Isabel Higgins

Belongingness: a montage of nursing students' stories of their clinical placement experiences.

The psychological and social sciences literature is replete with assertions that human beings are fundamentally and pervasively motivated by the need to belong. This paper reports on some of the findings from the qualitative phase of a mixed-method, multi-site study that explored nursing students’ experience of belongingness while on clinical placements. Students from Australia and the United Kingdom were interviewed to identify factors that impact upon and are consequences of belongingness. A montage of participants’ stories is used to illustrate some of the key features of clinical workplaces that are conducive to the development of belongingness. Contextual factors and interpersonal dynamics were seen to have a significant bearing on students’ experiences. Clinical leaders/managers who were welcoming, accepting and supportive, and nursing staff who were inclusive and encouraging, facilitated students’ perception of being valued and respected as members of the nursing team. Additionally, the provision of consistent, quality mentorship was identified as important to students’ feelings of connectedness and fit. The experience of belongingness, in turn, enhanced students’ potential for learning and influenced their future career decisions. Alternatively, alienation resulted from unreceptive and unwelcoming clinical environments and from the dissonance created when students’ personal and professional values did not articulate with those evident in practice environments. Consequently, distress, detachment and disengagement occurred and students’ capacity and motivation for learning was negatively impacted.

The negative attitudes of nurses towards older patients in the acute hospital setting: a qualitative descriptive study.

Aim: This paper reports the findings of a sub-sample of interviews from a larger study designed to explore the attitudes of health care workers towards older people in that acute care setting. The discussion in this paper focuses only on interviews with nurses and their negative attitudes towards older people in their care. Background: As Australia’s ageing population continues to grow exponentially, their demand for hospital care also increases. Many nurses in the acute care setting have had little, if any, specialist education in the care of older people and therefore do not understand the extent of their needs. Coupled with the lack of specialist knowledge is the low status of older person care in this setting. Many nurses prefer to care for younger patients with acute illnesses that are curable (Nay 1993 in Nay & Garratt 2004: 61). As with the population at large, health care professionals hold negative views about old age and this is reflected in their attitudes. Method: The findings presented in this paper focus on data analysed from in depth interviews with nurses. As a prompt to discussions, nurses were presented with scenarios that exemplified both positive and negative attitudes to care. However, much of what was discussed in interviews focused on negative attitudes. Interviews with medical and allied health staff will be reported in a separate paper. Results: The analysis of data with nurses reveals two themes and sub-themes. ‘Marginalisation and oppression of the older person’ shows the ways in which nurses perceive older people are relegated to a lower status in the acute care setting, how this is ‘contagious’ and how ‘lack of time’for care for older people is problematic and has become their ‘catchcry’. ‘Stereotyping the older person’ depicts some of the ways in which this evolves, for example, through ‘Chinese Whispers’ (UsingEnglish.com 2006), but has become part of the ageist culture.

Patient and health professional's perceived barriers to the delivery of psychosocial care to adults with cancer: a systematic review

To explore the barriers experienced and perceived by health professionals and patients in the delivery of psychosocial care to adults with cancer.

Multidimensional assessment and tailored interventions for COPD: respiratory utopia or common sense?

Introduction The rising disease burden from chronic obstructive pulmonary disease (COPD) requires new approaches. Method We suggest an approach based around three elements: inflammometry and multidimensional assessment to identify therapeutic targets and case management to design and implement an individualised treatment programme based on these assessments. Discussion This tailored approach to treatment would maximise efficacy, limit cost and permit a better risk–benefit ratio of treatment. The advantages include the ability to add up the benefits of individual therapies leading to a cumulative therapeutic benefit that is greater than each individual therapy alone. We can now design a multifaceted inflammometry intervention for airway diseases based on targeting eosinophilic inflammation, non-eosinophilic pathways and systemic inflammation. COPD is a complex and challenging disease. The use of inflammometry and multidimensional assessment is necessary to identify relevant treatment targets and maximise the scope of therapy while limiting unnecessary use of drugs. An individualised programme of management can be designed and coordinated by using a case manager. This new approach may provide tangible benefits to people with COPD.

