Anne McMurray

Bedside handover: quality improvement strategy to "transform care at the bedside".

This quality improvement project implemented bedside handover in nursing. Using Lewins 3-Step Model for Change, 3 wards in an Australian hospital changed from verbal reporting in an isolated room to bedside handover. Practice guidelines and a competency standard were developed. The change was received positively by both staff and patients. Staff members reported that bedside handover improved safety, efficiency, teamwork, and the level of support from senior staff members.

Bedside nursing handover: A case study

A case study of six wards in two hospitals was undertaken to describe the structures, processes and perceptions of outcomes of bedside handover in nursing. A total of 532 bedside handovers were observed and 34 interviews with nurses were conducted. Important structural elements related to the staff, patients, the handover sheet and the bedside chart. A number of processes before, during and after the handover were implemented. They included processes for managing patients and their visitors, sensitive information, and the flow of communication for variable shift starting times. Other key processes identified were the implementation of a safety scan and medication check. The situation, background, assessment and recommendations approach was used only in specific circumstances. Perceived outcomes were categorized as improving accuracy and service delivery, and promoting patient-centred care. Although the move to bedside handover is not the norm, it reflects a patient-centred approach.

Modernity's paradox and the structural determinants of child health and well-being

Abstract The decline in indicators of human development linked to rising social inequalities, despite post-modern society’s unprecedented economic prosperity, has been called ‘modernity’s paradox’ (Keating and Hertzman 1999). Scholars of developmental health suggest that micro-level influences from the social, economic and psychological circumstances in early life may explain social inequalities across the lifespan. However, children’s poor developmental and health outcomes are also a product of the wider contexts of their lives. This paper extends the human developmental framework by linking the proximal determinants of health and well-being with macro-level forces. It reviews recent changes in the political, economic and social environments in developed countries, to provide insights into the recent trends in poor outcomes in children and youth, which remain paradoxical given the expectations of economic prosperity and the advances in medical and other technologies. The paper concludes with policy and research recommendations to reduce social disparities in child outcomes.

Social determinants of child health and well-being

Strong associations between socioeconomic status, measured by such factors as level of education, income, and occupational status, greater access to resources and political power, and an individuals health and well-being are well established and evident throughout the whole life course. Clearly, social factors are fundamental elements of the causal pathways to ill health and disease (Link and Phelan 1995; Marmot and Wilkinson 1999; CSDH 2008) and indirectly through their impact on early child development. Hence they also influence our current and future wealth (Keating and Hertzman 1999). With the growing evidence of the impact of social inequalities on health, policy makers in all countries are showing an increased interest in understanding them and in seeking ways to create more equitable societies. The importance of this trend is charted in two editions of Social Determinants of Health by Michael Marmot and Richard Wilkinson (1999, 2006), the establishment of the Commission on the Social Determinants of Health (CSDH) by the World Health Organisation (WHO), the CSDH Final Report (CSDH 2008), governmental initiatives to tackle health inequalities (the UK Department of Health 2005; EUROTHINE 2007; the Ministry of Social Affairs and Health - Helsinki Finland 2008; The UN Special Rapporteur 2008) and the proliferation of scholarly publications on social inequity in health in leading journals, such as The Lancet, British Medical Journal, Social Science and Medicine, The New England Journal of Medicine, the International Journal of Epidemiology, American Journal of Public Health and Journal of Epidemiology and Community Health.Research on the social determinants of health has moved beyond the initial stage of simplistic descriptions of diseases and illness patterns by socio-economic status (Townsend and Davidson 1982; Acheson et al 1998; Marmot et al 1991; Marmot and Wilkinson 1999, to cite just a few), to a quest for deeper knowledge of what might be the complex mechanisms that underpin the commonly observed social disparities and gradients in health from both theoretical and empirical approaches (Berkman and Kawachi 2000; Kelly et al 2006; Eckersley et al 2001; Spencer 2006; Thrane 2006). While it is accepted that social gradients and disparity in health are universal and strong, there is less agreement as to what might explain them. Three dominant perspectives offering different explanations exist (Thrane 2006; Turrell 2001; Taylor 2001; Raphael 2002): materialistic explanations, psychosocial perspectives (Marmot and Wilkinson 1999; Marmot 2004; Kawachi et al 1997, 1999) and life style explanations.According to the materialistic explanations, social disparities and gradients in health stem from differential access to economic and social resources that enable healthy living, and to preventive and curative health care, and differential exposures to occupational hazards and unhealthy living environments. The psychosocial explanation emphasises social support, social capital and perceived and relative income inequality as the main causes of health inequality. The life style perspective sees different life style choices individuals make, such as smoking, drinking, diet and exercise, as the primary causes of health inequality (see Raphael 2002; Thrane 2006 for a review). By themselves, none of these explanations can adequately explain the pervasive health inequality so consistently evident cross time and space. The social, economic and behavioural factors highlighted in each of these perspectives may jointly influence, mediate or moderate each other to produce health inequality and there is emerging research that attempts to combine them (Thrane 2006).However, much of the literature on the social determinants of health still lacks a common structural approach to explain universally observed health inequity. Whilst there is some research on the link between childhood social and economic circumstances and adult morbidity and mortality (Davey Smith et al 2001; Osler et al 2003; Pulton et al 2002; Hayward and Gorman 2004), most focus primarily on adult health. …

