Jan Paterson

The retention of the older nursing workforce: a literature review exploring factors which influence the retention and turnover of older nurses

In an era of nursing shortages and increased health care demands, it is important to explore factors which contribute to the retention of nursing staff, especially older nurses who contribute a wealth of knowledge and experience to their employing organization.This literature review explored the factors that influence older nurses to leave an organization or to retire early and identified a number of key issues which can influence this decision.These included the need to respect and recognise the achievements of older staff, specific managerial characteristics which influence staff retention, the importance of empowerment and autonomy, the valuing of expertise, the provision of challenges, creating a sense of community within an organization, the importance of education and peer development, the impact of work demands and environment, the influence of flexible working and shift options and the issue of adequate financial reimbursement. From this review, a variety of recommendations have been generated which it is hoped will help to inform the creation of policies and practices that specifically address the issue of retention of older nursing staff.

Older people have lived their lives': First year nursing students' attitudes towards older people

A survey was conducted with 262 commencing nursing students at a South Australian university, during a compulsory orientation week lecture prior to the first week of their nursing degree, to determine their attitudes towards older people and to working with older people. The survey provides baseline data to evaluate the efficacy of the Partnerships in Aged Care (PACE) Action Research project. The focus of which is developing aged care curriculum and placements with aged care industry partners. The survey will be replicated when this cohort completes their nursing degree. The results of this initial survey show that while commencing students generally have positive attitudes towards older people they do not aspire to work with them. The reasons cited for a lack of interest in working with older people include: poor experiences of providing care for older people; an inability to relate to or communicate with older people and a perception that the work is depressing and boring. Underpinning a negative perception of working with older people is the association of ageing with disability. Ageing for this cohort, is associated with loss of mental and physical function; loss of independence and increasing reliance on others to meet self care needs. This is viewed as evidence of a biomedical view of ageing. Contrary to previous research, many students studied in this project, who have had experience of working with older people demonstrate more positive attitudes to older people and are less likely to express stereotypical attitudes towards ageing suggesting that positive exposure to older people can challenge ageist views. The PACE project seeks to demonstrate that strategies which may promote a positive attitude to ageing such as development of educational content which promotes a quality of life rather than a biomedical approach to ageing and supported clinical placements can impact positively on nursing students perception of ageing and of working with older people.

Stigma associated with postprostatectomy urinary incontinence

Purpose This collective case study explored the social implications of postprostatectomy urinary incontinence (UI). Design Collective case study. Settings and subjects Three men older than age 60 years dwelling in the community who had urinary incontinence following prostatectomy. Methods Unstructured, in-depth interviews were thematically analyzed and presented in the form of a collective case study. Results Participants articulated two separate entities: a private and public identity. In their public identity, the participants went to great lengths to appear as a person who was continent of urine, and they expressed fear that their UI would be exposed. In revising their private identity, men used knowledge of their anatomy and physiology, family history, and life events to reject the cultural attitudes towards UI and renegotiate a new sense of self that was accepting of their leaking body. Conclusion A stigma exists for men who experience UI following prostatectomy; this stigma affects public and private identity. Naturalistic inquiry methods such as the collective case study described here provide new knowledge for continence nurses as they assist these patients to manage their UI within a social context.

Selection of continence products: perspectives of people who have incontinence and their carers.

Purpose : The needs, issues and concerns of people with incontinence and their carers were explored in order to inform the development of a comprehensive Australian consumer guide to continence products. Participants and methods : Semi-structured interviews and focus groups were conducted with a wide range of people with incontinence and carers. Questions centred around issues and concerns regarding continence product selection, what information people need to make informed choices, and how the information should be presented. Qualitative analysis highlighted common themes and specific issues. Results : Issues raised by consumers included the paucity of written information currently available, ignorance among health professionals concerning continence products and the lack of information about sources of help. Most consumers selected products by trial and error and were unaware of the range of products and services available. They wanted a consumer guide to continence products to be user-friendly and easily accessible, with information on product availability, cost, quality, comfort and design. They also wanted more general information on incontinence, sources of help, and how to select, care for and dispose of products. Participants wanted the guide to be made available in different languages, in large print and simple language. Conclusions : The findings highlight the need and provide a framework for a consumer guide and information on continence products.

Gerontological Education in Undergraduate Nursing Programs: An Australian Perspective

Literature reveals difficulties in preparing nurses to care for older people. This article reports a study that aimed to facilitate positive changes in gerontological education in an undergraduate nursing program by identifying barriers and effective actions. A critical research approach was applied to the study. Data were mainly collected through focus groups. A total of five barriers were identified in gerontological education in an undergraduate nursing program. Actions which may address these barriers were explored. Critical reflection on educational practice based on partnerships between education and service sectors has the potential of leading an educational reform in gerontological nursing.

Cross-Cultural Comparison of Attitudes and Preferences for Care of the Elderly Among Australian and Chinese Nursing Students

Purpose: The aim of this study was to compare Australian and Chinese nursing students’ attitudes and intentions to care for the elderly and the factors affecting these intentions. Method: A cross-sectional design employed two questionnaires to survey 256 Australian nursing students and 204 Chinese nursing students within the first weeks of their nursing curriculum. Factor analysis and logistical regression analysis were performed to identify predictors of intent to care for the elderly. Results: The percentage of students more likely to care for the elderly was significantly higher among the Chinese group (72.1%) than the Australian group (45.3%). Work experience with older people and being under the age of 20 were found to be positive predictors, whereas factors such as prejudice toward the elderly and beliefs that elders should live in separate housing were negatively associated with an intention to care for the elderly. Conclusions: The collectivist culture has a more positive influence on nursing students’ attitudes toward the elderly compared with the individualist culture. Implications for Research and Practice: It is highly recommended that elderly care settings should be incorporated in clinical placements and further research is needed to explore how clinical experience affects students’ career choice.

