Saras Henderson

Resilience: The Power Within

PURPOSE/OBJECTIVES To advance understanding of resilience as an innate resource and its potential and relevance in the management of workplace stress for oncology nurses. DATA SOURCES Journal articles and research results, particularly seminal literature from a variety of Australian and international journals and published texts, including government and nursing organizations. DATA SYNTHESIS Resilience is defined as an innate energy or motivating life force present to varying degrees in every individual, exemplified by the presence of particular traits or characteristics that, through application of dynamic processes, enable an individual to cope with, recover from, and grow as a result of stress or adversity. Literature from a wide variety of fields, including physics, medicine, theology, philosophy, psychology, and spirituality, was reviewed to build an overview of existing knowledge and evolving theories on the subject of resilience and further the understanding of resilience as an innate personal resource. CONCLUSIONS Innate resilience can be developed or enhanced through cognitive transformational practices, education, and environmental support. Such processes may have use in ameliorating the effects of workplace stress. IMPLICATIONS FOR NURSING The complex nature of oncology and other specialty nursing roles creates a certain amount of inevitable stress that depletes the self and may lead to compassion fatigue and burnout. A greater understanding of resilience as an innate stress response resource highlights the need for processes that support resilience development and organizational and personal stress-management strategies for nurses to be part of mainstream nursing education.

The effectiveness of culturally appropriate interventions to manage or prevent chronic disease in culturally and linguistically diverse communities: a systematic literature review.

Culturally and linguistically diverse (CALD) communities in Australia experience both significant health disparities and a lack of access to services. Consequently, there have been calls for culturally appropriate services for people with chronic disease in CALD populations. This paper presents a systematic review of the literature on the effectiveness of culturally appropriate interventions to manage or prevent chronic disease in CALD communities. Evidence was sought from randomized controlled trials and controlled studies that examined strategies for promoting cultural competence in health service delivery to CALD communities. The outcomes examined included changes in consumer health behaviours, utilisation/satisfaction with the service, and the cultural competence of health-care providers. Of the 202 studies that were identified only 24 met the inclusion criteria. The five categories of intervention that were identified included: (1) the use of community-based bi-lingual health workers; (2) providing cultural competency training for health workers; (3) using interpreter service for CALD people; (4) using multimedia and culturally sensitive videos to promote health for CALD people and (5) establishing community point-of-care services for CALD people with chronic disease. The review supported the use of trained bi-lingual health workers, who are culturally competent, as a major consideration in the development of an appropriate health service model for CALD communities.

Culturally and linguistically diverse peoples’ knowledge of accessibility and utilisation of health services: exploring the need for improvement in health service delivery

With 28% of Australias population having a culturally and linguistically diverse (CALD) background, the health system faces an increasing challenge to provide accessible and culturally competent health care. The view that all CALD communities are homogenous and solutions can be developed for the entire nation is detrimental. Despite available health services, CALD communities are reluctant to use them due to cultural differences, perceived racism and misunderstandings leading to the existing health disparities. Therefore, gathering data from four prominent CALD communities, such as the Sudanese, Afghani, Pacific Islander and Burmese communities in Logan, Queensland, about how they perceive and use health services can provide insightful information towards development of a service model that will better suit these CALD communities. The objective of the study was to examine the extent to which four prominent CALD communities (Sudanese, Afghani, Pacific Islander and Burmese) access and use health services in Logan, Queensland. Six focus group interviews using interpreters were conducted in English with Sudanese, Afghani, Pacific Islander and Burmese people. The results indicated that even long-standing CALD communities, such as the Pacific Islander people, were unfamiliar with health services and experienced difficulties accessing appropriate health care. Most wanted doctors to use traditional healing methods alongside orthodox medicine, but did not feel respected for their beliefs. Language difficulties impeded communication with health professionals who were hindered by ineffective use of interpreters. In conclusion, a clear role for bilingual community-based navigators was identified by CALD participants to address concerns about the health system, and to improve accessibility and health service usage.

