Sandra Mackey

Front line nurses' experiences with deteriorating ward patients: a qualitative study

BACKGROUNDnNurses in the general ward are faced with patients who are at high risk of clinical deterioration. Having the key role in performing routine vital signs monitoring, non-registered nurses such as enrolled nurses are the front line nurses who play a pivotal role in detecting and responding to the deteriorating ward patient.nnnAIMSn(1) To explore the experience of enrolled nurses with deteriorating patients in pre-cardiac arrest situations and (2) to identify strategies to enhance their role in caring for deteriorating ward patients.nnnMETHODnA qualitative study using critical incident technique was conducted. Fifteen enrolled nurses who had encountered deteriorating ward patients were interviewed. Data were analysed using content analysis.nnnFINDINGSnThree themes emerged describing enrolled nurses experience with deteriorating patients: recognizing deterioration, responding to deterioration and taking responsibility. Two themes, including educational development and modifying clinical processes, were strategies identified to enhance the ability of enrolled nurses in recognizing and managing deteriorating patients.nnnCONCLUSIONnThe study highlighted a need to enhance the ability of front line nurses in recognizing and responding to patient deterioration through nursing education and modifications of clinical processes.nnnIMPLICATIONS FOR NURSING AND HEALTH POLICYnNursing education could focus on increasing the awareness of the importance of performing complete vital signs monitoring and undertaking accurate interpretation of vital signs. Strategies to improve clinical processes could include the need for registered nurses to provide supervision of enrolled nurses in the interpretation of vital signs readings and share the responsibility of performing vital signs monitoring.

An exploratory study of traditional birthing practices of Chinese, Malay and Indian women in Singapore

OBJECTIVESnto explore the traditional birthing practices of Singaporean women.nnnRESEARCH DESIGNna qualitative study using a phenomenological approach. Data were collected using individual interviews, which were audio-recorded and transcribed verbatim. Colaizzis phenomenological method was used to analyse the data.nnnSETTINGnobstetric outpatient clinics in a tertiary hospital in Singapore.nnnPARTICIPANTSna purposive sample of 30 women, 1-3 months postpartum.nnnFINDINGSntwo broad themes emerged-following tradition and challenging tradition.nnnKEY CONCLUSIONSnSingaporean women experiencing pregnancy and childbirth follow tradition through the influence of their mother and mother-in-law and because of worry over consequences that may result if they do not. Tradition is also challenged through the modification or rejection of traditional practices and changing family roles and expectations.nnnIMPLICATIONSnhealth professionals need to provide accurate information on traditional birthing practices and scientific evidence to support or refute such practices with the aim of preventing women from adhering to practices that are hazardous to them and the baby.

An exploration of Singaporean parental experiences in managing school-aged children's postoperative pain: a descriptive qualitative approach.

AIMS AND OBJECTIVESnTo enhance understanding of the experience of parents in managing their childrens postoperative pain in Singapore.nnnBACKGROUNDnParents play a significant role in their hospitalised childs postoperative pain care. Their active involvement may contribute to accurate pain assessment and effective pain management for their child. However, there is a lack of in-depth research exploring the experience of parents involved in their childrens postoperative pain management.nnnDESIGNnThis study adopted a descriptive qualitative approach, which is situated in the interpretive paradigm.nnnMETHODnSemi-structured interviews were conducted to collect data from 14 parents whose children were hospitalised in one of the three paediatric surgical wards in a hospital in Singapore in December 2009. Thematic analysis was used to analyse the data.nnnRESULTSnThree themes were identified: Actions used by parents to alleviate their childs postoperative pain, Factors influencing parents management of their childs postoperative pain and Parents needs in the process of caring for their childs postoperative pain. Parents used a range of non-pharmacological pain relief interventions for their child. Parental roles and expectations, bond between parent and child, support from nurses, family and own religious beliefs, as well as childrens age and maturity level were factors which promoted parental participation, whereas parents negative feelings, knowledge deficit and nurses busy schedule were hindering factors. Parents expressed needs for more involvement in their childs care, adequate rest and information support from nurses.nnnCONCLUSIONSnThis study highlights the importance of involving parents in their childs postoperative pain management. It provides evidence for health care professionals to pay attention to factors that may influence parental participation and, therefore, guide their practice.nnnRELEVANCE TO CLINICAL PRACTICEnNurses need to provide parents with support and education to facilitate their roles and improve their childs postoperative pain management.

