Australian consumers expectations for expanded nursing roles in general practice - choice not gatekeeping

While research has focussed on the current and potential role of the practice nurse (PN) in Australia, the acceptability of this role by consumers has not been investigated. In 2002, two independent studies were carried out into consumer perceptions of PNs. A discussion between the two groups of researchers at the inaugural National Practice Nurse Conference in 2003, identified significant similarities in the findings of these studies. This article reports the combined findings as they relate to consumers' desire for access to the health practitioner of their choice, and their concern that PNs may assume a gatekeeping role. These perceptions may have significant impact on the acceptance of PNs across Australia.

Caring a a resilient practice in mental health nursing

This paper will develop a discussion about caring as a modern mental health nurse. We argue that the demands of mental health nursing today extend beyond the more traditional skills of care and caring. We believe that in order to meet mental health needs in the 21st century that caring should be extended to encompass the additional expertise of emotional intelligence and resilience. Emotional intelligence, resilience, and resilient behaviours have the potential to assist individuals to transcend negative experiences and transform these experiences into positive self-enhancing ones. This has implications for improved consumer outcomes through role-modelling and educational processes, but also may hold implications in supporting a strong workforce in mental health.

Evidence-based mental health nursing in Australia: our history and our future

This paper will develop a discussion related to evidence-based knowledge for mental health nursing, arguing for a historical component to be included in the comprehensive degree programme that will offer significant insights into mental health nursing knowledge from historical information and constructing implications for contemporary practice. Our understanding of the present is clearer by this looking back and forth and by adding meaning (and what the meanings mean) to what historically preceded. It allows the history of psychiatry to be a much more productive, useful, and a continual source of wisdom for the here and now. This blending of past knowledge with contemporary inquiry can offer depth in mental health nursing practices by forming a context for practice for the beginning nurse practitioner.

Simulation to practice: developing nursing skills in mental health: an Australian perspective

A variety of developments in nursing education in Australia including some innovative and exciting models, educational enterprises between education and industry, and evidence of developing strengths in research and professional alliances on a national level have been discussed recently. This paper presents Simulation to Practice as an example of an educational program that can maximise skill mastery for nurses in mental health fields as practised by Deakin University in Victoria, Australia. The program is multimodal and is under-pinned by a problem-solving approach and has an online presentation. The extension of nursing skills through this approach encourages nurses to take theoretical skills to practice during these scenarios which help student nurses to gain experience through simulated real life characters. These sessions, while challenging at the time, were highly valued by students and seen as a beneficial part of their learning as a beginning nurse and often instrumental in moving comprehensively trained students into mental health careers.

Stigmatization of AIDS patients : disentangling Thai nursing students' attitudes towards HIV/AIDS, drug use and commercial sex

This paper analyzes the interrelationships between the stigma of HIV/AIDS stigma and the co-stigmas of commercial sex (CS) and injecting drug use (IDU). Students of a Bangkok nursing college (N = 144) were presented with vignettes describing a person varying in the disease diagnoses (AIDS, leukemia, no disease) and co-characteristics (IDU, CS, blood transfusion, no co-characteristic). For each vignette, participants completed a social distance measure assessing their attitudes towards the hypothetical person portrayed. Multivariate analyses showed strong interactions between the stigmas of AIDS and IDU but not between AIDS and CS. Although AIDS was shown to be stigmatizing in and of itself, it was significantly less stigmatizing than IDU. The findings highlight the need to consider the non-disease-related stigmas associated with HIV as well as the actual stigma of HIV/AIDS in treatment and care settings. Methodological strengths and limitations were evaluated and implications for future research discussed.

The nature and impact of incontinence in men who have undergone prostate surgery and implications for nursing practice

Aim: The aim of this study was to increase knowledge and understanding of the nature and experiences of incontinence in men one or more years post prostate surgery.

