David Lindsay

PRN psychotropic medications: The need for nursing research

Abstract This paper highlights the inadequacy of existing research for the purposes of evidence-based prn (Latin, pro re nata or ‘as needed’) medication practice in psychiatric settings and notes the absence of relevant evidence-based clinical practice guidelines and policies, both nationally and internationally. The professional, ethical and legal importance of PRN medication practices is also discussed, and shown to add to the urgency of developing a research agenda which will serve as an adequate basis for good clinical practice. This paper summarises the relevant research and identifies problems that can arise for clinicians involved in the administration of prn medications in mental health settings. It concludes by highlighting key issues which urgently require empirical investigation.

Challenges faced by Indigenous nursing students and strategies that aided their progress in the course: A descriptive study

Abstract Marked improvements in Indigenous health can be achieved by increasing the participation of Indigenous people in the health professions. Currently in Australia the participation by Indigenous people in the health professions is low and the Indigenous people of Australia continue to have poor health outcomes. This qualitative study utilised interviews with 22 Indigenous students enrolled in undergraduate nursing degrees across Australia, to explore the challenges they faced and uncover the strategies they had found helpful to their progress in the course. The findings indicate that students are challenged by financial hardship, staff insensitivity to cultural issues, discrimination, lack of Indigenous mentors, poor study skills, lack of adequate educational preparation, lack of resources, and ongoing family commitments. Strategies identified as particularly helpful to tenure within the course include specific Indigenous support units, adequate financial support, interested academics, Aboriginal Tertiary Assistance Scheme (ATAS) tutors, support from family and friends, and support from other students.

The nurse practitioner role in Fiji: Results of an impact study

ABSTRACT The Nurse Practitioner role, a relatively new role in Fiji, was introduced by the Ministry of Health in order to increase local access to adequate health care for people living in remote areas. Both developed and developing countries have introduced Nurse Practitioner or similar roles in order to provide a cost effective and sustainable health workforce. This paper provides the results of a qualitative, descriptive study undertaken to explore the introduction of this role and its impact on health service delivery in Fiji. It involved semi-structured and focus group interviews with nurse practitioners, key stake holders and community members. The findings demonstrate the positive impact of the role and its benefits to people living in the remote areas of Fiji. It also outlines the satisfaction of villagers with Nurse Practitioners and the extensive scope of practice undertaken by these practitioners. Issues related to the introduction of the role are also discussed. Finally, recommendations for future research and practice are offered.

Self-reported long-term conditions of nurses and midwives across a northern Australian health service: A survey

BACKGROUND Although nurses generally constitute the largest component of the health workforce there is no systematic collection of data about their health status. Similarly, little is known about how nurses manage any long-term condition they may have, which could contribute to their reducing hours of employment or leaving the workforce completely. Such information will become more important against the backdrop of a global shortage of nurses, and ageing of the nursing population. OBJECTIVES This study aimed to identify the types and impacts of reported long-term conditions, and strategies employed by nurses to manage their conditions. DESIGN A cross-sectional survey design was used. SETTINGS The setting was a large regional health service in North Queensland, Australia, comprising a tertiary referral hospital, two residential aged care facilities and several rural and remote hospitals and community health services. PARTICIPANTS All full-time, part-time and casual nurses and midwives employed within the health service were invited to participate; 665 (30.9%) completed surveys were returned. METHODS A paper-based questionnaire, comprising six sections, was individually addressed to all potential participants, together with reply-paid envelopes for returning completed questionnaires. The anonymous questionnaire took approximately 15 to 25min to complete, less time if the nurse reported no long-term conditions. RESULTS Three-fifths of respondents had at least one long-term condition. Respondents older than 50 years were statistically more likely to report having at least one long-term condition (χ(2)=5.64, p=0.018). Back pain, migraine and asthma were the most frequently reported individual conditions; more than one-quarter of respondents reported a condition relating to mental health and wellbeing. Respondents who reported more than one long-term condition compared to a single long-term condition were statistically more likely to have had more years of nursing experience (t=02.2, p=0.03). Nurses used a combination of varied personal and workplace strategies for many conditions; however personal strategies were most frequently used for all conditions. CONCLUSIONS This survey elicited information about reported long-term conditions, and strategies that nurses used to manage the condition they considered most important to them. We recommend that further investigation into how the full range of workplace strategies could be implemented to assist nurses to manage long-term conditions.

