Pamela van der Riet

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.

End of life care education, past and present: A review of the literature

BACKGROUND Research on end of life care education suggests that undergraduate nursing students are largely unprepared to provide end of life care to dying patients and their families. Although there have been attempts to address the issue of lack of preparedness, little is known on how to improve this. LITERATURE REVIEW AIMS To examine how end of life care education has been delivered to undergraduate nursing students and to critically discuss the research on modes of delivery and teaching strategies. REVIEW METHODS An extensive literature search on end of life care education in the undergraduate nursing curriculum was conducted in CINAHL, Mosbys Index, Cochrane Database, Scopus, Eric via Proquest, and Medline. 18 research papers published between 1984 and 2012 that met the selection criteria are included in the review. FINDINGS Findings of these 18 articles are reported under two main themes: Modes of End of Life Education Delivery and End of Life Care Education Initiatives. CONCLUSION This review highlights issues with end of life care education and suggests that end of life care simulation is an innovative strategy that may help to prepare undergraduate nursing students to provide quality end of life care.

The prevalence and characteristics of young and mid-age women who use yoga and meditation: Results of a nationally representative survey of 19,209 Australian women ☆

OBJECTIVE To determine the characteristics of yoga and meditation users and non-users amongst young and mid-aged Australian women. DESIGN AND SETTING The research was conducted as part of the Australian Longitudinal Study on Womens Health (ALSWH) which was designed to investigate multiple factors affecting the health and well being of women over a 20-year period. PARTICIPANTS The younger (28-33 years) (n=8885) and mid-aged (56-61 years) (n=10,324) cohorts of the ALSWH who completed Survey 5 in 2006 and 2007 respectively. MAIN OUTCOME MEASURE Use of yoga. RESULTS This study estimates that 35% of Australian women aged 28-33 and 27% of Australian women aged 56-61 use yoga or meditation. Younger women with back pain (OR=1.28; 95% CI: 1.08, 1.52) and allergies (OR=1.25; 95% CI: 1.06, 1.49) were more likely to use yoga or meditation, while younger women with migraines or headaches (OR=0.73; 95% CI: 0.62, 0.87) were less likely to use yoga or meditation. Mid-age women with low iron (OR=1.68; 95% CI: 1.29, 2.19) and bowel problems (OR=1.37; 95% CI: 1.13, 1.65) were more likely to use yoga or meditation, while mid age women with hypertension (OR=0.62; 95% CI: 0.52, 0.76) were less likely to use yoga or meditation. CONCLUSION A large percentage of the female population are using yoga or meditation. Given that women who regularly use yoga or meditation positively associated with measures of mental and physical health, there is a need for further research to examine the experiences and potential benefits of these mind-body practices for womens health.

A discourse analysis of difficult clinical situations in relation to nutrition and hydration during end of life care

AIM AND OBJECTIVES The following discussion builds upon a previous publication that reported on the perceptions and discourses of palliative care nurses and doctors in relation to nutrition and hydration at the end of life. The aim of this paper is to report the discourses of nurses and doctors in relation to the challenges they faced when managing the care of patients with severe brain injury vs. the clearer cut situations when caring for terminally ill patients with cancer. The objectives of the study were to: explore the tensions in the discourses during end of life care, explore the challenges regarding nutrition and hydration at the end of life. BACKGROUND The decision to withdraw life support seems to be made more readily than the decision to withdraw nutrition and hydration at the end of life. The abatement of nutrition and hydration during the terminal phase of life is a controversial issue for a range reasons. Indeed, whilst it is accepted practice in the palliative care setting, nurses and doctors often struggle with the idea. DESIGN The design for this study used discourse analysis framed by a post structural framework. METHOD Focus groups were conducted with nurses working in palliative care units. Single interviews were conducted with doctors from a tertiary palliative care unit. RESULTS The findings revealed contesting discourses involving quality of life and the prolongation of life. CONCLUSIONS The provision of food and fluid has profound emotional and social meanings for patients and families. The study reported here examined these issues with health professionals. The findings point to the challenges and tensions faced by health professionals in relation to decision making and medical hydration during end of life care. The concern is that tensions arise when decisions need to be made and how best to make these. The contesting discourses for nurses and doctors when nutrition and hydration is ceased involve maintaining quality of life vs. the prolongation of life. RELEVANCE TO CLINICAL PRACTICE Medical and nursing staff have different attitudes and beliefs towards end of life care. Tensions arise when decisions need to be made based on quality of life or prolongation of life. The successful merging of curative and palliative care is not without challenges. There has been little exploration of this situation.

What do midwives need to understand/know about smoking in pregnancy?

AIM This paper seeks to help midwives more fully understand smoking in pregnancy, particularly from a midwifery partnership perspective. METHOD Using the midwifery philosophy of partnership as a framework for reviewing literature on smoking in pregnancy, we explored the literature on nicotine metabolism and addiction in general, and the changes that occur in pregnancy. Quit smoking interventions commonly used were examined to see if knowledge about addiction and the physiological adaptations of pregnancy are incorporated into anti-smoking efforts aimed at pregnant women. RESULTS Quitting is harder for the pregnant woman because the physiological adaptations of pregnancy increase the clearance of nicotine thus lowering nicotine levels and increasing the desire to smoke. Women who continue to smoke generally have fewer external sources of pleasure and satisfaction in their lives, which, when combined with the physiological and emotional challenges of pregnancy, means that they are less likely to quit smoking and remain abstinent. These factors do not appear to be taken into account for pregnant smokers. The concept of partnership between women and midwives during anti-smoking interactions is lacking. CONCLUSION Midwives are in a position to support women and their families in all health related issues, including smoking cessation. We recommend that midwives ask permission before making enquires about sensitive issues such as smoking. When discussing smoking with pregnant women, midwives work within the philosophy of midwifery, with the emphasis on building trust and maintaining relationships. Great sensitivity is required and as much as possible the conversation should be a dialogue, not a monologue.

