Educational funding for Indigenous education continues to operate from a ‘deficiency’ model, whereby educational outcomes are often measured against set criteria, reflecting a pass/fail structure, than a more comprehensive investigation of educational outcomes and quality of learning experiences. Teacher knowledge, effective parental and community engagement into students’ learning and students’ experiences of schooling continue to be secondary to students’ final results. This paper presents preliminary findings of Parent School Partnership Initiative (PSPI) project conducted by the Oodgeroo Unit at the Queensland University of Technology in partnerships with the Aboriginal and Torres Strait Islander Education Focus Group for the Caboolture Shire, in South East Queensland. The state government sponsored initiative was to examine factors that promote and enhance parent/school engagement with their students’ schooling, and to contribute to Aboriginal and Torres Strait Islander students’ learning and completion of secondary schooling within the participating schools in a more holistic way. We present four school case studies and discuss some of the early findings. We conclude by arguing the importance of the recognition of Indigenous knowledge and its place in enhancing parent – schools partnerships.

Researching employment relations : a self-reflexive analysis of a multi-method, school-based project

Drawing on primary data and adjunct material, this article adopts a critical self-reflexive approach to a three-year, Australian Research Council-funded projectthat explored themes around 'employment citizenship'for high school students in Queensland. The article addresses three overlapping areas that reflect some of the central dilemmas and challenges arising through the project- consent in the context of research ethics, questionnaire administration in schools, and focus group research practice. It contributes to the broader methodological literature addressing research with young people by canvassing pragmatic suggestions for future school-based research, and research addressing adolescent employment.

Water rights and water governance : a cautionary tale and the case for interdisciplinary governance

Although Australia is the world’s driest continent without the complication of international borders and a generally good governance reputation, its record of water governance is very poor. This chapter considers some of the potentially general lessons that might be derived for water governance. These include: the difficulties of delineatingwater rights; the apparent preference for creating property rights in unsustainable uses of water while failing to deliver basic water rights; the inter twining of carbon and water crises; the dangers of privatising networks that form natural monopolies; the dangers of disciplinary hubris where interdisciplinary understanding is critical. It concludes by starting to address some of the water governance issues raised by globalisation.

Clinical education for nephrology nurse practitioner candidates in Australia : a consensus statement

Objectives: To develop recommendations for the clinical education required to prepare Australian Nurse Practitioner candidates for advanced and extended practice in nephrology settings. Methods: Using the Delphi research technique a consensus statement was developed over a nine month period. All endorsed and candidate Nephrology Nurse Practitioners (NNP) were invited to participate as the expert panel. The Delphi research technique uses a systematic and iterative process. The expert panel were asked to generate a list of items which were then circulated to all NNPs. They were asked to determine their degree of agreement or disagreement with each statement using a 5-point Likert scale There was opportunity for free-text comments to be provided if desired. Results from each round were collated; the document was refined and circulated to the experts for a subsequent round. Consensus was demonstrated after three Delphi rounds. Results: The consensus statement comprises four components explaining the role and membership of the mentorship team, the setting and location of NNP clinical education, learning strategies to support the NNP, and outcomes of NNP clinical education. Demographic questions in the final survey revealed information about the qualifications, years of experience, and practice location of Australian NNPs. Conclusions: The consensus statement is not prescriptive but it will inform NNP candidates, university course providers and mentors about the expected extended nephrology specific clinical education that will enable the NNP to provide advanced nursing care for patients regardless of the stage of chronic kidney disease (CKD) and the practice setting.