Methods: This descriptive study used a sample of convenience. Two hundred and twelve male participants who had undergone prostate surgery more than a year ago were asked about their experiences of incontinence. Participants were asked to fill in two questionnaires: The Expanded Prostate Cancer Index Composite and the Incontinence Impact Questionnaire. Participants were also asked about their prostate surgery, their health seeking behaviour in relation to incontinence, the type of discharge information they were given, and demographic information.

Results: Sixty-six percent of participants indicated that, in the last four weeks, their overall urinary function had been a problem and 36.3% reported their bowel habits were problematic, which affected the quality of their lives. In addition, 41% of participants reported that they were not given discharge information regarding the possibility of developing urinary incontinence and sexual problems post prostate surgery.

Conclusions: Health care professionals should pay more attention to routinely providing information to all men regarding the possibility of developing incontinence or sexual problems post prostate surgery. This may assist them to better manage these problems.

Issues in the provision of nursing care to people undergoing cardiac surgery who also have type 2 diabetes

There has been little investigation of the issues associated with caring for patients presenting for cardiac surgery with a comorbid diagnosis of diabetes although there is some evidence that the diabetes management is suboptimal. This study aimed to identify issues that patients and cardiac specialist nurses experience with the provision of inpatient services for people undergoing cardiac surgery who also have type 2 diabetes. A qualitative interpretive design, using individual interviews with patients and nurses, provided data about some of these issues. The study found that nurses had high levels of confidence in their cardiac care but little confidence in diabetes management. Patients described concerns about their diabetes care and treatment regimens. A 'typical journey' for a person with diabetes undergoing cardiac surgery was identified. The findings support the need to build increased capacity in specialist nurses to support diabetes care as a secondary diagnosis.

ACCCN national nursing workforce survey of intensive care units

A descriptive study was designed and implemented by the Australian College of Critical Care Nurses (ACCCN) Workforce Planning Advisory Committee to capture data pertaining to workforce issues of intensive care nurses. All intensive care units (ICUs) within Australia were mailed a self reporting survey. Despite a low response rate (52 per cent) and difficulty reported by respondents in gaining the appropriate data requested, the results revealed an interesting snapshot of the intensive care nursing workforce.
Types of services offered by units varied considerably; paid overtime hours were low (<2 per cent of total hours worked) and use of both part-time and agency staff was also low (10 per cent of total hours worked). Private hospitals utilised a greater proportion of part-time and agency nursing staff than public hospitals (20:10 per cent). The turnover rate for registered nursing staff was estimated at 18 per cent, with education, skill acquisition and improved communication reported as the major incentives used by managers to attract and retain staff. This study demonstrated that valuable data are currently uncaptured and recommends a more refined process of a national database to record and manage this important information for future workforce planning.

Acute pain management: Implications of scientific evidence for nursing practice in the postoperative context

Unrelieved acute pain remains prevalent in hospitalized patients despite advances in pain management. A decade after the Australian National Health and Medical Research Council called for improved pain management practices by health professionals, it released clinical guidelines to provide clinicians with current scientific evidence to augment their clinical decision-making. This paper examines the implications of national guidelines on nursing practice and highlights the inadequacies of current implementation policies. Pain management guidelines have failed to decrease patients' postoperative pain because organizations and researchers have ignored the impact of contextual influences on clinicians' decision-making. It is recommended that for successful implementation of national guidelines to occur at the local level of practice, organizations must assist clinicians to identify local influences on their decision-making, to address the issues specific to their own work environment and to evaluate any changes in practice.

Painful nipples in nursing mothers: fungal or staphylococcal?

Painful nipples, or ‘breast thrush’, in nursing mothers is a well recognised condition. It is a clinical diagnosis characterised by intense nipple pain often radiating into the breast, especially during breastfeeding. Between feeds it may cause a burning sensation and tenderness; breastfeeding may be abandoned because of it.

