Marion Tower

Solution Focused Teaching: A Transformative Approach to Teaching Nursing

Nurses work in complex health care systems, which today are based not only on medical treatment and cure, but also on enabling individuals and strengthening communities. This paper describes a curriculum approach to teaching nursing in an Australian university which seeks to prepare students for this environment. Underpinned by transformative education principles, and termed Solution Focused Nursing, specific teaching and learning strategies are discussed. A goal is to cultivate critical thinkers and knowledge workers, that is, nurses who are not only able to work skillfully, strategically, and respectfully with clients, but who also demonstrate discernment, optimism, and vision about nursing and health care.

Intimate partner violence and the health care response: a postmodern critique.

Despite the overwhelming acknowledgment by health professionals that intimate partner violence is a health issue for women, the present health care response is inadequate to meet womens needs, according to Stark, in the Source Book on Violence Against Women (2001). This article examines through a postmodern lens the health care response. The dominant discourses in the literature indicate that health professionals lack knowledge about intimate partner violence, have attitudes and values that inhibit an effective response, and have no time to respond to these women. To date, strategies to improve the health care response have been limited in effectiveness as structural constraints of the health service and models of practice employed have not been addressed.

Domestic violence, health and health care: Women’s accounts of their experiences

Abstract The current health service response to women’s domestic violence related health issues seeks to categorise their presenting symptoms into physical and psychological ailments This gives a narrow and somewhat simplistic focus to what is a complex phenomenon and may obscure women’s experiences and limit the opportunities to provide proactive health care.The purpose of this study was to expand knowledge about the health issues of women who are subjected to domestic violence, by affording primacy to women’s accounts of health, in order to problematise current services and establish a more woman-centered underpinning for healthcare.The study involved narrative analysis of nine interviews with women who spoke about their health and health issues while they lived with domestic violence. Findings revealed that health was complex, and that health issues were not adequately addressed by health services, in fact health care responses were implicated in further adversely affecting the health of participants. These findings illuminate patterns that underlie individual realities of health and give a foundation from which current services can be evaluated and further developed in ways that may be more sensitive to women’s realities and needs.

Novel technologies can provide effective dressing and securement for peripheral arterial catheters: A pilot randomised controlled trial in the operating theatre and the intensive care unit

BACKGROUND Peripheral arterial catheters are widely used in the care of intensive care patients for continuous blood pressure monitoring and blood sampling, yet failure - from dislodgement, accidental removal, and complications of phlebitis, pain, occlusion and infection - is common. While appropriate methods of dressing and securement are required to reduce these complications that cause failure, few studies have been conducted in this area. OBJECTIVES To determine initial effectiveness of one dressing and two securement methods versus usual care, in minimising failure in peripheral arterial catheters. Feasibility objectives were considered successful if 90/120 patients (75%) received the study intervention and protocol correctly, and had ease and satisfaction scores for the study dressing and securement devices of ≥ 7 on Numerical Rating Scale scores 1-10. METHODS In this single-site, four-arm, parallel, pilot randomised controlled trial, patients with arterial catheters, inserted in the operating theatre and admitted to the intensive care unit postoperatively, were randomly assigned to either one of the three treatment groups (bordered polyurethane dressing (n=30); a sutureless securement device (n=31); tissue adhesive (n=32)), or a control group (usual practice polyurethane dressing (not bordered) (n=30)). RESULTS One hundred and twenty-three patients completed the trial. The primary outcome of catheter failure was 2/32 (6.3%) for tissue adhesive, 4/30 (13.3%) for bordered polyurethane, 5/31 (16.1%) for the sutureless securement device, and 6/30 (20%) for the control usual care polyurethane. Feasibility criteria were fulfilled. Cost analysis suggested that tissue adhesive was the most cost effective. CONCLUSIONS The pilot trial showed that the novel technologies were at least as effective as the present method of a polyurethane dressing for dressing and securement of arterial catheters, and may be cost effective. The trial also provided evidence that a larger, multicentre trial would be feasible.

Identifying outcomes associated with co-managed care models for patients who have sustained a hip fracture: an integrative literature review.