Culturally sensitive evidence-based practice

Developing an evidence base for nursing practice illustrates the vital role that nurses can play in advancing quality in the healthcare agenda. This lies at the heart of the evidence-based movement. Evidence-based nursing is aimed at demonstrating the linkages between nursing interventions and patient needs, preferences, outcomes and satisfaction. In collecting, analysing and disseminating information in these areas, nurses can provide clinical evidence for competent practice. To date, nursing discourse on evidence-based practice has tended to be polarised, with advocates of the movement often at odds with those who conceive of their work in the language of caring and social justice. It is argued that a broader, more inclusive approach to building the evidence base for practice would incorporate cultural insights into the ways health and illness are socially determined. Including culturally sensitive lines of inquiry into nursings base of evidence acknowledges the diversity of individuals, families and communities. This in turn, reflects the link between knowledge, caring, and the primary health care social justice agenda embraced by health professions, including nursing. Our research agenda should highlight the primacy of ethnic and cultural diversity as an integral part of the social world that shapes health behaviours and health outcomes.

Domestic violence, health and health care: Women’s accounts of their experiences

Abstract The current health service response to women’s domestic violence related health issues seeks to categorise their presenting symptoms into physical and psychological ailments This gives a narrow and somewhat simplistic focus to what is a complex phenomenon and may obscure women’s experiences and limit the opportunities to provide proactive health care.The purpose of this study was to expand knowledge about the health issues of women who are subjected to domestic violence, by affording primacy to women’s accounts of health, in order to problematise current services and establish a more woman-centered underpinning for healthcare.The study involved narrative analysis of nine interviews with women who spoke about their health and health issues while they lived with domestic violence. Findings revealed that health was complex, and that health issues were not adequately addressed by health services, in fact health care responses were implicated in further adversely affecting the health of participants. These findings illuminate patterns that underlie individual realities of health and give a foundation from which current services can be evaluated and further developed in ways that may be more sensitive to women’s realities and needs.

Perceived changes in the knowledge and confidence of doctors and midwives to manage obstetric emergencies following completion of an Advanced Life Support in Obstetrics course in Australia

The Advanced Life Support in Obstetrics (ALSO) course is an internationally recognised interprofessional course to support health professionals to develop and maintain the knowledge and skills to manage obstetric emergencies.

Culture-specific care for Indigenous people: a primary health care perspective

Abstract This article argues that a primary health care approach is an appropriate conceptual framework for addressing the health needs of Indigenous people. Primary health care is strategic, focusing on equity, access, empowerment and intersectoral partnerships as essential elements for maintaining health. Stereotypical notions of Indigenous ill health as being embedded in a general view of ‘culture’ can mitigate against achieving equity, access to health care and ultimately self-determinism. Because health is embedded in the social conditions of people’s lives, the emphasis in Indigenous health care should first address Indigenous social disadvantage and ways of working in partnership with various groups of Indigenous people to achieve their health goals. A critical multicultural approach situates cultural differences within the wider nexus of power relations, and helps overcome the negative stereotyping that often prevents inclusive, self-determined care. Recommendations are suggested for change at the societal, professional and individual level.

Psychosocial issues facilitating recovery post-CABG surgery

Background The acute illness phase following coronary artery bypass graft (CABG) surgery is a difficult time for patients as they try to adjust to the physical and emotional changes brought about by surgery. Aims To conduct an indepth examination of psychosocial issues experienced by patients post-CABG surgery and how patients manage these psychosocial issues during their recovery. Methods A qualitative research approach, naturalistic inquiry, guided the study. Thirty patients were interviewed 4–5 weeks following discharge from hospital after CABG surgery and at 12 months after the initial interview. Results esults found that adjusting to life after surgery was difficult, and patients experienced some form of physical pain or change. An unexpected finding was the extent to which many of the patients were attuned to their post-operative physical adjustments. Patients spoke of mental and emotional changes, and coming to terms with lifestyle adjustments. Conclusion Study findings suggest the need for a re-examination of hospital discharge preparation and further provision and monitoring of home support services.

Leadership in primary health care: An international perspective

Abstract A primary health care approach is essential to contemporary nursing roles such as practice nursing. This paper examines the evolution of primary health care as a global strategy for responding to the social determinants of health. Primary health care roles require knowledge of, and a focus on social determinants of health, particularly the societal factors that allow and perpetuate inequities and disadvantage. They also require a depth and breadth of leadership skills that are responsive to health needs, appropriate in the social and regulatory context, and visionary in balancing both workforce and client needs. The key to succeeding in working with communities and groups under a primary health care umbrella is to balance the big picture of comprehensive primary health care with operational strategies for selective primary health care. The other essential element involves using leadership skills to promote inclusiveness, empowerment and health literacy, and ultimately, better health.