Sally Wellard

The impact of fatigue on daily activity in people with chronic kidney disease

AIMS AND OBJECTIVES To examine the impact of fatigue on the daily activity levels of people with chronic kidney disease, compare whether being predialysis or receiving different renal replacement therapies had any effect on fatigue and activity and identify whether any items in the fatigue severity scale were more predictive of daily activity levels. BACKGROUND Chronic kidney disease is a complex and long-term disease where people commonly experience fatigue and reduced levels of fitness; both of which impact on an individuals ability to carry out routine activities of daily life. DESIGN A descriptive cross-sectional design. METHODS A convenience sample of 112 people completed the fatigue severity scale and Human Activity Profile. Participants differed in their renal history and were either predialysis or receiving renal replacement therapy. RESULTS Women or older participants were significantly more fatigued and less active than men or younger participants. A significant difference between mean fatigue and activity scores was found for type of renal replacement therapy, with participants receiving peritoneal dialysis being the most fatigued and the least active. Additionally, lower levels of albumin were significantly correlated with greater levels of fatigue and the ability to engage in fewer activities. CONCLUSION People with chronic kidney disease regardless of whether they are predialysis or receiving either peritoneal or haemodialysis experience high levels of fatigue and are able to engage in fewer daily activities. The fatigue severity scale and the Human Activity Profile are useful indicators of fatigue and physical activities which can be used in routine assessment practices. RELEVANCE TO CLINICAL PRACTICE Renal nurses are ideally positioned to engage in early identification and regular monitoring of both fatigue and activity levels in people with chronic kidney disease. Individual care plans can be developed to incorporate supportive rehabilitative strategies which aim to reduce fatigue and maximise activity levels.

Perceptions of People with Type 2 Diabetes about Self-Management and the Efficacy of Community Based Services

Abstract Self-management has become a key strategy for managing the health care of people with diabetes. This study explored issues people with type 2 diabetes experienced in their self-management practices and access to regional community based services. Using a qualitative interpretative design data was collected from four participants who were interviews about their perceptions of facilitators, barriers and issues they encountered in their diabetes care in a regional setting.The findings indicate difficulties participants experienced in gaining access to quality services in regional areas, including long waiting times, difficulties making appointments, and their perception that healthcare professionals fail to acknowledge patients self-management knowledge and practices. Additionally, participants reported food choices affected their family relationships and experience of social stigma. These issues compromised their self-management decisions. The findings support other studies that show a need for health professionals to develop strategies to improve community based services for people with type 2 diabetes and to increase public awareness of the scope of diabetes management.

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.

Problematising autonomy and advocacy in nursing

Customarily patient advocacy is argued to be an essential part of nursing, and this is reinforced in contemporary nursing codes of conduct, as well as codes of ethics and competency standards governing practice. However, the role of the nurse as an advocate is not clearly understood. Autonomy is a key concept in understanding advocacy, but traditional views of individual autonomy can be argued as being outdated and misguided in nursing. Instead, the feminist perspective of relational autonomy is arguably more relevant within the context of advocacy and nurses’ work in clinical healthcare settings. This article serves to highlight and problematise some of the assumptions and influences around the perceived role of the nurse as an advocate for patients in contemporary Western healthcare systems by focusing on key assumptions concerning autonomy inherent in the role of the advocate.

Assessing Australian undergraduate clinical Learning

Determining the clinical preparedness of undergraduate nursing students is vital in developing graduates who are ready to assume the roles of registered nurses. This paper reports findings relating to clinical assessment in Australian undergraduate nursing programs. Using data collected in a national survey and selected case studies, current assessment practices are described. Although students were increasingly exposed to a narrower range of clinical experiences, claims to comprehensive preparation of nurses remain prominent. Issues in the congruity between assessment methods and purported outcomes of clinical learning programs are discussed.

Picture of Norwegian clinical learning laboratories for undergraduate nursing students.

Clinical preparation for practice is a vital part of undergraduate education in nursing. This study explored contemporary constructions of clinical skills laboratories in two nursing undergraduate programs in Norway using qualitative collective case study methods. Data were gathered using individual and group interviews and observation during site visits. The data revealed slightly different ways of organizing teaching and experimenting with use of pedagogical methods to facilitate learning of technical skills as well as encouraging students to activate relevant theoretical knowledge. While there was a lively and striking enthusiasm among staff about the way learning was managed within the laboratories, the pedagogical underpinnings for their particular approaches were less certain amongst participants. The paper concludes with the necessity to provide evidence for the outcome of laboratories learning and investigate suitable pedagogical methods for effective teaching and learning of practice skills. Hence, a need for research on transfer of knowledge and skills between the different sites (academy, clinical settings, and laboratories) is identified.

