Mary Cruickshank

Total Quality Management in the higher education sector: A literature review from an international and Australian perspective

In the past decade, much has been written about Total Quality Management (TQM) and Continuous Quality Improvement (CQI) in the manufacturing and healthcare industries; however, less attention has been paid to the application of these quality approaches in the higher education sector. This literature review will focus on higher education institutions in the US, UK and Australia to identify current quality management practices. The review, which will commence with the early TQM writings in higher education and proceed throughout the 1990s, will demonstrate that the degree of TQM development in education has not kept pace with that of TQM in the manufacturing and healthcare industries.

Perceptions from the front line: professional identity in mental health nursing.

In the context of a growing population of people experiencing mental illness worldwide, mental health nurses are a crucial workforce. Their recruitment and retention, however, is in decline. Drawing on qualitative data obtained from interviews with mental health nurses (MHN) in Victoria, Australia, the paper employs a range of concepts from role theory to explore professional identity within mental health nursing. The data highlight three key issues in relation to the future recruitment and retention of MHN: (i) the ambiguity of the MHN role; (ii) the weak definition and lack of understanding of the scope of the MHN role by nursing students; and (iii) a lack of communication about MHN as a profession to a wider audience. These findings indicate three avenues through which recruitment and retention in mental health nursing could be improved: (i) public communication; (ii) training and educating of the next generation of MHN; and (iii) more accurately defining the role of the MHN.

Experiences of Families Who Help Young Rural Men with Emergent Mental Health Problems in a Rural Community in New South Wales, Australia

Abstract A qualitative study was conducted in rural New South Wales, Australia, to understand the barriers to helpseeking among young rural men with emergent mental health problems. Participants who had real life experiences of these problems within their families were interviewed. Themes emerged from the data which explained some barriers to early intervention. Despite these barriers, families had developed skills in helping and in providing early mental health help to their sons. The findings of this study showed that a substantial burden on the emotional and social integrity of the family, combined with diminished psychological well-being, caused some parents to question how long they could cope before they reached ‘the end of their strings’. This downward spiralling trajectory of mental health and well-being for both the young men and their families has implications for clinical practice. Current models of mental health service delivery do not adequately capture the early help-seeking dynamics of young rural men and their families. A more flexible approach is needed to identify and help the family and the young men, without the pre-requisite for a formal medical diagnosis. Future research should involve health and well-being solution focused service delivery.

Venous access: the patient experience

IntroductionThe evolution of venous access via peripheral cannulation, particularly in relation to the risks and the benefits of this procedure, is reported widely in the literature. However, there is limited research specific to the patient experience of undergoing venous access.AimThe intent of this qualitative study was to understand patients’ experience of venous access, with the aim of bringing forth their voices about the experiences of repeated venous access/cannulation attempts.MethodologyThis qualitative study used a hermeneutic phenomenological approach to explore the experiences of 15 participants in two rural oncology units in Australia. The participants had experienced repeated peripheral cannulation in order to receive chemotherapy. Study participants were asked to describe what it was like for them to be repeatedly cannulated. Data were collected via audiotaped individual interviews, the participants’ stories were transcribed and analysed thematically.OutcomesThemes emerged from the participants’ stories that provided insights into their perceptions of the experience of being cannulated and the decision-making processes regarding how and where the procedure occurred. The findings suggest that a holistic approach to care was often missing causing the participants to feel vulnerable. Gaining insight into their experiences led to a greater understanding of the impact of this procedure on patients and the need to improve care through encouraging more collaborative decision-making processes between clinicians and patients.ConclusionThe implications for policy and practice focus on improving patient outcomes via procedural governance and education, with the intent of translating the findings from this research into evidence-based practice.

Health managers and health reform

This qualitative study was undertaken with a diverse sample of Australian health managers to exam- ine their perceptions regarding the health system and to understand how they learned to become health manag- ers. The fi ndings showed that they viewed the health system as one of constant change, mostly non-adaptive, and a system of parts controlled by bureaucrats and political interests. While the respondents enjoyed their managerial role, they see it as contested between the professions. This study concluded that greater emphasis on the education and train- ing of health managers and their continuing professional development is required if they are to manage increasingly complex, dynamic and changing health systems. In Australia, the health debate continues with the recently announced national health reform agenda. The perceptions of health managers in health reform and change management are impor- tant given that they are said to be central to the implementation of health reform and the management of change. n Australia, the health debate continues with the recently implemented national health reform agenda. The perceptions of health managers in health reform and change management are important given that they are said to be central to the implementation of health reform and the management of change. Given the central role of health managers in implementing health reform, this study through an interpretivist phenomenological approach describes the perceptions of a diverse range of Australian and New Zealand health managers about the health system in which they are engaged and about their role as health managers. This article traverses the history and context of health care reform in Australia, describes studies and theories relevant to the managerial role and managing health care organisations. It describes the methods utilised in this study. It presents the results of the reality of the perceptions of this group of health managers as perceiving the health system as one of constant change, contested roles, their career journey and their solutions to address- ing the challenges they face. The implications and limitations of this study are then presented.