Designing the future in wound care: the role of the nurse practitioner

The nurse practitioner is emerging as a new level and type of health care. Increasing specialisation and advanced educational opportunities in nursing and the inequality in access to health care for sectors of the community have established the conditions under which the nurse practitioner movement has strengthened both nationally and internationally. The boundaries of responsibility for nurses are changing, not only because of increased demands but also because nurses have demonstrated their competence in varied extended and expanded practice roles. The nurse practitioner role reflects the continuing development of the nursing profession and substantially extends the career path for clinical nurses.

This paper describes an aspect of a large-scale investigation into the feasibility of the role of the nurse practitioner in the Australian Capital Territory (ACT) health care system. The paper reports on the trial of practice for a wound care nurse practitioner model in a tertiary institution. In the trial the wound care nurse practitioner worked in an extended practice role for 10 months. The nurse practitioner practice was supported, monitored and mentored by a clinical support team. Data were collected relating to a range of outcomes including definition of the scope of practice for the model, description of patient demographics and outcomes and the efficacy of the nurse practitioner service.

The findings informed the development of clinical protocols that define the scope of practice and the parameters of the wound care nurse practitioner model and provided information on the efficacy of this model of health care for the tertiary care environment. The findings further suggest that this model brings expert wound care and case management to an at-risk patient population. Recommendations are made relating to ongoing research into the role of the wound care nurse practitioner model in the ACT health care system.

Nursing education and graduates : profiles for 1999 and 2000, with projections for 2001

An analysis of DEST statistical data on nursing education had suggested that there were issues with the classification of undergraduate data and new initiatives, such as combined degrees, which were poorly captured. This project had two distinct aims. First, to explore and map exhaustively the range of undergraduate programs offered by tertiary education providers across Australia leading to an initial qualification and entry into nursing practice. Second, to explore and map in detail specialist nursing education courses offered by tertiary and other education providers across Australia. This research was funded under the Evaluations and Investigations Programme (EIP).

Nursing educations and graduates : profiles for 2001 and projections for 2002

The present study was commissioned for the National Review of Nursing Education. This is the second of two national studies commissioned to map in detail nursing education programs and to profile and make future projections regarding graduates from undergraduate and postgraduate nursing education courses in Australia.

The first study was undertaken in 2001 by Deakin University School of Nursing under the auspices of the 2001 Evaluation Investigations Project titled "Nursing Education and Graduates: Profiles for 1999, and 2000 with projections for 2001". This project sought data on nursing education within Australia in order to improve the accuracy of nursing education databases and to strengthen the ability of DETYA to provide advice on workforce planning. Issues that arose from that project included differences in data sets for undergraduate nursing courses in Australia and the complex process of attempting to tease out and accurately quantify postgraduate specialty courses when a trend towards postgraduate generic courses was evident. Approximately 26% of postgraduate domestic student enrolment data were reported utilising a generic nursing course category.

The purpose of this study was, therefore, twofold. Firstly, this study validated and extended the existing database developed in the previous study mapping in detail the full range of undergraduate programs offered by tertiary education providers across Australia that lead to an initial qualification and entry into nursing practice.

New data about the following was sought:

* Undergraduate nursing degrees (both three-year and four-year courses);
* Double/combined nursing degrees;
* Courses offered by private universities;
* Four-year bachelor degrees that concurrently provide both initial nurse registration and preparation for specialty nursing practice;
* Courses that facilitate ‘fast-tracking’ of students for initial nurse registration with previous tertiary or nursing studies,
* Hours and configuration of clinical experience in undergraduate nursing courses.

Nursing education and graduates in Victoria : profiles for 2000, 2001, and 2002 with projections for 2003

This project is the second of two projects commissioned by the Nurse Policy Branch, Victorian Department of Human Services (VDHS). The project investigated nursing education at the undergraduate and postgraduate levels in the university sector and in the VET sector. The data gathered from the project provided VDHS with a better understanding of nurse labour force issues.