Towards an ontological theory of wellness: a discussion of conceptual foundations and implications for nursing

In this article a discussion of the phenomenon of wellness and its relevance to contemporary nursing practice is developed. Drawing on phenomenology, the research literature and the authors own wellness research, an exposition of the concept of wellness is presented. It is proposed that the experience of being well is lived as a continuity of time and that it involves both a taking-for-granted of the body and containment of the horizon of concern. The state of actually being well is also clarified and contrasted with the more common understanding of wellness as an optimal or future state. This discussion has significance for nursing knowledge development, in terms of our understanding of the experience of wellness and illness. It also has implications for how nurses approach their practice, particularly in the area of health promotion.

Student feedback on teaching: Some issues for consideration for nurse educators

In this paper, we outline some key points about student feedback for nurse educators to consider. For nursing students, providing feedback offers an opportunity to communicate whether relevant and effective learning has occurred. Given the importance of student feedback for the quality of learning and teaching, and the significant resources invested in it, it is essential that accurate feedback is obtained and responded to by nurse educators. The aim of this paper, therefore, is to present an overview of factors influencing the quality and reliability of student feedback of their theoretical and clinical learning experiences, and ways the feedback might be used by educators for improving teaching and career enhancement. Nurse educators need to be prepared to respond to well-intentioned feedback without undue defensiveness to ensure good and effective teaching. Ultimately, feedback systems that are well managed should benefit nursing students, nurse educators and their respective institutions.In this paper, we outline some key points about student feedback for nurse educators to consider. For nursing students, providing feedback offers an opportunity to communicate whether relevant and effective learning has occurred. Given the importance of student feedback for the quality of learning and teaching, and the significant resources invested in it, it is essential that accurate feedback is obtained and responded to by nurse educators. The aim of this paper, therefore, is to present an overview of factors influencing the quality and reliability of student feedback of their theoretical and clinical learning experiences, and ways the feedback might be used by educators for improving teaching and career enhancement. Nurse educators need to be prepared to respond to well-intentioned feedback without undue defensiveness to ensure good and effective teaching. Ultimately, feedback systems that are well managed should benefit nursing students, nurse educators and their respective institutions.

Factors relating to perioperative experience of older persons undergoing joint replacement surgery: an integrative literature review

Abstract Purpose: The purpose of this literature review was to examine factors relating to the perioperative experience of older persons undergoing total hip and knee replacement surgery resulting from osteoarthritis. Method: A literature search was undertaken using databases CINAHL, PubMed, Scopus and Web of Science to provide relevant research articles. Articles were included if they examined the factors relating to the HRQOL, QOL and perioperative experience of older persons undergoing joint replacement surgery resulting from osteoarthritis. The use of Joanna Briggs Institute’s critical appraisal checklist facilitated a systematic appraisal of studies with regard to the scientific rigor of the studies. Results: Twenty-two publications were categorized into one main theme: “factors relating to perioperative experience” subcategorized into eight subthemes: “waiting time”, “pain and disability”, “mental health”, “race/ethnicity, age and gender”, “body image”, “coping and social support”, “patient education” and “care continuity”. Conclusion: There is a need to conduct further research to examine the perioperative experience of older persons undergoing joint replacement surgery, in particular, the lived perioperative experience of a diverse race, ethnicity and culture in an Asian population. Implications for Rehabilitation Healthcare services should remain focused on reducing waiting time as prolonged waiting time for joint replacement surgery was detrimental to patients’ HRQOL. Healthcare professionals need to identify strategies to improve the perioperative pain experience through patient education on pain management and positive social support to support the process of recovery. Patients’ expectations of pain and their process of recovery were closely linked to patient education. One model of patient education that was seen to be successful and linked to good post-operative outcomes was care continuity model. Being actively involved in the care continuity results in better post-operative outcomes for the patient and their family.

Primary health care as a philosophical and practical framework for nursing education: rhetoric or reality?