Community-based child health nurses: An exploration of current practice

Abstract The purpose of this research was to define, the practice domain of community-based child health nursing in light of widespread political, economic and social changes in Western Australia. The project was conducted by a group of nurse researchers with experience in child health nursing from the School of Nursing and Midwifery at Curtin University and the Child and Adolescent Community Health Division at the Department of Health, Western Australia. The overall aim of the project was to map the scope of nursing practice in the community child health setting in Western Australia and to identify the decision making framework that underpins this nursing specialty. Given the widespread social, economic and health service management changes, it was important for nurses involved with, or contemplating a career in, community-based child health to have the role accurately defined. In addition, consumer expectations of the service needed to be explored within the current climate. A descriptive qualitative study was used for this project. A purposive sample of 60 participants was drawn from the pool of child health nurses in the South Metropolitan Community Health Service, North Metropolitan Health Service and Western Australian Country Health Service. Following ethical approval data was collected via participants keeping a 2-week work diary. The data was coded and thematic analysis was applied. Several themes emerged from the analysis which were validated by follow up focus group interviews with participants. This clearly demonstrated common, recurring issues. The results identified that the community-based child health nurses are currently undertaking a more complex and expanded child health service role for an increasingly diverse client population, over their traditional practices which are still maintained. Excessive workloads and lack of human and non human resources also presented challenges. There are increasing requirements for child health nurses to engage in community development and capacity building, often through a multidisciplinary partnership, which requires them to have sound brokerage and facilitation skills to enable community inclusion and inter-agency collaboration at the local level. The study has highlighted the importance and multifaceted nature of the role of the community-based child health nurse. To enable them to function optimally, the following suggestions/recommendations are offered. These being: More physical resources be allocated to communitybased child health nursing More resources allocated to assist community-based child health nurses to support culturally and linguistically diverse families Mapping of child health nurses’ workloads The development of community health client dependency rating criteria reflecting the social determinants of health in order for health service refinement of staffing allocations based on an acuity scale Specific staff development opportunities to reflect the increased workload complexity Managerial support for the implementation of formal clinical (reflective) supervision Additional clerical assistance with non-nursing duties.

Community Child Health (CCH) nurses' experience of home visits for new mothers: A quality improvement project

Abstract This papesr explores Community Child Health (CCH) nurses’ experience of home visits for new mothers in a health service region of Western Australia. Reported benefits of home visits include improvement in maternal and child health and better parenting skills leading to positive maternal–child interaction. Despite CCH nurses’ support for home visits factors such as costs, lack of resources and staffing issues have made home visits increasingly difficult. Twelve child health nurses participated in a focus group taped interview to explore how these nurses experienced home visits for new mothers in order to evaluate and improve home visits. Data were transcribed verbatim and content analysed. Three themes emerged from the nurses’ experience of home visits. These were: (1) finding out about home visits with sub-themes such as scheduling first home visits and making the first phone call, (2) staying safe during home visits with sub-themes such as managing high risk clients and scheduling subsequent visits and (3) building positive partnerships with clients during home visits. The findings indicated CCH nurses followed a set pathway towards successfully completing home visits. This may provide valuable insights for other CCH nurses.

Perceptions of infection control practices among health professionals

Abstract Infection control practice is a cornerstone of modern health care. However, there is minimal research into health professionals’ perception of infection control practices and how those perceptions influence staff compliance with recommended protocols.The objective of this study was to explore health care professionals’ perceptions of infection control practices in relation to the management of infectious diseases. A grounded theory approach was used as the research framework. Semi-structured interviews were completed with a sample of 16 nurses and doctors working at hospitals in Western Australia. Four major categories emerged from the data. These were: knowledge, culture, conflict, and risk assessment. The findings indicate the importance of both individual and organisational factors in determining clinicians’ levels of compliance with recommended infection control practices. Identification of the factors that influence health professionals’ level of compliance can be uased to develop strategies to support long-term compliance with infection control practices.

Using Interprofessional Learning for Continuing Education: Development and Evaluation of the Graduate Certificate Program in Health Professional Education for Clinicians.

Introduction: Health professionals may be expert clinicians but do not automatically make effective teachers and need educational development. In response, a team of health academics at an Australian university developed and evaluated the continuing education Graduate Certificate in Health Professional Education Program using an interprofessional learning model. Methods: The model was informed by Collins interactional expertise and Knowles adult learning theories. The team collaboratively developed and taught four courses in the program. Blended learning methods such as web-based learning, face-to-face workshops, and online discussion forums were used. Twenty-seven multidisciplinary participants enrolled in the inaugural program. Focus group interview, self-report questionnaires, and teacher observations were used to evaluate the program. Results: Online learning motivated participants to learn in a collaborative virtual environment. The workshops conducted in an interprofessional environment promoted knowledge sharing and helped participants to better understand other discipline roles, so they could conduct clinical education within a broader health care team context. Work-integrated assessments supported learning relevance. The teachers, however, observed that some participants struggled because of lack of computer skills. Discussion: Although the interprofessional learning model promoted collaboration and flexibility, it is important to note that consideration be given to participants who are not computer literate. We therefore conducted a library and computer literacy workshop in orientation week which helped. An interprofessional learning environment can assist health professionals to operate outside their “traditional silos” leading to a more collaborative approach to the provision of care. Our experience may assist other organizations in developing similar programs.