An Integrative Review of Enablement in Primary Health Care.

Objectives: To review how enablement is conceptualized and practiced in primary health care and to explore the factors that influence patient enablement in this setting. Method: A narrative integrative literature review was undertaken. Results: Twenty-four articles specifically relating to enablement in primary health care were identified. Three literature reviews, 4 qualitative studies, and 17 quantitative studies were included in the analysis. Conclusions: In the primary health care setting, the concept of enablement is well defined as an outcome measure of quality. The literature exploring the practice of enablement is sparse, but 2 randomized controlled trials suggest enablement is linked to better outcomes for patients with asthma and diabetes. Primary factors influencing enablement included the practitioners’ open communication style, the degree to which the practitioner is patient centered, and longer consultations. Other factors found to be associated with enablement were the presenting health issue, general state of health, ethnicity, the patient’s own coping strategies and degree of independence, and socioeconomic status. The association between enablement and patients’ expectations and satisfaction is less clear. The majority of research on enablement was carried out among general practitioners. Further research into the degree to which patients are enabled by a wider range of health care providers is needed. Additional qualitative research would provide a deeper understanding of the attributes of enablement in the primary health care setting.

Stereotyping Stigma: Undergraduate Health Students’ Perceptions at Handover

The World Health Organization (WHO) has recognized that errors in communication are one of the leading causes of adverse patient outcomes. Consequently, the WHO developed the High 5s Project to review, among other variables, handover of patients between shifts, professionals, and organizations. Seven countries were involved in the initial project. Australia responded by using the ISOBAR (Identify, Situation, Observations, Background, Agreed plan, and Read-back) tool as a template. However, none of the countries involved considered the social and emotional effects of handover on the staff or patients, although research has demonstrated that attitudes and values can be handed over from one nurse to another during this process. This article shows how the nurse who hands over care from one shift to the next can transfer stigma and labeling and offers suggestions for nurse educators and clinicians to apply national standards and core values to clinical practice and education.

The Influence of Managers on Job Satisfaction in Occupational Therapy

Promoting job satisfaction in a workplace can make a positive contribution towards the recruitment and retention of staff. The aim of this study, using a hermeneutical phenomenological approach, was to investigate what occupational therapy managers did to have a positive and a negative influence on the job satisfaction of their staff. It was clear that managers played a key role in influencing job satisfaction through their actions and behaviours. In particular, managers who demonstrated care and support towards their staff, while at the same time demonstrating that they were strong advocates and able to make decisions for the good of the department rather than for the benefit of the individual, influenced job satisfaction positively. Job dissatisfaction was strongest when managers were seen to treat staff differently, which was construed as a demonstration of bias stemming from favouritism. The results from this study suggest that staff access to benefits, such as flexible working conditions and educational funding, should be transparent and guided by clear policies.

The social lives of rural Australian nursing home residents

ABSTRACT Contact with family and friends, in the form of visiting, is very important to the quality of the lives of rural nursing home residents. However, there has been little recent research that examines the frequency and determinants of visits to rural nursing homes and none in the rural Australian context. This study aimed to address this gap in the literature. A telephone survey with a close family member (N=257) of each participating resident in the rural New England area of New South Wales, Australia gathered data about 3,738 people who formed the potential social networks of these residents. This study found that the wider, potential, social networks of rural nursing home residents comprised approximately 17 people and involved a wide range of family and friends. However, their actual social networks consisted of approximately two females, daughters and friends, who had high-quality relationships with the resident and who visited at least once per month. In contrast to previous assertions that nursing home residents have robust support from their family and friends, the actual social networks of these residents have dwindled considerably over recent years, which may place them at risk of social isolation. This study has implications for nursing home policy and practice and recommendations for addressing the risk of social isolation that rural nursing home residents face are made.

Identifying challenges and barriers in the delivery of primary healthcare at the district level: a study in one Thai province

In 2001, the universal health coverage policy was adopted by Thailand with primary healthcare (PHC) as the major focus of the policy. In order to understand the structural and institutional factors affecting the implementation of PHC in rural Thailand, a qualitative study, utilising individual interviews with national and provincial policy decision makers, community health directors, heads of hospital primary care units, chiefs of district health offices, heads of health centres and community representatives, from one rural province was undertaken. Findings showed that the sustainability of PHC service provision under the administration of community hospitals is problematic as barriers exist at the policy and operational levels and access to PHC for all citizens may not be achieved until these barriers are addressed. Furthermore, although PHC needs to be acknowledged and implemented by all stakeholders within the health industry and government, the roles and responsibilities of the stakeholders in health services management at the district level need to be clarified.