Multidimensional assessment of older people with asthma and COPD: clinical management and health status

BACKGROUND the diagnosis and management of obstructive airway diseases (OADs) such as asthma and chronic obstructive pulmonary disease (COPD) can be challenging in older people. OBJECTIVE to assess the clinical, functional, biological and behavioural characteristics relevant to the management of older people with OAD. METHODS a cross-sectional study was conducted in a tertiary teaching hospital. Older people (> 55 years) (n = 100) with an OAD underwent a multidimensional assessment (MDA) involving questionnaires, clinical assessments, physiological measurements and biomarkers. RESULTS the assessment identified a mean (SD) of 11.3 (2.5) clinical management issues and 3.1 (1.8) comorbid conditions per participant. Common problems were: airways hyper-responsiveness (80%); airway inflammation (74%); activity limitation (74%) and systemic inflammation (60.5%). The number and type of issues were similar irrespective of a diagnosis of asthma or COPD (P = 0.2). The degree of health status impairment correlated significantly with the number of clinical management issues detected (r = 0.59; P < 0.0001). CONCLUSIONS older people with OAD experience multiple clinical issues that adversely impact their health status. The number and type are similar irrespective of diagnosis. This MDA identifies significant clinical issues that may not be addressed in a diagnosis centred approach suggesting that a multidisciplinary approach is necessary when assessing and managing older people with OAD.

Doing clinical research: The challenges and benefits

Abstract The need for research in practice is well documented within nursing and other health care disciplines. This acceptance is predicated on the belief that clinically applied research will inform and improve practice and health service delivery resulting in better outcomes for consumers and their families. Nurses, however, find doing clinical research challenging. This paper describes nurses’ experiences of doing clinical research. The main challenges of doing clinical research arise from a culture that prioritises practice where nursing work is core business and there is the need to address immediate and short term goals. There are also problems associated with the use of research language amongst clinical nurses and ambiguity in relation to research role expectations. Lack of support and resources for doing research along with keeping up the momentum for a research project also pose significant challenges. The benefits of doing clinical nursing research include experiential learning that has the potential to lead to practice change and improved patient outcomes that are evidence based.

Towards innovation: the development of a person-centred model of care for older people in acute care.

Abstract That the population is ageing poses many challenges for health care planners. Some argue that these challenges, exacerbated by limited funding, maintaining increased community expectations and the need for quality health care outcomes, may be overcome by exploring alternate models of care. These ideas have led health planners to reconceptualise contemporary philosophies of care with the current emphasis on multidisciplinary teams and a person-centred approach to care. This paper presents a model for the care of older people in the acute care setting. The concepts for the development of the model were derived from the international literature. In the model the care of older people is underpinned by a philosophy of person-centredness. The complex nature of care is represented along with those factors that enable a person-centred approach to be taken. The functions of the model in practice are highlighted and discussion of how it is being implemented within the acute care sector outlined.

Reflections on Conducting Qualitative Research with Elderly People

It should come as no surprise that conducting research with elderly people can be challenging and problematic. A review of the literature in this area provides some indication of what many other researchers have encountered, particularly in relation to doing quantitative studies. The majority of these challenges deal with issues involving consent. Although there have been a few articles dealing with doing qualitative research with this population, they were not informative in terms of preparing the author for day-to-day situations. This article is an attempt to redress some of this by sharing the authors experience of collecting data for a phenomenological study involving elderly people who reside in nursing homes. The aim is not to provide solutions but rather to highlight some of the challenges that confront qualitative researchers in this context.

Advance care planning (ACP): the nurse as 'broker' in residential aged care facilities.

Abstract This paper describes one aspect of a study that investigated how Advance Care Planning (ACP) was implemented in residential care facilities (RACFs) in Australia and the role of a Clinical Nurse Consultant (CNC) for ACP. Three RACFs were included in the study. This paper focuses on the implementation process of ACP by the CNC in the RACFs. The preliminary findings highlight the need to dispel the myths about ACP and Advanced Care Directives (ACDs), and how the CNC acted as a broker for ACP. The CNC’s role is represented by a Nursing Brokerage Model. By revealing how ACP is implemented the research contributes to the limited existing knowledge of options that are currently available to older adults and their families in order to help them make care choices about the end of their lives.

Managing Older Patients with Coexistent Asthma and Chronic Obstructive Pulmonary Disease

Asthma and chronic obstructive pulmonary disease (COPD) are common obstructive airway diseases, especially among older people. These conditions are associated with a significant and increasing disease burden. The diagnosis and management of asthma and COPD in older populations are complex, and consequently clinicians are faced with many therapeutic and diagnostic challenges. Both aging and obstructive airway diseases are associated with complex co-morbidities and these coexisting illnesses confound management. Moreover, the age-related physiological changes that occur in the lungs may lead to airflow limitation, and this may be difficult to distinguish from an active disease state. In practice, management of asthma and COPD is informed by disease-specific clinical practice guidelines; however, most older people with these conditions are excluded from clinical trials that are designed to inform practice, creating major evidence gaps. Furthermore, seldom do clinical practice guidelines consider the complexities of management in older populations. The problems experienced by older people are complex and multifactorial and our approach to management must reflect these challenges. Opportunities exist to improve the management and outcomes for older people with obstructive airway disease and there is an urgent need for clinical trials to test management approaches in this population; current research must consider the challenges and evidence gaps that exist.