Danielle Williams

What are the support experiences and needs of patients who have received bariatric surgery

To explore the support needs and experiences of patients who had received publicly or privately funded bariatric surgery and the importance of this support in mediating outcomes of surgery.

A systematic review of experiences of advanced practice nursing in general practice

BackgroundDespite efforts to achieve conceptual clarity, advanced practice nursing continues to reside in a liminal space, unable to secure ongoing recognition as a viable means of healthcare delivery. This is particularly evident in general practice where advanced practice role development is more fluid and generally less supported by the hierarchical structures evident in the hospital system. This review synthesises published qualitative studies reporting experiences of advanced practice nursing in general practice. The panoramic view provided by patients, nurses and doctors within this novel context, offers a fresh perspective on why advanced practice nurses have struggled to gain acceptance within the healthcare milieu.MethodsWe conducted a systematic review of qualitative studies that explored the experiences of patients, nurses and doctors who had contact with advanced practice nurses working in general practice. Published work from 1990 to June 2016 was located using CINAHL and PubMed. The full text of relevant studies was retrieved after reading the title and abstract. Critical appraisal was undertaken and the findings of included studies were analysed using the constant comparative method. Emergent codes were collapsed into sub-themes and themes.ResultsTwenty articles reporting the experiences of 486 participants were included. We identified one major theme: legitimacy; and three sub-themes: (1) establishing and maintaining confidence in the advanced practice nurse, (2) strengthening and weakening boundaries between general practitioners and advanced practice nurses and (3) establishing and maintaining the value of advanced practice nursing.ConclusionsWe set out to describe experiences of advanced practice nursing in general practice. We discovered that general practitioners and patients continue to have concerns around responsibility, trust and accountability. Additionally, advanced practice nurses struggle to negotiate and clarify scopes of practice while general practitioners have trouble justifying the costs associated with advanced practice nursing roles. Therefore, much work remains to establish and maintain the legitimacy of advanced practice nursing in general practice.

The support needs of patients waiting for publicly funded bariatric surgery - implications for health service planners

The objective of this study was to investigate the experience of waiting for publicly funded bariatric surgery in an Australian tertiary healthcare setting. Focus groups and individual interviews involving people waiting for or who had undergone publicly funded bariatric surgery were audio‐recorded, transcribed and analysed thematically. A total of 11 women and 6 men engaged in one of six focus groups in 2014, and an additional 10 women and 9 men were interviewed in 2015. Mean age was 53 years (range 23–66); mean waiting time was 6 years (range 0–12), and mean time since surgery was 4 years (range 0–11). Waiting was commonly reported as emotionally challenging (e.g. frustrating, depressing, stressful) and often associated with weight gain (despite weight‐loss attempts) and deteriorating physical health (e.g. development of new or worsening obesity‐related comorbidity or decline in mobility) or psychological health (e.g. development of or worsening depression). Peer support, health and mental health counselling, integrated care and better communication about waitlist position and management (e.g. patient prioritization) were identified support needs. Even if wait times cannot be reduced, better peer and health professional supports, together with better communication from health departments, may improve the experience or outcomes of waiting and confer quality‐of‐life gains irrespective of weight loss.

Understanding the gendered nature of weight loss surgery: insights from an Australian qualitative study

ABSTRACT Internationally, weight loss surgery is primarily undertaken by women (75%). This difference has been attributed to the appearance concerns of women which is a simplistic and unsatisfactory explanation. The study aims to explore the way gender influences the processes leading up to surgery and life after surgery providing important new insights into the differences in uptake of weight loss surgery between men and women. Ten single-gender focus groups were conducted in Australia in 2014 (Women = 32, Men = 17). Aspects of particular importance for understanding the gendered nature of weight loss surgery include different understandings of the mechanisms that contribute to weight gain, the relationship with food, experiences of having a big body and approaches to disclosure of surgery. To maximise outcomes following surgery, health services and supports need to give greater consideration to the way gender influences experiences for men and women pre and post-surgery.

Social Justice and Constructivist Grounded Theory

What is an appropriate structure for reporting a study of equity in Vocational Education and Training (VET) for adult learners experiencing disadvantage, using qualitative research and constructivist grounded theory as methodology.

Australian women’s experiences of smoking, cessation and ‘cutting down’ during pregnancy

ABSTRACT This article presents an analysis of interviews with Australian women who had smoked or were currently smoking during pregnancy. It explores how they spoke about their experiences of smoking, cessation and harm minimisation during pregnancy. Eighteen women underwent a single in-depth interview, these were analysed using an iterative thematic method. We found that smoking, cessation and harm minimisation by pregnant women are complex social practices. Participants viewed smoking as a potential risk to fetal health and as an actual risk to their own health and described feeling embarrassed and ashamed of smoking when pregnant. Their opinions about the relative seriousness of health risks posed by smoking when pregnant were often informed by their own personal observations and experiences. Participants used this knowledge to engage in lay epidemiological processes as they rationalised and made sense of the relative risks of smoking, quitting or cutting down. They also sought legitimacy for their claims about the safety of quitting or cutting down in two potentially contradictory ways. These were personal experience/observations and medical advice. Our findings contribute to sociological understanding about lay responses to medical advice on smoking in pregnancy and will be of value to healthcare professionals who work with pregnant women.

‘Being defined’: large-bodied women’s experiences as healthcare consumers

ABSTRACT Despite an increasingly pathologised discourse on overweight and obesity, the clinical experiences of large bodied individuals remain relatively unexplored. In addition, interventions targeting overweight and obesity have generally failed to recognise the role that weight related discrimination and stigma play in both the uptake of interventions and the experience of healthcare consumers. This Australian research used a grounded theory approach, informed by constructivism, to further understanding and generate dialogue about the experiences of large bodied female healthcare consumers. Participants included 22 women, who were purposively sampled, all of whom identified as overweight or obese. Data was collected from two major sources: intensive interviews with participants and literature. For the participants in this study, being overweight or obese created a significant barrier to positive clinical interactions with their medical professionals. Women described their interactions with medical professionals, particularly general practitioners (GPs) as the most challenging to manage. Participants believed that when they became patients, they were defined by their body size, which worked to create a one-dimensional identity – that of a fat patient. These findings suggest that weight-related discrimination and stigma has a significant impact on both the clinical interaction, and the health and wellbeing of large bodied, female healthcare consumers.