Eileen Willis

Identification of patients with noncancer diseases for palliative care services

OBJECTIVE To identify criteria for measuring the eligibility of patients with end-stage noncancer diseases for palliative care services in Australian residential aged care facilities. METHODS No validated set if guidelines were available so five instruments were used: an adaptation of the American National Hospice Association Guidelines; a recent adaptation of the Karnofsky Performance Scale; the Modified Barthel Index; the Abbey Pain Score for assessment of people who are nonverbal and a Verbal Descriptor Scale, also for pain measurement. In addition, nutritional status and the presence of other problematic symptoms and their severity were also sought. RESULTS The adapted American National Hospice Association Guidelines provided an initial indicative framework and the other instruments were useful in providing confirmatory data for service eligibility and delivery.

The severe sepsis bundles as processes of care: a meta-analysis.

OBJECTIVE The use of the sepsis bundles in patients with severe sepsis and septic shock has been controversial in the last decade. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate survival effects. DATA SOURCE Database searches (2004-current) of Medline, CINAHL, Pubmed, Cochrane, Scopus and Google scholar databases which covered full publications, abstracts from conferences and digital thesis were performed using the search terms sepsis, septic shock and/or bundles, processes of care, guidelines, early goal directed therapy, resuscitation. RESULTS From 253 identified studies, 21 sepsis bundle original studies were selected and included 23,438 patients. The Resuscitation 6 hour Bundle pooled analysis (1819 patients) achieved the greatest survival benefit (odds ratio (OR) 2.124, 95% CI 1.701-2.651, p<0.000) with the Management 24 hour Bundle pooled analysis the lowest survival benefit (16,521 patients) (OR 1.646, 95% CI 1.036-2.614, p<0.035). Both bundles together (Complete Bundle) achieved a combined survival benefit (OR 1.744, 95% CI 1.421-2.141, p<0.000). ScvO2 and blood glucose components were analysed individually to assess their contribution to survival. CONCLUSION The Resuscitation 6 hour bundle in the context of the patient population at hand is unlikely to do harm and is yet to be established in primary research in Australia. The Management 24 hour Bundle could not establish a strong enough survival benefit above current routine practice. The sepsis guidelines and bundles have demanded more credible process measurements and debate to induce positive changes in the intervention and treatment care of patients with severe sepsis.

Documenting end of life decisions in residential aged care facilities in South Australia

Objective:

Predicting Household Water Consumption With Individual-Level Variables

Few studies investigating the psychological determinants of water consumption and conservation use metered household water data. Studies that have used metered consumption have found that individual-level motivations are often weak predictors. This may be due to the psychological determinants being measured at the individual level and metered consumption at the household level. This article contributes to the water consumption literature by (a) identifying the determinants of change in water consumption over time and (b) testing effects in single-person households where levels of analysis are equivalent. We applied models to data from South Australia (N = 410) and Victoria (N = 205) and found that variables at the individual, household, dwelling, and regional levels predict the initial level of consumption and/or its rate of change. Some individual-level variables were not significant predictors of household consumption but did predict individual consumption. We discuss these results in light of previous research and offer avenues for future research.

The problem of time in ethnographic health care research

Drawing on the ideas outlined by anthropologist Fabian and feminist scholars Halford, Savage, and Witz, in this article I make two arguments that challenge ethnography’s claim to theoretical inference and empirical generalization, particularly for research examining contemporary health care practices. For Fabian, the dilemma arose out of ethnography’s origins in the secularization of time. Accounts of the subject’s experiences using present tense assume no progress; accounts using past tense freeze the subjects in the past. For Halford and her colleagues, the methodological problem was reversed. Their respondents were engaged in a battle with health systems in constant change that resulted in the loss of memory of a corporate past. The problem now for the ethnographer, as in many other research approaches, is one of verification of observations and reliability of interpretations. The ethnographer now becomes frozen in time as is his or her account of events in the field. Drawing on ethnographic research in hospital workplace change, in this article I examine these time-based implications for truth claims.