Abstract At least three decades after primary health care (PHC) took nursing by storm it is time to re-examine the philosophical shift to a PHC framework in pre-registration nursing curricula and overview factors which may hinder or promote full integration of PHC as a course philosophy and a contemporary approach to professional practice. Whilst nurse education has traditionally focused on preparing graduates for practice in the acute care setting, there is continuing emphasis on preparing nurses for community based primary health roles, with a focus on illness prevention and health promotion. This is driven by growing evidence that health systems are not responding adequately to the needs and challenges of diverse populations, as well as economic imperatives to reduce the burden of disease associated with the growth of chronic and complex diseases and to reduce the costs associated with the provision of health care. Nursing pre-registration programs in Australia and internationally have philosophically adopted PHC as a curriculum model for preparing graduates with the necessary competencies to function effectively across a range of settings. Anecdotal evidence, however, suggests that when adopted as a program philosophy PHC is not always well integrated across the curriculum. In order to develop a strong and resilient contemporary nursing workforce prepared for practice in both acute and community settings, pre-registration nursing programs need to comprehensively consider and address the factors impacting on the curricula integration of PHC philosophy.

Young Singaporean women's knowledge of cervical cancer and pap smear screening: a descriptive study.

AIMS AND OBJECTIVESnTo assess the knowledge of young female Singaporeans regarding cervical cancer and pap smear, the intention to participate in pap smear and whether there is any relationship between knowledge and intention to participate in pap smear screening.nnnBACKGROUNDnWhile cervical cancer has poor prognosis in the later stages, pap smear is effective in identifying precancerous lesions, which are more treatable. Pap smear screening is available to women in Singapore, but its uptake is opportunistic. Research has shown that knowledge about pap smear and cervical cancer is important determinant of screening behaviour in Singaporean women.nnnDESIGNnCross-sectional descriptive correlational design was used.nnnMETHODSnThree hundred and ninety-three young Singaporean undergraduates, aged 18-25 years, were recruited via convenience sampling from a local university over a four-month period. Data were collected through self-administered questionnaires.nnnRESULTSnMajority of the participants knew the term pap smear and its function. However, knowledge of the risk factors for cervical cancer was lacking among the young women. Knowledge of pap smear and cervical cancer had a weak correlation with the intention to go for the future uptake of pap smear.nnnCONCLUSIONSnEducational efforts among younger Singaporean women on the knowledge of pap smear and risk factors for cervical cancer are needed. Improving knowledge will enable them to understand the importance of reducing exposure to risk factors and regular pap smear screening.nnnRELEVANCE TO CLINICAL PRACTICEnAll health professionals working with young Asian women should be prepared to educate and counsel young women to participate in pap smear screening according to current guidelines. In particular, knowledge of the age to attend the first pap smear and the recommended frequency for screening need to be targeted for health education.

Patients' experiences on donation of their residual biological samples and the impact of these experiences on the type of consent given for the future research use of the tissue: A systematic review

AIMnThis review aimed to critically appraise, synthesise and present the best available evidence related to the experiences of patients who have donated their residual biological samples and the impact of this experience on the type of consent given for future research use of these tissues.nnnMETHODnThe three-step search strategy aimed to find both published and unpublished studies published in English between 1990 and 2010 in electronic databases (PubMed, CINAHL, Scopus, Embase, PsycINFO, Mednar, PROQUEST). Using the standardised data extraction tool from the Joanna Briggs Institute, the Qualitative Assessment and Review Instrument, 131 findings were extracted from the 18 papers included in this review. These findings generated 19 categories and four synthesised findings.nnnRESULTSnThe synthesised findings generated were related to the different stages of the handling of leftover tissue. The first synthesised finding: patient consent to the use of leftover tissue is a complex interaction between many factors and not solely driven by perceptions of benefits to self or others, relates to the collection of the leftover tissue - the initial consent process. The second synthesised finding: healthcare institutions and regulatory authorities must provide clear and transparent safeguards and controls, and communicate these to the patient prior to the consenting process, outlines the issues affecting consent during the processing and storage of the tissues in biobanks or research institutions. The third synthesised finding: views on ownership and rights to the further use of the leftover tissue varies between individual patients and influences their willingness to consent to further use, demonstrates the concerns relating to the safeguards on the collection and storage of leftover tissue. The fourth synthesised finding: patients have opposing views on the use of their leftover tissue for commercial purposes, reflecting the differing community beliefs around using leftover tissue for research which may provide a commercial benefit to some, but not all, the community.nnnCONCLUSIONnFor leftover tissues to be used, patients must clearly understand: the type of consent they are providing (opt in or opt out); the parameters for the future research use of their leftover tissues; the safeguards put into place to protect the individual and the donated tissue from unethical use; and the commercial implications of their consent.nnnIMPLICATIONS FOR PRACTICEnThis review provides information on patients experiences on the collection, storage, distribution and future use of leftover tissue. These preferences need to be understood when designing a prospective model of consent regimen which respects patients confidentiality and wishes. The information in this review is especially important for policy-makers designing a prospective model of consent regimen for the use of existing and previously collected biological samples with no consent taken.nnnIMPLICATIONS FOR RESEARCHnFurther research is needed to ascertain what factors specifically influence patients willingness to consent for the use of leftover tissue. Factors for further exploration include the effects of culture, religion and age. Additionally, further research is required to inform the development of specific consent regimes for the use of leftover tissue for commercial, stem cell and genetic research.