How Does Culture Shape Roles and Relationships in Taiwanese Family Caregiving for an Adolescent With Cancer

Background: Chinese culture plays a significant part in how Taiwanese families view life events. Caregivers envisage themselves as guardians of their children in all facets of family life, including wellness and strive to maintain harmonious relationships within the family. However, it remains unclear what impact caring for an adolescent with cancer has on family roles and relationships in Taiwanese families, nor are the processes for managing change in family roles and relationships associated with caregiving well understood. Objective: This study explores the impact of caregiving for an adolescent with cancer on the roles and relationships within Taiwanese families. Methods: Seven families were recruited from a medical hospital in Taiwan. Data were collected through qualitative interviews and analyzed following Strauss and Corbin’s grounded theory. Results: The core category, underpinned by Chinese culture, proved to be experiencing the broken chain of family life. This was the central issue brought about by 4 consequences for the broken chain of family life. The expression “the broken chain of family life” encapsulates how important Chinese cultural values are in defining caregiver task performance. Conclusions: The findings have implications for Taiwanese families in perceiving, adjusting to, and fulfilling the altered roles and relationships associated with caring for an adolescent with cancer at home. Implications for Practice: The delivery of exceptional care and services depends on gaining insight into how caregiving influences family roles and relationships. How families failed to manage the process of caregiving provides valuable insight for informing and providing recommendations for services and support.

Reflecting on the tensions faced by a community-based multicultural health navigator service

The community navigator model was developed to assist four culturally and linguistically diverse communities (Sudanese, Burmese, Pacific Islander Group, Afghani) in south-east Queensland to negotiate the Australian health system and promote health. Using participatory action research, we developed the model in partnership with community leaders and members, the local health department and two non-governmental organisations. Following implementation, we evaluated the model, with the results published elsewhere. However, our evaluation revealed that although the model was accepted by the communities and was associated with positive health outcomes, the financial, social and organisational durability of the model was problematic. Ironically, this situation was inadvertently created by critical decisions made during the development process to enhance the durability and acceptability of the model. This paper explores these critical decisions, our rationale for making those decisions and the four hidden tensions that subsequently emerged. Using a reflective case study method to guide our analysis, we provide possible resolutions to these tensions that may promote the longevity and utility of similar models in the future. WHAT IS KNOWN ABOUT THE TOPIC?: The use of community navigators to assist culturally diverse communities to access health services is not new. Many benefits have been documented for communities, individuals and heath service providers following the use of such models. What is not well documented is how to maintain these models in a safe and cost-effective way within the Australian health system while respecting cultural and community practices and reducing the burden of service delivery on the navigators. WHAT DOES THIS PAPER ADD?: This paper provides a perspective on how the development of community-based service models inherently places them in a position of tension that must be resolved if they are to be long lasting. Four core tensions experienced during the development and implementation of our model in south-east Queensland are explored to develop potential resolutions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Reducing the tensions inherent in culturally appropriate community-based service models will increase the durability of the approach. By addressing these tensions, we can create a more durable pool of community navigators that can facilitate community empowerment, self-governance of health issues and a sense of community ownership of health services.

Partnership Functioning: A Case in Point Between Government, Nongovernment, and a University in Australia

Background: Culturally and linguistically diverse (CALD) communities in Queensland, Australia, do not access health services, contributing to poor health outcomes. To improve health in CALD communities, a partnership was formed between the state government, two nongovernment CALD-specific organizations (NGOs), and a university to develop a service that could facilitate health service use. This qualitative research explored the partners’ perspectives on how the partnership functioned and its outcomes. Objectives: We sought to (1) explore how participants engaged with the principles of partnership, the processes they used, and their beliefs about the facilitators and barriers to intersectoral collaboration and (2) gain insights into how the partners perceived the development and functioning of the partnership. Methods: Qualitative, semistructured interviews were conducted with each of the key stakeholders in the partnership (n = 4). A focus group was also conducted with those working within the two NGO partners in the delivery of the service (n = 8). Open-ended questions drawn from the literature on partnership principles were used to guide the interviews and focus group data collection. The data were transcribed and analyzed using thematic principles. Results: The four themes identified were: (1) Perceived benefits of the partnership outweighed organizational differences; (2) respectful relationships sustained the partnership; (3) mitigating conflict enabled the purpose of the partnership to be fulfilled; and (4) a neutral interpersonal space enabled the partnership to be enacted. Conclusions: Our study showed how contextual pressures created within the system can damage tenuous connections that have been developed between otherwise competitive organizations, leading to dissolution of partnerships. However, the study has also shown that partnerships may be purpose and time bound, not necessarily with respect to longevity. Through strategic negotiations, partnerships can be sustained until the goal of the partnership is attained, which in this instance was the development of a new service delivery model.