Lisa McKenna

The use of complementary and alternative medicine by pregnant women: A literature review

BACKGROUND The use of complementary and alternative medicine (CAM) has become increasingly prevalent in industrialised countries, with women being the most prolific users. Some women continue to consume these therapies when they become pregnant. AIM To review the literature exploring prevalence and motivation for use of complementary and alternative medicine by pregnant women. METHOD A search for relevant literature published from 2001 was undertaken using a range of databases and by examining relevant bibliographies. RESULTS Although the estimates vary widely from 1% to 87%, the general trend indicates that a significant number of pregnant women use complementary and alternative medicine. Common modalities used include massage, vitamin and mineral supplements, herbal medicine, relaxation therapies and aromatherapy. Reasons for use are varied and include the belief that these therapies offer safe alternatives to pharmaceuticals, they allow greater choice and control over the childbearing experiences, and they are congruent with their holistic health beliefs. The influence of traditional cultural practices on the use of these therapies is unclear. Most expectant women rely on advice from family and friends, and many do not disclose their use to their pregnancy care providers. CONCLUSIONS Many women use complementary and alternative medicine when they are pregnant. Further research is needed to gain a greater understanding of the true prevalence and expectant womens motivation for the use of complementary and alternative medicine. Health-care professionals are encouraged to ask women about their use of these treatments and seek out relevant information.

Exploring a pedagogical approach to integrating research, practice and teaching

Application of evidence is accepted as an important component of clinical practice. Teaching research to undergraduate students has been reported internationally as a challenge, particularly for nurse educators. In this paper, reported is a strategy designed to enhance research learning for undergraduate midwifery students at one university, which formed part of a larger, international investigation into womens responses to caesarean birth. Following theory classes and briefings, students worked with their clinical educators in practice to interview women using existing tools, and were engaged in qualitative data analysis. A number of challenges were encountered throughout the process, both for the educators and students. However, the teaching approach provided benefits for students in learning about midwifery research. Recommended as essential is for continued development of pedagogical approaches that make research tangible for students. Furthermore, provision of support for clinical staff working with students is important for success of such approaches.

Experiences and learning during a graduate nurse program: an examination using a focus group approach.

The graduate nurse year requires individuals to make a huge transition from university student to registered nurse as part of the health care workforce. New graduates experience steep learning curves throughout the first year of professional practice. This study sought to explore experiences and learning occurring throughout the graduate nurse program for a group of seven new nurse graduates. Focus group interviews were conducted at six months and 12 months into the program using the same set of guiding questions. The first interview highlighted that graduates early in the graduate year were internalised, concentrating on their own survival in managing workloads, facing practice realities and coming to terms with themselves as nurses. Learning was primarily about survival strategies and performing tasks. By the second interview, graduates were much less focussed on themselves. They understood their place in the health care team, had gained confidence in their relationships, and were showing concern for the next graduates arriving. Learning at this stage involved more higher order skills, including critical thinking.

Levels of empathy in undergraduate nursing students

McKenna L, Boyle M, Brown T, Williams B, Molloy A, Lewis B, Molloy L. International Journal of Nursing Practice 2012; 18: 246–251 Levels of empathy in undergraduate nursing students Empathy and absence of prejudice and stigma are instrumental in facilitating effective nurse–patient relations. This study assessed empathy levels and regard for specific medical conditions in undergraduate nursing students. A cross-sectional study was undertaken using paper-based versions of the Jefferson Scale of Physician Empathy (JSPE) and Medical Condition Regard Scale (MCRS), along with a brief set of demographic questions. Participants reported good empathy levels on JSPE. Attitudes towards intellectual disability, chronic pain, acute mental illness and terminal illness rated well on MCRS. Attitudes towards substance abuse, however, were lower. There were no significant differences between age groups, gender or year level of study. Overall results of this study were positive. Nursing students demonstrated acceptable empathy levels. Attitudes towards patients who abuse substances highlight an area that needs both further exploration and addressing. Attitudes towards mental health diagnoses were particularly favourable given that these often attract stigma and negative attitudes.Empathy and absence of prejudice and stigma are instrumental in facilitating effective nurse-patient relations. This study assessed empathy levels and regard for specific medical conditions in undergraduate nursing students. A cross-sectional study was undertaken using paper-based versions of the Jefferson Scale of Physician Empathy (JSPE) and Medical Condition Regard Scale (MCRS), along with a brief set of demographic questions. Participants reported good empathy levels on JSPE. Attitudes towards intellectual disability, chronic pain, acute mental illness and terminal illness rated well on MCRS. Attitudes towards substance abuse, however, were lower. There were no significant differences between age groups, gender or year level of study. Overall results of this study were positive. Nursing students demonstrated acceptable empathy levels. Attitudes towards patients who abuse substances highlight an area that needs both further exploration and addressing. Attitudes towards mental health diagnoses were particularly favourable given that these often attract stigma and negative attitudes.