Reputations: a critical yet neglected area of scholarly enquiry

‘Reputations’ are an ever-present aspect of human groupings and society. How often might we hear that a certain individual has an excellent reputation in a certain field, while another’s reputation is less favourable, or that a particular institution’s high reputation is a reason to seek entry there, and contrasts with another institution’s poor reputation, which is a deterrent? Despite the ubiquitous nature of reputations, and their myriad potential consequences, the subject has attracted limited attention in the academic and health literature. In this editorial, we flesh out some of the dimensions of reputation, with a view to encouraging further debate and discussion, and suggest a way to achieve and maintain a positive reputation if working in an academic setting. The importance of the topic was recently underscored by the Ethics Resource Center, which suggested that ‘Among all of an organization’s assets, a good reputation may be the most important. It is also the easiest to lose and the most challenging to maintain’ (Ethics Resource Center 2011, p. 3). What is meant by a reputation? According to the Free Dictionary (http://www.thefreedictionary.com/reputation), reputation may be defined as ‘the general estimation in which a person is held by the public or the state, or situation of being held in high esteem, or a specific characteristic or trait ascribed to a person or thing’. It follows from definitions like this that a key aspect of reputation is its subjective quality. While reputation traditionally bypasses a measure of objective performance to encompass what the ‘person in the street’ thinks and says about somebody or an institution, it is noteworthy that there have been some recent attempts to quantify reputation, at least at the institutional level. For example, there is now a formal ranking of universities according to reputation (http://www.timeshighereducation. co.uk/world-university-rankings/2011-2012/reputation-rankings.html). In this ranking system, reputation draws on opinions about research and, to a lesser extent, teaching. This information may then be used by prospective students to make judgements about institutions where they may choose to study. Similarly, academic staff will be understandably keen to work at facilities that are highly ranked in terms of measurable reputation. So, what are the elements of a reputation? We would suggest that, in general, the two critical components of reputation are work performance itself (by an individual or institution) and, as importantly, dissemination of news about such performance to others. At the heart of a ‘positive’ reputation, then, is performing one’s duties to a reasonably high standard – as a bare minimum, performing according to the position requirements is required. A positive reputation also has an element of others learning about one’s work – the ‘hearsay’ aspect, if you will – so not being shy about tactfully promoting one’s work, without being ‘excessively’ selfpromoting, is essential. Many ‘quiet achievers’ who might otherwise have a positive reputation, regrettably go unnoticed. It follows that reputations may be enhanced, or sullied, by various means. First, as mentioned, it is essential for a person or institution to perform their expected tasks. A range of factors – inertia, unsuitability, poor organizational skills, lack of training, inadequate supervision, etc. – may mitigate against this occurring. It is worth digressing to note here the potential influence of mental illness on reputation: certain mental illnesses, e.g. manic episodes of bipolar disorder, are notorious for damaging a person’s reputation, but the active phase of any psychiatric illness can tarnish a reputation and warrants due attention for this, among other reasons. Second, various factors may have an impact on one’s work being detected by others. The situation of the ‘quiet achiever’ has been noted. Not actively seeking or having opportunity for disseminating information about one’s work (e.g. through conference and other presentations and journal article submissions) will not add to a positive reputation. Establishing a strong professional reputation requires not only strong personal characteristics, including credibility, competence, and trustworthiness, but also purposeful action, political