R Bull

Palliative care in end‐stage kidney disease

Patients with end‐stage kidney disease have significantly increased morbidity and mortality. While greater attention has been focused on advanced care planning, end‐of‐life decisions, conservative therapy and withdrawal from dialysis these must be supported by adequate palliative care incorporating symptom control. With the increase in the elderly, with their inherent comorbidities, accepted onto dialysis, patients, their nephrologists, families and multidisciplinary teams, are often faced with end‐of‐life decisions and the provision of palliative care. While dialysis may offer a better quality and quantity of life compared with conservative management, this may not always be the case; hence the patient is entitled to be well‐informed of all options and potential outcomes before embarking on such therapy. They should be assured of adequate symptom control and palliative care whichever option is selected. No randomized controlled trials have been conducted in this area and only a small number of observational studies provide guidance; thus predicting which patients will have poor outcomes is problematic. Those undertaking dialysis may benefit from being fully aware of their choices between active and conservative treatment should their functional status seriously deteriorate and this should be shared with caregivers. This clarifies treatment pathways and reduces the ambiguity surrounding decision making. If conservative therapy or withdrawal from dialysis is chosen, each should be supported by palliative care. The objective of this review is to summarize published studies and evidence‐based guidelines, core curricula, position statements, standards and tools in palliative care in end‐stage kidney disease.

The daily patterns of time use for parents of children with complex needs: A systematic review

The aim of this systematic review was to critically examine the research that quantifies and describes the daily patterns of time use by parents of children with complex needs. Four electronic databases were searched. A total of 32 studies (30 peer-reviewed journal articles and two theses) met the inclusion criteria. Three key findings emerged from the review: (a) Parents of children with complex needs carry a significant caregiving burden that often does not reduce as the age of the child increases, (b) supervision or ‘vigilance’ is a category of childcare that carries a particular time requirement for these parents and (c) parents of children with complex needs spend (sometimes considerable) time undertaking health care–related tasks outside the ‘normal’ parenting role. The time demands placed on parents caring for a child or children with complex needs at home should be considered when health professionals are negotiating essential and/or additional therapies or treatments to be included in a child’s home care regime.

Sleep Deprivation in Parents Caring for Children With Complex Needs at Home: A Mixed Methods Systematic Review

A significant number of children with a range of complex conditions and health care needs are being cared for by parents in the home environment. This mixed methods systematic review aimed to determine the amount of sleep obtained by these parents and the extent to which the child-related overnight health or care needs affected parental sleep experience and daily functioning. Summary statistics were not able to be determined due to the heterogeneity of included studies, but the common themes that emerged are that parents of children with complex needs experience sleep deprivation that can be both relentless and draining and affects the parents themselves and their relationships. The degree of sleep deprivation varies by diagnosis, but a key contributing factor is the need for parents to be vigilant at night. Of particular importance to health care professionals is the inadequate overnight support provided to parents of children with complex needs, potentially placing these parents at risk of poorer health outcomes associated with sleep deprivation and disturbance. This needs to be addressed to enable parents to remain well and continue to provide the care that their child and family require.

The Invisible Nurse—Behind the Scenes in an Australian OR

THE DWINDLING NUMBER of RNs choosing to work in the OR has been caused by many factors, such as restricted undergraduate exposure to the perioperative experience and fewer postgraduate opportunities. PRESSURE TO IDENTIFY alternative health care workers to replace RNs in the OR is escalating to a point where the role of the perioperative RN, as currently understood, is threatened. FINDINGS from an Australian ethnographic study suggest that both patients and non-nursing colleagues have limited appreciation of the contribution that perioperative nurses make. THE NEED FOR NURSES to take a proactive stance on this subject is discussed within the context of professional and structural change.

Collective Agency for Service Volunteers A Critical Realist Study of Identity Representation

Policy makers promote volunteering in part because it is a powerful mechanism for expanding local community services. Volunteers, however, are subject to processes and power dynamics within organizations, which limit their collective agency. This article reports key findings of a study of rural ambulance volunteers’ agency. The study demonstrated that collective identity is part of the ensemble of power that allows volunteers’ interests to be marginalized within organizations. Findings highlighted barriers for volunteers who were unhappy with the organizational support they received. A critical realist analysis revealed that rural location and community discourses underpinned the volunteers’ lack of collective agency.