Turning tapes into text: issues surrounding the transcription of interviews

Abstract Transcription of interview data is a common practice in qualitative health research. However, there has been little discussion of the techniques of transcription and the issues inherent in the use of transcription as a strategy for managing qualitative data in nursing publications. The process of transcription may disclose or obscure certain information. Researchers need to question practices of transcription that have been taken for granted and make transparent the processes used to preserve the integrity of data. This paper first examines research reported in nursing and allied health journals employing interviews for data collection and the attention given to the transcription phase. It then deals with issues of concern regarding the transcription of interviews, and offers suggestions for promoting validity.

The changing skill mix in nursing: considerations for and against different levels of nurse.

AIM To investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs. BACKGROUND Due to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care. EVALUATION Research literature was used to determine the current use of skill mix and its impact on patient care and health-care costs. KEY ISSUE The use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity. CONCLUSION Economic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality. IMPLICATIONS FOR NURSING MANAGEMENT When evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.

Australian registered and enrolled nurses: Is there a difference?

There are two categories of nurse registered to practise in Australia, the degree-educated registered nurse and the certificate/diploma trained enrolled nurse (EN). While it is argued that the roles of the two categories of nurse in Australia are different, recent changes to the educational preparation and supervision requirements of ENs have narrowed these differences. This paper examines the existing literature to determine the perceived differences and similarities between registered and ENs in Australia. Differences identified included registration requirements, educational preparation, supervisory requirements and role expectation. Further research needs to be undertaken to examine the educational preparation of registered and ENs in order to obtain a greater understanding of role expectations on graduation. Supervision processes also require reviewing to demonstrate differences between indirect supervision and independent practice for ENs.Jacob E, Sellick K, McKenna L. International Journal of Nursing Practice 2012; 18: 303–307 Australian registered and enrolled nurses: Is there a difference? There are two categories of nurse registered to practise in Australia, the degree-educated registered nurse and the certificate/diploma trained enrolled nurse (EN). While it is argued that the roles of the two categories of nurse in Australia are different, recent changes to the educational preparation and supervision requirements of ENs have narrowed these differences. This paper examines the existing literature to determine the perceived differences and similarities between registered and ENs in Australia. Differences identified included registration requirements, educational preparation, supervisory requirements and role expectation. Further research needs to be undertaken to examine the educational preparation of registered and ENs in order to obtain a greater understanding of role expectations on graduation. Supervision processes also require reviewing to demonstrate differences between indirect supervision and independent practice for ENs.