Comparing Norton, Braden and Waterlow risk assessment scales for pressure ulcers in spinal cord injuries

Abstract When pressure ulcers occur health care services are faced with considerable challenges and costs. Additionally these ulcers cause significant physical and psycho-social impairment for patients and their families. The complexity of pressure ulcer management is widely acknowledged in the literature. However, the applicability of the major risk assessment scales in the context of spinal cord injury has not been explored. Retrospective case history audit of individuals with pressure ulcers provided data to compare the three commonly used Norton, Braden and Waterlow scales. Waterlow’s scale was the most sensitive of the three scales compared.

Mothering: an unacknowledged aspect of undergraduate clinical teachers’ work in nursing

Clinical education is an important component of undergraduate nurse education, in which clinical teachers facilitate students’ application of theoretical classroom knowledge into the clinical practice setting. Mothering as part of clinical teachers’ work was a major finding from a larger study exploring clinical teaching work to identify what shaped their work and barriers to their work in clinical settings. The study used semi-structured interviews, informed by the work of Foucault. Maternal discourses emerged as a predominant one as participants presented their relationships with students describing examples of nurturing, protecting, supporting, guiding and providing discipline. The unexpected finding contradicted the dominant view of students as adult learners, and potentially positions them as dependent in their learning in clinical environments. Exploration of this discourse in the context of the study forms the basis of this paper. It is argued that the overall impact of maternal discourses on clinical teaching and learning is unclear but warrants more detailed investigation.

Investigation of adaptation after liver transplantation using Roy's Adaptation Model

In this study we explored the adaptation of transplant recipients in Turkey using the Roy Adaptation Model. A descriptive qualitative design was used with data collected from liver transplant recipients in either individual or group interviews between May 2009 and February 2010. Using deductive content analysis, four themes were identified in the data: physiological mode, self-concept mode, role function mode, and interdependence mode. Each theme included both adaptive and ineffective behaviors of liver transplant recipients. The findings of this study indicate that liver transplant recipients need information and support about their ineffective behaviors in all modes of the Roy Adaptation Model. The findings also support the use of a nursing model in the delivery of nursing care for liver transplantation recipients.In this study we explored the adaptation of transplant recipients in Turkey using the Roy Adaptation Model. A descriptive qualitative design was used with data collected from liver transplant recipients in either individual or group interviews between May 2009 and February 2010. Using deductive content analysis, four themes were identified in the data: physiological mode, self-concept mode, role function mode, and interdependence mode. Each theme included both adaptive and ineffective behaviors of liver transplant recipients. The findings of this study indicate that liver transplant recipients need information and support about their ineffective behaviors in all modes of the Roy Adaptation Model. The findings also support the use of a nursing model in the delivery of nursing care for liver transplantation recipients.

Exploring staff diabetes medication knowledge and practices in regional residential care: triangulation study

AIMS AND OBJECTIVES This study is drawn from a larger project that aimed to identify the staffing and organisational factors influencing the quality of diabetes care for older people living in residential care in regional Victoria, Australia. The focus of the current study is on medication management for residents with diabetes. BACKGROUND With a continuous rise in diabetes in the population, there is an associated increase in the prevalence of diabetes in aged care residential settings. However, there is little specific guidance on how to manage diabetes in older people living in institutional settings who experience multiple concurrent chronic conditions. DESIGN A triangulation strategy consisting of three phases. METHODS A one-shot cross-sectional survey (n = 68) focus group interviews and a case file audit (n = 20). Data were collected between May 2009-January 2010. FINDINGS Staff knowledge of diabetes and its contemporary medication management was found to be suboptimal. Challenges to managing residents with diabetes included limited time, resident characteristics and communication systems. Additionally, the variability in medical support available to residents and a high level of polypharmacy added to the complexity of medication management of resident. CONCLUSIONS The current study suggests administering medicine to residents in aged care settings is difficult and has potentially serious medical, professional and economic consequences. Limitations to staff knowledge of contemporary diabetes care and medications potentially place residents with diabetes at risk of receiving less than optimal diabetes care. RELEVANCE TO CLINICAL PRACTICE Providing evidence-based guidelines about diabetes care in residential care settings is essential to achieve acceptable outcomes and increase the quality of life for residents in public aged care. Continuing education programs in diabetes care specifically related to medication must be provided to all health professionals and encompass scope of practice.