Developing a patient focussed professional identity: an exploratory investigation of medical students’ encounters with patient partnership in learning

Patient encounters are central to the provision of learning opportunities for medical students and their development as medical professionals. The primary aim of the study reported in this paper was to discover how partnering medical students with patients with chronic illness in undergraduate learning influenced the development of a patient centred professional identity and professionalism. An exploratory interpretive research design was used to address the research aim within a patient partner program (P3). Three qualitative data collection methods were used: (1) focus groups (2) extended response questionnaire and (3) semi-structured interviews. Data were coded and analysed thematically. The professional identity of medical students is constructed along traditional lines in the preclinical years. Patient-partnership offers a disruption to this development by way of an intersection with patients with chronic illness which potentially allows meaningful construction of what a patient-centred identity should be. This point of reflection provides an opportunity to engage at a higher level in medical identity development and professionalism. The findings discussed in this paper further stimulate the patient-centred agenda by understanding the conflict associated with the student–patient nexus in medical education and its potential for building professionalism and a patient-centred professional identity. To continue the drive for a patient-centred professional identity there must be ongoing engagement with patients in medical education, preferably commencing early in a student’s journey so that it becomes the expected norm. This study has highlighted that a true patient-centred emphasis is being encountered too late in their socialisation process.

Supporting Graduate Nurse Transition: Collaboration Between Practice and University

Making the transition from student to RN is challenging and demanding. In Australia, where nurses commonly graduate after 3 years in a Bachelor of Nursing program, graduate transition programs have been established in the workplace to support and socialize new graduates to nursing practice. These programs vary in content, rigor, and available support mechanisms, and no nationally agreed upon standards of expected graduate performance exist. Providing a structured, evidence-based, and clinically focused education and support program specific to the needs of graduate nurses contributes to quality care and patient safety and has significant benefits for the individual graduate, the employing organizations, and health care. This article presents the development and implementation of the Bachelor of Nursing With Clinical Honors (Transition to Practice) program offered by the University of Tasmania, in collaboration with St. Vincents Private Hospital, Sydney, Australia.

The ‘radiographer-referrer game’: image interpretation dynamics in rural practice

Effective interprofessional communication is intrinsic to safe health care. Despite the identified positive impact of collaborative radiographic interpretation between rural radiographers and referrers, communication difficulties still exist. This article describes the strategies that Australian rural radiographers use for communication of their radiographic opinion to the referring doctor.

Pharmacy student views on preceptorship during rural placements

Aims: To identify factors that undergraduate pharmacy students valued most highly in a rural clinical placement experience. Methods: Pharmacy students from four universities were invited to participate in a survey and/or focus group. A 42 item questionnaire was used in which students were asked to rate various aspects of their rural placement on a five point Likert scale. During the focus groups students were invited to explore positive and negative aspects of their rural placement and to make suggestions for future placements. Results: About 108 students responded to the questionnaire and 26 participated in the focus groups. Students rated most highly the role of the preceptor in making their rural placement a success. Two themes emerged from the focus groups which highlighted the relationship between preceptorship and learning. Conclusion: Students valued their placements highly when they were in a supportive learning environment, with an organised structure and adequately supported by the universities.

Brief Report: Competence, Value and Enjoyment of Childcare Activities Undertaken by Parents of Children With Complex Needs

UNLABELLED Parents combine many roles when caring for a child with complex needs, but few studies measure parental value and enjoyment of childcare related activities. This study aimed to describe parental competence, enjoyment and value of childcare related activities, particularly healthcare related activities, when parenting a child with complex needs. DESIGN AND METHODS This was a pilot cross sectional study. Ten mothers of children with complex needs rated their competence, value and enjoyment of 156 childcare related activities using the Occupational Questionnaire (Smith, Kielhofner, & Hawkins Watts, 1986). RESULTS The mothers rated childcare related activities as important and rated themselves as competent to undertake them. Mothers disliked performing healthcare related activities, but enjoyed emotional care activities. CONCLUSION This study extends the current knowledge regarding the role tension described by parents of children with complex needs. The finding that parents dislike performing healthcare related activities despite self-reporting high levels of competence warrants further investigation. PRACTICE IMPLICATIONS Gaining a better understanding of the role tension described by parents of children with complex needs may enable pediatric nurses to better understand the impact of home based care provision on parents and assist them to find ways to support families so this care can continue to be provided.