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.

Living with cancer : an ethnographic study of Thai cancer patients

This thesis is an ethnographic investigation aimed at describing the lived experiences of Thai cancer patients residing in Cancer Hostel, a shelter provided for the needy whilst undergoing radiation treatment at Siam Hospital. All names, including the hospital, the shelter, and all respondents have been altered to preserve anonymity. The practice of withholding the true diagnosis from Thai patients meant that very little was known about their own feelings on cancer and its treatment. That, coupled with entrenched medical practice beliefs, presented an unusual challenge, for which an ethnographic research method was advocated as being most appropriate in helping toward a better understanding of the problem and resolving the existing dilemma. To understand the real experiences of Thai cancer patients, it was extremely important that the researcher get as near as possible to becoming one of them. Therefore, by physically 'being with’, establishing rapport, and gaining patients trust, the researcher was assured of acceptance as an insider, and was thus allowed to share the experiences of their life encounters. Research findings graphically illustrated the flaws in the practice of protecting patients from their diagnosis, who almost universally, wanted to know more about their diagnosis in order to seek help from the medical care system. Towards this, patients created meaning by linking folk beliefs, culturally inherited knowledge and a common sense, albeit naive approach in trying to make sense of their illness and treatment. Although patients saw cancer illness and its treatment, especially radiotherapy, as life threatening, it was the fear of radiation treatment, not cancer illness which turned patients away from medical treatment. As well, uncertainty, fear and frustration through the lack of information and involvement in their treatment saw patients employ strategies of both reciprocal and fatalistic acceptance; stoic resistance; and thinking positively in their efforts at coping with those life threatening situations.

Reflexivity in nursing : where is the Patient? Where is the Nurse?

Drawing upon forty years of nursing experience, in this paper we are reflexive about four issues relative to nursing clinical practices: seeking technological solutions to health and ill-health; moving from the nurse-patient relationship to the patient-healer relationship; utilising critical pathways; and, supporting evidence-based nursing. We examine current nursing practices and ask probing questions to generate debate. Most of all, we encourage nurses to engage in reflexivity and not to lose sight of their selves (knowledge, expertise and skills), and their patients' voices and subjectivity, in their contribution to health care.

Registered and enrolled nurses : experiences of ethical issues in nursing practice

Research aims:
To explore and describe registered and enrolled nurses’ experiences of ethics and human rights issues in nursing practice in the Australian State of Victoria.

Method:
Descriptive survey of 398 Victorian nurses using the Ethical Issues Scale (EIS) survey questionnaire.

Major findings:
The most frequent and most disturbing ethical issues reported by the nurses surveyed included: protecting patients’ rights and human dignity, providing care with possible risk to their own health, informed consent, staffing patterns that limited patient access to nursing care, the use of physical/chemical restraints, prolonging the dying process with inappropriate measures, working with unethical/impaired colleagues, caring for patients/families who are misinformed, not considering a patient’s quality of life, poor working conditions.

Conclusions:
Nurses in Victoria frequently experience disturbing ethical issues in nursing practice that warrant focussed attention by health service managers, educators and policy makers.

Psychosocial care of family of critically-ill patients in emergency departments

Responding to families with a critically ill relative is difficult for emergency department clinicians. This innovative research program used best evidence, integrated with perspectives from families and clinicians, to develop context specific guidelines and sensitive tools to assist emergency department clinicians provide quality psychosocial care to meet multidimensional family needs.

General practitioners' nutrition promotion among cardiac patients

General practitioners fall into three categories in their pursuit of dietary counselling: little involvement, or provider of referrals, or they have strong involvement. The barriers to dietary counselling are inadequate partnerships with dietitians, patients suffering multiple medical conditions and the view that HMG-CoA-reductase-inhibitors (statins) reduce the need for dietary change.

Companion animal visitation and its effectiveness with stroke patients

The study employed a randomised controlled trial design to determine whether a companion animal intervention had any effect on wellbeing and quality of life in patients who were admitted to hospital after suffering a stroke. The study found significant benefits for their wellbeing and improvements in quality of life.

Dialysing acutely ill patients : the lived experience of renal nurses

This interpretive study is based on Heideggarian phenomenology and explores the lived experiences of four registered nurses experienced in the use of haemodialysis as a renal replacement therapy.

