Wendy Madsen

Using health promotion competencies for curriculum development in higher education

Health promotion core competencies are used for a variety of reasons. Recently there have been moves to gain international consensus regarding core competencies within health promotion. One of the main reasons put forward for having core competencies is to guide curriculum development within higher education institutions. This article outlines the endeavours of one institution to develop undergraduate and postgraduate curricula around the Australian core competencies for health promotion practitioners. It argues that until core competencies have been agreed upon internationally, basing curricula on these carries a risk associated with change. However, delaying curricula until such risks are ameliorated decreases opportunities to deliver dynamic and current health promotion education within higher institutions.

Newton's cradle: a metaphor to consider the flexibility, resistance and direction of nursing's future

Nursing faces an uncertain future as technological developments, structural changes within health systems and rapidly evolving health needs create new and challenging possibilities. This article draws on the results of a qualitative study undertaken with a range of Queensland nurse leaders to explore their perceptions of these changes. The study re-surfaced, and allows for a re-examination of, four issues that have long created tension within nursing and which continue to have a negative impact on the profession as a whole. These are as follows: professionalisation; preparation of graduates; myths and narratives of nursing; and leadership. We provide a metaphor that imagines all of these tensions operating in dynamic interplay. The image is that of a Newtons Cradle - a model for energy and momentum. The metaphor allows one to see the wide context of changes affecting nursing and the significance of the interconnections. If tensions within nursing maintain their own integrity through containment, understanding and development, they remain in alignment, and energy is conserved rather than wasted or misdirected. It suggests that with increased awareness and attention paid to internal challenges, and by taking a broad-based approach to systemic improvements, nursing could become more effective, progressive and proactive in shaping its own future.

‘Knowing me, knowing you’: Exploring the effects of a rural leadership programme on community resilience

Abstract Rural leadership programmes have proliferated in the past 15 years in countries, including Australia. Whilst most programmes have focussed on transactional leadership which aims to develop individual leaders, increased attention is being paid to transformational approaches to leadership which aim to enhance social networks, cohesiveness and civic activity within communities. In this way, leadership can enhance community resilience. This article uses interpretive case study methodology to evaluate a rural leadership programme in Central Queensland, Australia. Two key themes, self-development and building social capital, illustrate how leadership programmes can contribute to the development of community resilience. The article provides greater insight into the importance of leadership as a community responsibility rather than leadership as a narrow set of skills and highlights the need for such approaches to be transformative in the way they contribute to both individual and community wellbeing.

Bottom lines: the influence of government funding on 20th century district nursing practice in Australia.

AIMS AND OBJECTIVES To investigate the impact of past government policy and legislation on the practice of district nursing in Australia. BACKGROUND Nurses have historically been politically passive and have not engaged in the political processes of policy development. However, legislation can have profound impacts on the daily work of nurses as demonstrated in this paper. DESIGN Historical analysis. METHODS The archival records of six district nursing services in Australia were analysed within the political, social and economic context of the 20th century, with particular focus on the 1950s and 1970s. RESULTS Two pieces of Federal legislation passed in 1956 and 1973, respectively, had critical effects on the work of district nurses. Both resulted in significant expansion of district nursing in Australia; neither was formulated with input from district nursing services. However, together these acts shifted district nursing from being a voluntary, charity based activity to one that was greatly controlled by government. CONCLUSIONS Greater government funding allowed district nursing to expand beyond the capacity possible when funding was locally based, but with government funding came other restrictions related to accountability processes and expectations regarding services provided, and these had profound effects on nursing practice, including excess workloads to the point of unsafe practice. RELEVANCE TO CLINICAL PRACTICE Nurses need to engage with the political processes associated with government policy formulation and implementation if they are to avoid placing themselves and their clients in vulnerable situations as a result of government decisions.

Overcoming Tradition: Teaching Wound Management into the Twenty-First Century

Wound management has been an integral part of nursing practice for the past century. However, the expectations associated with wound management within nursing have altered significantly in the past twenty years. These changes have not always been reflected in the curricula of undergraduate nursing programs. This paper provides an overview of the changes in wound management within nursing practice from the mid nineteenth century and identifies what aspects have undergone change and why such changes have not always been taught to nursing students. We then outline how wound management has been incorporated into the undergraduate nursing curriculum at Central Queensland University using curriculum mapping.