Nurse practitioners for rural and remote Australia: Creating opportunities for better health in the bush

[Extract] Controversy has dogged the introduction of nurse practitioner (NP) positions in rural and remote Australia, despite the need for an increase in flexible and affordable health-care services outside metropolitan areas. Ironically, it was the need for a new model of rural and remote health care that provided the impetus for developing the NP role in Australia in the late 1990s. Almost a decade after the first NP was authorised to practise in rural New South Wales, the number of endorsed NPs in rural and remote areas remains low relative to those practising in large regional and metropolitan hospitals. Indeed, the majority of new positions have been created in specialty areas of nursing.

“Do You Want Fries With That?”: The McDonaldization of University Education—Some Critical Reflections on Nursing Higher Education:

Public universities, as the predominant source of nurse education, serve an instrumental role as pressure mounts to produce large numbers of workready graduates to meet the needs of the labor market. Neoliberalism is recognized as the dominant political and economic philosophy across the globe, and new managerialist, corporatized practices, as its “organizational arms,” are ubiquitous within the higher education sector worldwide. Intersecting this agenda are dramatic developments in the way university courses are being conceived and delivered based upon the increasing integration of digital technologies. Given the radical transformations brought about by Web 2.0 technologies, it is timely to critically analyze current narratives shaping the teaching and learning agenda and their impact on the nature and quality of nursing higher education. This article draws on the “McDonaldization thesis” of George Ritzer, concepts from the work of the Italian philosopher Giorgio Agamben, Habermasian social theory, and critical pedagogy. It concludes with a short overview of possible outcomes of the new agenda, and some strategies for resistance. Although the focus is on Australia, it is relevant to other countries to the extent that they are facing similar challenges and undergoing analogous pedagogic transformations.

Medical and allied health staff self-reported long-term conditions: Findings from a regional Australian health service

Purpose The purpose of this paper is to describe the self-reported long-term conditions of medical officers and allied health staff working in a regional public health service in northern Australia and how these conditions are managed. Design/methodology/approach A cross-sectional survey design was used. The sample was all medical officers and allied health staff employed in mid-2015. Findings Of the 365 respondents, 217 (59.5 per cent) reported having at least one long-term condition. There was a statistically significant association between professional group and the number of long-term conditions reported, χ2=10.24, p<0.05. A greater proportion of medical officers (n=29, 43.9 per cent) reported having only one long-term condition compared with allied health staff (n=36, 24.5 per cent). The top four categories of conditions were respiratory, musculoskeletal, mental health and episodic and paroxysmal, although the patterns varied amongst the professional groups, and across age groups. Respondents usually managed their main long-term conditions with personal strategies, rarely using workplace strategies. Research limitations/implications Although somewhat low, the response rate of 32 per cent was similar to previous surveys in this health service. Since this survey, the health service has implemented a broad Health and Wellness Programme to support their qualified workforce. Future evaluations of this programme will be undertaken, including whether the programme has assisted health professionals to manage their long-term conditions. Practical implications There is an urgent need for targeted, workplace-based health promotion strategies to support staff with long-term conditions. Such strategies would complement self-management approaches, and also provide an important recruitment and retention initiative. Originality/value This study adds empirical evidence regarding the long-term conditions among health professionals and their self-management strategies. Little is known about the long-term conditions among the various health professional groups and the findings thus make an important contribution to the existing literature.

Learning from Experience: An Evaluation of an External Nursing Course in Regional Australia.

The delivery of pre‐registration Bachelor of Nursing courses in Australia has primarily been through the traditional on‐campus mode. The development and implementation of an external course mode necessitates pedagogical reflection on a number of delivery, design, implementation, and consequently evaluation, processes. This paper discusses one aspect of the course evaluation process of a pre‐registration nursing course offered by the School of Nursing, Midwifery and Nutrition at James Cook University in regional Australia. Course feedback was obtained from 26 respondents through an exit survey which used both quantitative and qualitative questions. While the majority of students were satisfied with the content of subjects, written course material, the use of email and Web‐based delivery of subjects, a number of respondents were less satisfied with access to staff and experienced difficulties with the financial costs of the course. Generally, however, respondents indicated they had gained a number of personal, academic and professional benefits through completing the course.