Perspectives of Carers on the Move From a Hospital to a Transitional Care Unit

The authors describe carers’ experiences of the traditional process of moving a relative into residential care from an acute hospital admission and how a transitional care unit affected this experience. Telephone interviews (total 31) confirmed that looking for permanent care was a stressful, time-consuming, and confusing process for all carers. The transitional care unit did not make a great difference to the stress of finding a residential care vacancy, but the overall experience of transitional care was positive, with carers feeling that it gave them time to consider residential care options. Carers felt that a hospital was not the best environment to assess ongoing care needs. The implementation of transitional care did not reduce the stress felt by carers when looking for a residential care facility, but it was an acceptable alternative to waiting for residential care in hospital.

An investigation of the support needs of men and partners throughout the prostate cancer journey.

Prostate cancer is one of the mostly commonly diagnosed cancers in men. Unfortunately, the treatment for this cancer can have a number of negative side effects, both for the man himself and his partner. This study investigated the support needs of both men and partners throughout the prostate cancer journey and how this journey may be optimally managed.

A health economic model for the development and evaluation of innovations in aged care: an application to consumer-directed care—study protocol

Introduction Consumer-directed care is currently being embraced within Australia and internationally as a means of promoting autonomy and choice in the delivery of health and aged care services. Despite its wide proliferation little research has been conducted to date to assess the views and preferences of older people for consumer-directed care or to assess the costs and benefits of such an approach relative to existing models of service delivery. Methods and analysis A comprehensive health economic model will be developed and applied to the evolution, implementation and evaluation of consumer-directed care in an Australian community aged care setting. A mixed methods approach comprising qualitative interviews and a discrete choice experiment will determine the attitudes and preferences of older people and their informal carers for consumer-directed care. The results of the qualitative interviews and the discrete choice experiment will inform the introduction of a new consumer-directed care innovation in service delivery. The cost-effectiveness of consumer-directed care will be evaluated by comparing incremental changes in resource use, costs and health and quality of life outcomes relative to traditional services. The discrete choice experiment will be repeated at the end of the implementation period to determine the extent to which attitudes and preferences change as a consequence of experience of consumer-directed care. The proposed framework will have wide applicability in the future development and economic evaluation of new innovations across the health and aged care sectors. Ethics and dissemination The study is approved by Flinders University Social and Behavioural Research Ethics Committee (Project No. 6114/SBREC). Findings from the qualitative interviews, discrete choice experiments and the economic evaluation will be reported at a workshop of stakeholders to be held in 2015 and will be documented in reports and in peer reviewed journal articles.

A pilot study of the development and implementation of a ‘best practice’ patient information booklet for patients with chronic venous insufficiency

Objective Chronic venous insufficiency (CVI) is a chronic condition that has a significant impact on the individual. For the effective, long-term management of CVI, it is important that patients are educated on the patho-physiology of the condition and strategies that can minimize the related complications. Therefore, the aim of this study was to develop and pilot a ‘best practice’ information booklet for CVI and to assess the impact of this booklet on CVI-related knowledge and quality of life (QOL). Method A ‘best practice’ CVI booklet was developed based on the best available evidence from the literature. Participants with a formal diagnosis of CVI with a clinical, aetiological, anatomical and pathological elements (CEAP) classification of 3–6 were recruited from vascular outpatient clinics at a tertiary hospital. Each participant was given and explained the CVI booklet and asked to undertake the recommended activities at home over the next six-month period. Measurements were taken at baseline, one month and six months postbooklet implementation via the previously validated Health Education Impact and the CVI Questionnaires. Results Twenty-six participants, aged 38–90 years (mean 71.8 ± 12.9 years) initially participated in the study, with 20 participants remaining at the six-month time point (77% completion rate). At the end of one month, there had been a significant improvement in doing at least one activity to improve CVI (P = 0.010), monitoring CVI (P = 0.045), having effective ways to prevent CVI symptoms (P = 0.045), knowing CVI triggers (P = 0.005), ability to travel by car and bus (P = 0.05), undertaking social activities (P = 0.030) and feeling less embarrassed about the legs (P = 0.025). At trial end (6 months), there was a significant improvement in doing at least one activity to improve CVI (P = 0.003), knowing CVI triggers (P = 0.016), having effective ways of preventing CVI symptoms (P = 0.008), worrying about the CVI (P = 0.030), feeling hopeless because of CVI problems (P = 0.007), leg and ankle pain (P = 0.038), ability to do domestic duties (P = 0.017), feeling nervous and tense (P = 0.026), and feeling less embarrassed about the legs (P = 0.008). Although other domains improved in the study, none of these improvements were statistically significant. Conclusion Although a small pilot study, the outcomes demonstrate that the implementation of a ‘best practice’ CVI information booklet into a patients management routine can improve both CVI-related knowledge and QOL.