AIMS AND OBJECTIVES The aim of this integrative literature review is to identify themes associated with improved patient outcomes related to orthogeriatric co-managed inpatient unit models of care for patients who had sustained a hip fracture. APPROACH An integrative literature review was undertaken from 2002-July 2013 using electronic databases with specific search terms. METHODS The theoretical framework of Whittemore and Knafl was used to guide the review. This framework was chosen as it allows for the inclusion of varied methodologies and has the capability to increase informed evidence-based nursing practice. RESULTS Five distinct themes relating to outcomes emerged from the analysis, which were: time from admission to surgery; complications; length of stay; mortality and initiation of osteoporosis treatment. CONCLUSION The analysis of this integrative literature review clearly indicates the need for national and international sets of agreed outcome measures to be adopted to facilitate the comparison of models of care. This would significantly improve the way in which outcomes and costs are reported, further enhancing international partnerships as the health care team strive to achieve overall improvements in the management of older people presenting to hospital with hip fracture.

An integrative review of self‐efficacy and patient recovery post acute injury

AIM To present an integrative literature review examining the relationship between self-efficacy and patient recovery post acute injury. BACKGROUND Self-efficacy is a belief in ones ability to perform a set of actions; the greater a persons confidence, the more likely they will initiate and continue activity that will produce a positive outcome in terms of recovery. Increasingly, research indicates that application of self-efficacy theory into clinical practice is likely to promote recovery in the rehabilitation setting. This review examines self-efficacy in the post acute injury group. DESIGN Integrative literature review. DATA SOURCES A database search was conducted in PSYCHINFO, MEDLINE and CINAHL between 1990-2012. REVIEW METHODS Whittemore and Knafls theoretical framework was used to guide the review in conjunction with a critical appraisal template. Findings from studies were extracted, critically examined and grouped into key themes under factors (interventions) and outcomes relating to self-efficacy. RESULTS Eighteen articles met the inclusion criteria. Level of education may be a significant factor related to self-efficacy. Educational, physical and psychological interventions to improve self-efficacy emerged, but few interventions led to significantly enhanced self-efficacy. Self-efficacy was found to influence outcomes, including pain and disability, adherence to discharge instructions, locomotion recovery and quality of life. CONCLUSION Interventions addressing the connection between physical and psychological health with respect to mood, emotion, stress, fear and anxiety to improve the psychological response to acute injury may enhance self-efficacy and patient recovery.Aim To present an integrative literature review examining the relationship between self-efficacy and patient recovery post acute injury. Background Self-efficacy is a belief in ones ability to perform a set of actions; the greater a persons confidence, the more likely they will initiate and continue activity that will produce a positive outcome in terms of recovery. Increasingly, research indicates that application of self-efficacy theory into clinical practice is likely to promote recovery in the rehabilitation setting. This review examines self-efficacy in the post acute injury group. Design Integrative literature review. Data sources A database search was conducted in PSYCHINFO, MEDLINE and CINAHL between 1990–2012. Review methods Whittemore and Knafls theoretical framework was used to guide the review in conjunction with a critical appraisal template. Findings from studies were extracted, critically examined and grouped into key themes under factors (interventions) and outcomes relating to self-efficacy. Results Eighteen articles met the inclusion criteria. Level of education may be a significant factor related to self-efficacy. Educational, physical and psychological interventions to improve self-efficacy emerged, but few interventions led to significantly enhanced self-efficacy. Self-efficacy was found to influence outcomes, including pain and disability, adherence to discharge instructions, locomotion recovery and quality of life. Conclusion Interventions addressing the connection between physical and psychological health with respect to mood, emotion, stress, fear and anxiety to improve the psychological response to acute injury may enhance self-efficacy and patient recovery.