Between a rock and a hard place: exploring the conflict between respecting the privacy of patients and informing their carers

Background: A patient's right to privacy is considered fundamental to medical care, with physicians assuming the role of guardian of the clinical information which is conveyed to the patient. However, as a patient's health declines, physicians are often challenged by the need to protect patient privacy while addressing the expectations of the patient's carers, who seek medical information to provide appropriate care at home.

Aims: This study sought to explore the expectations of patients, their carers and physicians regarding the communication of clinical information to carers.

Methods: Surveys were distributed in outpatient clinics at a metropolitan quaternary hospital, with responses from 102 patients and carers, as well as 219 medical staff.

Results: The expectations of patients and carers differed from those of medical staff. Physicians typically believed discussions with carers should begin following the patient's permission and at the patient's request. Patients and carers, however, believed information should be automatically offered or provided when questioned. Further, carers generally felt information updates should occur regularly and routinely, whereas physicians indicated updates should occur with prompting either by a major clinical change or in response to a carer's concern.

Conclusion: Physicians should be aware that the expectations of patients and carers regarding information communication to carers may not match their own. Meanwhile, patients and carers should be made aware of the constraints upon physicians and should be encouraged to convey their preferences for information sharing. These tasks could be facilitated by the development of a prompt sheet to assist the clinical encounter.

Factors facilitating successful engagement among patients with first-episode psychosis

This thesis investigated factors that facilitate successful engagement with psychiatric treatment among young patients experiencing first-onset psychosis. The results revealed the importance of the treatment setting and key relationships in achieving engagement. Service delivery implications include the need for a social relationship model between clinicians, patients, and their peers.

Emergency department presentations of patients from CALDB receiving chemotherapy in day oncology settings

Objective
The objectives of this research were to compare the emergency department (ED) presentations for cancer patients from culturally and linguistically diverse backgrounds (CALDB) treated with chemotherapy through day oncology units with other cancer patients.

Design
A retrospective audit was conducted. Data collected included demographic factors and ED presentation characteristics. Descriptive statistics and direct logistic regression was used to summarise and compare the ED presentation rates and ED presentation characteristics of patients from CALDB and other patients.

Setting
Primary and secondary care.

Patients
All adult day oncology patients who were treated with chemotherapy and presented to an ED between 1 January and 31 December, 2007. Across the two health sites, 770 day oncology patients attended an ED on at least one occasion. Of these 37.7% were born in a non-English speaking country.

Results
Patients from CALDB were more likely to present (p < 0.001, OR = 1.55, C.I. = 1.29–1.88) and re-present to an ED (p < 0.001, OR = 2.08, C.I. = 1.37–3.16), however there was no association between CALDB and admission to hospital following the ED presentation, triage category or being seen within the clinically recommended time. Patients from CALDB tended to present for potentially preventable conditions such as nausea/vomiting/dehydration and fever.

Conclusions
Our findings suggest that targeted interventions that incorporate education and information to assist with self-care for patients from CALDB may reduce potentially preventable presentations and representations to an ED and the subsequent economic, social and personal costs associated with these ED presentations.

Quality nephrology nursing care : beyond Kt/V

Ask nephrology nurses about the care in their hemodialysis units and they will probably say that high quality care is provided. This perception may reflect a genuine pride in their own and their colleagues' hemodialysis services, however, the meaning of high quality dialysis care remains unclear. Quality is often framed in terms of the high percentage of patients receiving a Kt/V of greater than 1.2 or 1.4. The unfortunate inference here is that high quality hemodialysis care is defined as the waste clearing service of the urea molecule. Defining quality in this narrow way conflicts with the caring and compassionate nursing ethic. Furthermore, it places a high value on a single mathematically derived formula that ignores many other indicators of quality dialysis care. In this article, the authors examine some historical, political, and technical features of Kt/V and use the metaphor of a hangover to illustrate the overuse of Kt/V, arguing that nurses have embraced Kt/V at the expense of other core elements of dialysis nursing care.

Horizons revealed : post anaesthetic nurse care for prisoner-patients

This qualitative study revealed the experiences of registered nurses who cared for prisoner-patients in a major public hospital setting. The study found that caring for prisoner-patients is an emotionally draining experience where knowing or imagining the prisoner-patient's crime subtly provokes registered nurses to give reactive and perfunctory care that straddles real and ideal perspectives.