Development and evaluation of an integrated clinical learning model to inform continuing education for acute care nurses

Background Significant ongoing learning needs for nurses have occurred as a direct result of the continuous introduction of technological innovations and research developments in the healthcare environment. Despite an increased worldwide emphasis on the importance of continuing education, there continues to be an absence of empirical evidence of program and session effectiveness. Few studies determine whether continuing education enhances or develops practice and the relative cost benefits of health professionals’ participation in professional development. The implications for future clinical practice and associated educational approaches to meet the needs of an increasingly diverse multigenerational and multicultural workforce are also not well documented. There is minimal research confirming that continuing education programs contribute to improved patient outcomes, nurses’ earlier detection of patient deterioration or that standards of continuing competence are maintained. Crucially, evidence-based practice is demonstrated and international quality and safety benchmarks are adhered to. An integrated clinical learning model was developed to inform ongoing education for acute care nurses. Educational strategies included the use of integrated learning approaches, interactive teaching concepts and learner-centred pedagogies. A Respiratory Skills Update education (ReSKU) program was used as the content for the educational intervention to inform surgical nurses’ clinical practice in the area of respiratory assessment. The aim of the research was to evaluate the effectiveness of implementing the ReSKU program using teaching and learning strategies, in the context of organisational utility, on improving surgical nurses’ practice in the area of respiratory assessment. The education program aimed to facilitate better awareness, knowledge and understanding of respiratory dysfunction in the postoperative clinical environment. This research was guided by the work of Forneris (2004), who developed a theoretical framework to operationalise a critical thinking process incorporating the complexities of the clinical context. The framework used educational strategies that are learner-centred and participatory. These strategies aimed to engage the clinician in dynamic thinking processes in clinical practice situations guided by coaches and educators. Methods A quasi experimental pre test, post test non–equivalent control group design was used to evaluate the impact of the ReSKU program on the clinical practice of surgical nurses. The research tested the hypothesis that participation in the ReSKU program improves the reported beliefs and attitudes of surgical nurses, increases their knowledge and reported use of respiratory assessment skills. The study was conducted in a 400 bed regional referral public hospital, the central hub of three smaller hospitals, in a health district servicing the coastal and hinterland areas north of Brisbane. The sample included 90 nurses working in the three surgical wards eligible for inclusion in the study. The experimental group consisted of 36 surgical nurses who had chosen to attend the ReSKU program and consented to be part of the study intervention group. The comparison group included the 39 surgical nurses who elected not to attend the ReSKU program, but agreed to participate in the study. Findings One of the most notable findings was that nurses choosing not to participate were older, more experienced and less well educated. The data demonstrated that there was a barrier for training which impacted on educational strategies as this mature aged cohort was less likely to take up educational opportunities. The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group’s reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales following attendance at the ReSKU program. These subscales included influence on nursing care, educational preparation and clinical development. Findings suggest that the use of an integrated educational model underpinned by a robust theoretical framework is a strong factor in some perceptions of the ReSKU program relating to attitudes and behaviour. There were minimal differences in knowledge between groups across time. Conclusions This study was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies and a robust overarching theoretical framework to support study concepts. The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful and collective reflection, was a powerful educational strategy to enhance competency and capability in clinicians.

Tailoring Consumer Resources to Enhance Self-Care in Chronic Heart Failure

Background Chronic heart failure (CHF) is associated with high hospitalisation and mortality rates and debilitating symptoms. In an effort to reduce hospitalisations and improve symptoms individuals must be supported in managing their condition. Patients who can effectively self-manage their symptoms through lifestyle modification and adherence to complex medication regimens will experience less hospitalisations and other adverse events. Aim The purpose of this paper is to explain how providing evidence-based information, using patient education resources, can support self-care. Discussion Self-care relates to the activities that individuals engage in relation to health seeking behaviours. Supporting self-care practices through tailored and relevant information can provide patients with resources and advice on strategies to manage their condition. Evidence-based approaches to improve adherence to self-care practices in patients with heart failure are not often reported. Low health literacy can result in poor understanding of the information about CHF and is related to adverse health outcomes. Also a lack of knowledge can lead to non-adherence with self-care practices such as following fluid restriction, low sodium diet and daily weighing routines. However these issues need to be addressed to improve self-management skills. Outcome Recently the Heart Foundation CHF consumer resource was updated based on evidence-based national clinical guidelines. The aim of this resource is to help consumers improve understanding of the disease, reduce uncertainty and anxiety about what to do when symptoms appear, encourage discussions with local doctors, and build confidence in self-care management. Conclusion Evidence-based CHF patient education resources promote self-care practices and early detection of symptom change that may reduce hospitalisations and improve the quality of life for people with CHF.