Using Goffman’s Theories of Social Interaction to Reflect First-Time Mothers’ Experiences With the Social Norms of Infant Feeding:

Infant feeding, particularly breastfeeding, is an important public health issue because early feeding methods have been shown to influence health throughout childhood. We investigated how social norms influence first-time mothers’ decisions around feeding methods. We conducted two in-depth interviews with 11 first-time mothers, the first 3 weeks after birth and the second 3 months following birth. We analyzed interview data using a third-level, thematic analysis, using Goffman’s theories of social interaction to guide our analysis. Our results highlighted several issues surrounding breastfeeding in modern society. We propose that nursing mothers are conscious of adhering to social norms of being a good mother, but must also cope with societal views about presenting normal appearances when they need to feed their babies in public.

Palliative care in aged care facilities for residents with a non-cancer disease: results of a survey of aged care facilities in South Australia

Objectives:  This study reports the results of a cross‐sectional study of residential aged care facilities in South Australia which sought to quantify the extent of specialist palliative care involvement in residential aged care facilities as well as identifying the current need for palliative care.

Rounding, work intensification and new public management.

In this study, we argue that contemporary nursing care has been overtaken by new public management strategies aimed at curtailing budgets in the public hospital sector in Australia. Drawing on qualitative interviews with 15 nurses from one public acute hospital with supporting documentary evidence, we demonstrate what happens to nursing work when management imposes rounding as a risk reduction strategy. In the case study outlined rounding was introduced across all wards in response to missed care, which in turn arose as a result of work intensification produced by efficiency, productivity, effectiveness and accountability demands. Rounding is a commercially sponsored practice consistent with new public management. Our study illustrates the impact that new public management strategies such as rounding have on how nurses work, both in terms of work intensity and in who controls their labour.

Some difficulties and inconsistencies when using habit strength and reasoned action variables in models of metered household water conservation.

Research employing household water consumption data has sought to test models of water demand and conservation using variables from attitude theory. A significant, albeit unrecognised, challenge has been that attitude models describe individual-level motivations while consumption data is recorded at the household level thereby creating inconsistency between units of theory and measurement. This study employs structural equation modelling and moderated regression techniques to addresses the level of analysis problem, and tests hypotheses by isolating effects on water conservation in single-person households. Furthermore, the results question the explanatory utility of habit strength, perceived behavioural control, and intentions for understanding metered water conservation in single-person households. For example, evidence that intentions predict water conservation or that they interact with habit strength in single-person households was contrary to theoretical expectations. On the other hand, habit strength, self-reports of past water conservation, and perceived behavioural control were good predictors of intentions to conserve water.

Indigenous women's expectations of clinical care during treatment for a gynaecological cancer: rural and remote differences in expectations

OBJECTIVES To report on differences in Indigenous womens expectations of clinical care during treatment for a gynaecological cancer in rural and remote regions. DESIGN Qualitative interviews were conducted in New South Wales, Victoria, South Australia and the Northern Territory in 2008 with 37 clinicians working in gynaecological cancer and 24 women with a gynaecological cancer. Three of the participants were Indigenous women living in large rural towns (others were non-Indigenous), whereas six of the 37 clinicians interviewed worked closely with Indigenous women in remote settings. Indigenous women were contacted through an Indigenous researcher. Interviews were analysed for emerging themes, then compared with each other and with the research literature for similarities and differences. RESULTS There is considerable variation between clinician observations of the expectations of Indigenous women in remote regions, and the views of Aboriginal women in rural settings. CONCLUSION Indigenous women in rural settings have specific views about quality medical care. These include expectations of timely and culturally appropriate care, and strong ties to family and kin, but do not accord with other research findings that suggest Aboriginal women must receive care from same sex clinicians or that care is often delayed. The paper alerts practitioners to the fact that culturally appropriate care will vary from group to group, particularly between remote, rural and urban populations.