Factors associated with self-efficacy for managing recovery in the trauma intensive care population: a prospective cohort study

OBJECTIVE The aim of this paper was to identify factors associated with self-efficacy for managing recovery in the trauma intensive care population. INTRODUCTION Injury accounts for 6.5% of disease burden in Australia, with similar levels being reported in other developed countries. While some studies regarding self-efficacy have identified a relationship to patient recovery post acute injury, others have been inconclusive. This study will identify factors associated with self-efficacy for managing recovery in the trauma intensive care population. METHODS A prospective cohort study of patients aged ≥ 18 years, admitted to a metropolitan tertiary hospital in South East Queensland between June 2008 and August 2010 for the acute treatment of injury. Demographic, injury, acute care and psychosocial factors were considered. The primary outcome was self-efficacy measured by the 6-item self-efficacy scale (SES) 1 and 6 months post hospital discharge. All factors significant (p<0.10) on univariate analysis were included in multivariable modelling where p<0.05 was considered significant. RESULTS A total of 88 patients were included. The mean self-efficacy score at 1 and 6 months was similar (6.8 vs 6.9 respectively). Self-efficacy at 1 month, psychological distress (K-10) Score and illness perception (K10) Score accounted for 68.4% (adjusted R(2)) of the variance in 6 month self-efficacy (F3,75)=57.17, p<0.001. Illness perception was the strongest contributor to 6 month self-efficacy (beta=-0.516), followed by psychological distress (beta=-0.243) and self-efficacy at 1 month (beta=0.205). CONCLUSION Significant factors associated with self-efficacy for managing recovery at 6 months included 1 month self-efficacy, illness perception and psychological distress. To promote patient recovery, screening patients at 1 month in order to commence relevant interventions could be beneficial.

Reconceptualising health and health care for women affected by domestic violence

Abstract Domestic violence is a major public health issue that influences all aspects of affected women’s lives (World Health Organisation, 2010). Women who are subjected to domestic violence seek help from a wide range of professionals within health and social care sectors, and evidence suggests that their experiences tend to be negative. We argue that current approaches are based on responses that are medically informed and provide an alternate lens from which to view women’s health care needs. This paper reports on the findings of the second phase of a two-phase study. The first phase of the study reported on women’s emerging health needs, efforts to seek help and experiences of seeking healthcare. The second phase examined how nurses constructed the health and health issues of women affected by domestic violence when women presented for health care. This paper brings together the findings of both phases to argue there is a disconnection in women’s experiences and needs and how nurses construct needs and deliver care. Biographical disruption is a new lens from which to view women’s experiences and is a framework which highlights how women experience significant dislocation of their sense of self as a result of domestic violence.

Normalizing Policies of Inaction-The Case of Health Care in Australia for Women Affected by Domestic Violence

Domestic violence impacts on all aspects of affected womens lives and results in poor general, reproductive, and psychological health (World Health Organisation, 2010). Despite mounting evidence that current health care responses to women affected by domestic violence are problematic, policies have nevertheless been rolled out without addressing issues identified. Funding cuts, fragmentation of services, and failure to establish good practice has resulted in a discourse where womens needs are pushed to the outside and they are marginalized, lost in the language and discourse of policy, normalizing a discourse of incompletion at policy and bureaucracy levels.

Engaging, supporting and retaining academic at-risk students in a Bachelor of Nursing: Setting risk markers, interventions and outcomes

Student attrition from nursing programs impacts on sustainability of the profession. Factors associated with attrition include: lack of academic capital, extracurricular responsibilities, first generation tertiary students, and low socio-economic or traditionally underrepresented cultural background. Successful Australian government reforms designed to advance equity in higher education have increased student population diversity, which is accompanied by a rise in the incidence of risk factors for attrition (Benson, Heagney, Hewitt, Crosling, & Devos, 2013).This prospective study examined commencing nursing students in their first semester to track critical risk markers associated with attrition, and implemented timely interventions to support subject completion or enrolment perseverance in the event of subject failure. Students who attended orientation, accessed blended learning, attended early tutorials, submitted and passed first assessment items, and studied part-time were significantly more likely to pass the subject overall. Interventions based on good practice principles for student engagement and support resulted in increased retention. Please cite this article as: Tower, M., Walker, R., Wilson, K., Watson, B., & Tronoff, G. (2015). Engaging, supporting and retaining academic at-risk students in a Bachelor of Nursing: Setting risk markers, interventions and outcomes. The International Journal of the First Year in Higher Education, 6(1), 121-134. doi: 10.5204/intjfyhe.v6i1.251 This article has been peer reviewed and accepted for publication in Int J FYHE. Please see the Editorial Policies under the ‘About’ section of the Journal website for further information.