Death and dying in Australia: perceptions of a Sudanese community

AIMS The aims of this study were to obtain information to support Palliative Care healthcare workers to meet the needs of the Sudanese population in death, dying, and bereavement. BACKGROUND Australia is a multicultural society and healthcare workers are faced with increasing numbers and diversity of immigrants to whom healthcare professionals strive to provide quality health care. METHODS A qualitative interpretive approach was used with data collected from a sample of 15 participants during focus group discussions. Data were collected in 2008-2009, transcribed and analysed. RESULTS The main themes and ideas identified in the dialogues were analysed under five main headings--Communication issues including disclosure and consent; Concepts of disease and illness; Attitudes towards medical treatments; Customs surrounding death, dying and bereavement; and Spiritual and religious issues. CONCLUSION The cultures and traditions of African countries vary widely; this study provides a snapshot of the views of a Sudanese African community about death and dying in Australia.

Complementary therapies in healthcare: Design, implementation and evaluation of an elective course for undergraduate students

Complementary therapies are making a significant and cost effective contribution to the health of the community, especially in relation to chronic disease management and prevention of disease. Because of the increased use of complementary therapies, nurses, and other health professionals need to be familiar with specific practices so that they can assist clients to make informed decisions in the use of these therapies. Importantly, with the increased interest in complementary therapies, there is a need to ensure these practices are safe, cause no harm and are used to enhance the well-being of patients. This paper reports on the design, implementation and evaluation of a complementary therapies course and a linked Thai cultural studies tour. The course was implemented at The University of Newcastle for the first time in 2009 with an enrollment of 200 students. It is an elective course for both nursing students and those from other disciplines. In this paper we describe the reasons for the introduction of this course and its value in nursing education. We then provide an overview of the course and report on evaluation results from both the course and the Thai cultural studies tour.

A narrative inquiry: how do nurses respond to patients' use of humour?

Abstract In today’s healthcare system where technical instruments and test results are used to implement care it is easy to lose the human aspect of nursing. Personal interaction can get lost and nurses sometimes miss humorous attempts made by patients. Humour is a very personal concept, what one person thinks is funny does not necessarily make another person smile, or might even be hurtful. Humour is an important communication tool for patients as it humanises the nurses, creates a bond and opens communication lines. Humour has the potential to change the hospital experience for patients. The aim of this paper is to highlight the importance of humour in the therapeutic relationship between patient and nurse. Semi-structured interviews were held with four registered nurses and narrative inquiry was used to analyse and present the findings because of its ability to capture human interaction and experience.

Living within stories: Exploring the experiences of people with transient ischemic attack

A transient ischemic attack (TIA) significantly increases a persons risk of ischemic stroke. However, little is known about the experiences of these people or what influences their decision to access care. This article explores the stories of three people who experienced a TIA. All participants were interviewed after receiving a diagnosis of TIA by a specialist neurologist. By utilizing a framework of narrative inquiry, several storylines were revealed across temporal, social, and geographical landscapes. The main storylines include: bodily disruption, time stasis, altered temporal perceptions, the roles of others, and help-seeking behavior. The primary author also reflects upon his own origin and explores how this inquiry has influenced his perceptions, career, and nursing practice. This inquiry may assist healthcare workers to gain insight into the experiences of people with TIA and suggests how involvement of significant others is beneficial when educating people at risk of TIA.

A systematic review and meta-synthesis of the qualitative literature exploring the experiences and quality of life of survivors of a cardiac arrest

Background: Survival following cardiac arrest and subsequent cardiopulmonary resuscitation (CPR) is increasing worldwide, mainly due to greater awareness of the symptoms of cardiac events and an increased attention to CPR training. Although patient outcomes remain unpredictable and quantitative studies suggest that the overall quality of life (QOL) is acceptable, it is valuable to synthesise qualitative studies exploring these phenomena in depth, providing a deeper knowledge of survivors’ experiences and QOL. Aims: To critically appraise and synthesise the qualitative literature on survivors’ experiences of a cardiac arrest and CPR with the aim of identifying common themes that can inform clinical pathways and thereby improve survivor outcomes and QOL. Methods: A systematic review and meta-synthesis of the qualitative literature, using Thomas and Harden’s framework, and confined to peer-reviewed papers published from 2000 to 2015, which were identified through database searches of EBSCO, OVID and ProQuest. Results: The search produced 204 papers, and of these, seven relevant papers were identified for review. Data extraction included setting, participants, research design, data collection, analysis and themes. Five qualitative themes were identified and were the subject of this meta-synthesis: multitude of contrasting feelings; disruption in the continuum of time; new reality and psychological challenges; changed body with new limitations; and confrontation with death. Conclusion: This review provides insights into the experiences of survivors’ QOL after CPR. Increased knowledge can improve person-centred care in the immediate and forthcoming care after the event, both in terms of planning for discharge and in the future care of people who survive a cardiac arrest.