Attitudes of undergraduate health science students towards patients with intellectual disability, substance abuse, and acute mental illness: a cross-sectional study

BackgroundThere is a long history of certain medical conditions being associated with stigma, stereotypes, and negative attitudes. Research has shown that such attitudes can have a detrimental effect on patients presenting with stigmatised medical conditions and can even flow on to impact their family. The objective of this study was to measure the attitudes of undergraduate students enrolled in six different health-related courses at Monash University toward patients with intellectual disability, substance abuse, and acute mental illness.MethodsA convenience sample of undergraduate students enrolled in six health-related courses in first, second and third years at Monash University were surveyed. The Medical Condition Regard Scale - a valid and reliable, self-report measure of attitudes - was administered to students along with a brief demographic form. Mean scores, t-tests, and ANOVA were used to analyse student attitudes. Ethics approval was granted.Results548 students participated. Statistically significant differences were found between the courses (p = 0.05), year of the course (p = 0.09), and gender (p = 0.04) for the medical condition of intellectual disability. There was no statistically significant difference between the courses, year of the course, gender, and age group for substance abuse or acute mental illness conditions.ConclusionThe findings suggest that students in undergraduate health-related courses, as a group, have a strong regard for patients with intellectual disability and some regard for patients with acute mental illness, but not for patients presenting with substance abuse problems.

Registered nurses' expectations and experiences of first year students' clinical skills and knowledge.

Abstract Background: Clinical education is a fundamental component of nurse education. In theory, this aspect involves integrated input from registered nurses, clinical educators and university lecturers. Registered nurses are important contributors to this process and play a major role in influencing and shaping undergraduate nursing students’ early clinical experiences. Despite this important function, their voice has been somewhat neglected. Little is known about registered nurses’ expectations and experiences of first year undergraduate nursing students undertaking their first clinical placement. Aim: The aim of this study was to explore registered nurses’ expectations and experiences of first year undergraduate students’ levels of knowledge and clinical skills. Method: Three consecutive focus groups were conducted with a purposive sample of 16 registered nurses. Interviews were audiotaped and transcribed and thematic analysis applied to the data to identify themes imbedded in the data sets. Findings: Three main themes emerged: (1) Clinical nursing skills (2) Knowledge requirements and (3) Experiences of reality shock. The findings highlight that registered nurses’ expectations of first year students’ clinical skills and knowledge were not consistently met. Registered nurses placed significant emphasis upon a range of basic skills, but acknowledged that some aspects of nursing knowledge can only be learned through experience. Furthermore, they demonstrated a considerable degree of empathy surrounding the reality shock that students might experience during early clinical placement. Conclusion: Findings from this study suggest that registered nurses and academics differ in their perceptions surrounding the level of clinical skills first year students should have during their first clinical placement. There appears to be a two way theory practice gap between registered nurses in clinical practice and academics in tertiary institutions. Improved communication between registered nurses and providers of nurse education may assist in addressing some of the issues raised by this study and reduce the theory practice gap, which remains ‘alive and well’.

Empathy levels among health professional students: a cross-sectional study at two universities in Australia.

Background Empathy is paramount in the health care setting, optimizing communication and rapport with patients. Recent empirical evidence suggests that empathy is associated with improved clinical outcomes. Therefore, given the importance of empathy in the health care setting, gaining a better understanding of students’ attitudes and self-reported empathy is important. The objective of this study was to examine self-reported empathy levels of students enrolled in different health disciplines from two large Australian universities. Materials and methods A total of 1,111 students from two different universities enrolled in eight different health professions were administered the Jefferson Scale of Physician Empathy – Health Profession Students version, a 20-item 7-point Likert scale questionnaire to evaluate self-reported empathy levels. Results A total of 1,111 students participated in this study. The majority of participants were from Monash University (n=771), with 340 students from Edith Cowan University. No statistically significant differences were found between universities: Monash University (mean 110.1, standard deviation [SD] 11.8); Edith Cowan University (mean 109.2, SD 13.3, P=0.306). The mean female empathy score (mean 110.8, SD 11.7) was significantly higher than the mean male score (mean 105.3, SD 13.5; P<0.0001; d=0.44). Paramedic students had significantly lower empathy scores (mean 106.3, SD 12.73) than all other participants except nursing students (P<0.0001). Conclusion Results relating to sex are reflective of previous studies. There is some discrepancy in results relating to empathy and its incline/decline as students progress through a program. Further study is warranted to explore why there are variations in empathy levels in students of different health disciplines.