Time enough! or not enough time! An oral history investigation of some British and Australian community nurses' responses to demands for "efficiency" in health care, 1960-2000

Oral history methodology was used to investigate the perspectives of retired British district nurses and Australian domiciliary nurses who had practiced between 1960 and 2000. Interviews yielded insights into the dramatic changes in community nursing practice during the last four decades of the 20th century. Massive changes in health care and government-led drives for greater efficiency meant moving from practice governed by “experiential time” (in which perception of time depends on the quality of experience) to practice governed by “measured time” (in which experience itself is molded by the measurement of time). Nurses recognized that the quality of their working lives and their relationships with families had been altered by the social, cultural, and political changes, including the drive for professional recognition in nursing itself, soaring economic costs of health care and push for deinstitutionalization of care. Community nurses faced several dilemmas as they grappled with the demands for efficiency created by these changes.

Institutionalised isolation: tuberculosis nursing at Westwood Sanatorium, Queensland, Australia 1919–55

From the mid nineteenth to mid twentieth century sanatoria loomed large in the popular consciousness as the space for the treatment of tuberculosis (TB). A review of the historiography of sanatoria at the beginning of this paper shows that the nursing contribution to the care of TB patients is at best ignored and at worst attracts negative comment. Added to this TB nursing was not viewed as prestigious by contemporaries, leading to problems attracting recruits. Using a case study approach based on surviving archival material, this paper sets out to provide a glimpse of the work of TB nurses in a rural sanatorium at Westwood, Queensland, Australia. For the nurses geographical isolation was compounded by professional stagnation, which created a working environment influenced by friction and discord among the staff. It reveals how despite this, nurses coped with working in hostile conditions, to make the long stay of their patients, separated from their families and familiar life style more bearable.

History in health: health promotion's underexplored tool for change

OBJECTIVES This paper outlined an argument as to why history and historians should be included in a healthy settings approach. STUDY DESIGN Qualitative descriptive study. METHODS A narrative review of the literature across a broad cross-section of history, health promotion and public health disciplines was undertaken. RESULTS Three reasons for including history were identified relating to the social role of history as a means of analysing social memory, of changing social narratives and by raising social consciousness. This allowed for a distinction between history in health and history of health. Precedents of this social role can be found in the fields of feminist and postcolonial histories, oral history and museums in health. CONCLUSION Reasons for why historians and health promotion practitioners and researchers have not previously had working relationships were explored, as were some of the factors that would need to be considered for such relationships to work well, including the need to recognise different languages, different understandings of the role of history, and a potential lack of awareness of the health implications of historical work.

Boundaries and barriers: a history of district nursing management in regional Queensland

Aim  To explore administrative constraints of district nursing during the latter part of the 20th century in regional Queensland, Australia. Background  A greater understanding of the evolution of district nursing can illuminate why present conditions and circumstances exist. Method  Thirteen interviews undertaken and analysed historically in association with other documentary evidence from the time period 1960–90. Findings  District nursing services of regional Queensland were initially established by voluntary organizations that had very lean budgets. Throughout the study period, government funding became increasingly available, but this coincided with increased regulation of the services. Conclusions  District nurses have worked within considerable boundaries and barriers associated with either a lack of funds or imposed regulations. While greater government funding solved some working conditions, it did so by imposing greater administrative responsibilities on the nurses and services that were not always seen as advantageous for clients or as professionally satisfying for the nurses.AIM To explore administrative constraints of district nursing during the latter part of the 20th century in regional Queensland, Australia. BACKGROUND A greater understanding of the evolution of district nursing can illuminate why present conditions and circumstances exist. METHOD Thirteen interviews undertaken and analysed historically in association with other documentary evidence from the time period 1960-90. FINDINGS District nursing services of regional Queensland were initially established by voluntary organizations that had very lean budgets. Throughout the study period, government funding became increasingly available, but this coincided with increased regulation of the services. CONCLUSIONS District nurses have worked within considerable boundaries and barriers associated with either a lack of funds or imposed regulations. While greater government funding solved some working conditions, it did so by imposing greater administrative responsibilities on the nurses and services that were not always seen as advantageous for clients or as professionally satisfying for the nurses.

Power, participation and partnerships: reflections on the co-creation of knowledge

Abstract Narrative writing was used to critically reflect on the reasons for the success and failure of two research partnerships: one between the authors and a community group, the other between the authors and academic colleagues. The reflections relate to a vignette constructed on the experiences of the authors and somewhat fictionalised, but brought together to highlight the contrasts, whereby one research partnership was successful in producing outcomes while the other was not. An analysis of these reflections was informed by Wenger’s Communities of Practice framework. This helped draw out issues around power and participation as fundamental for successful research partnerships, particularly multidisciplinary partnerships, intent on the co-creation of knowledge. Such issues related to recognising partnerships and the underlying assumptions when these partnerships cross boundaries include transparent communication, power and decision-making processes, critical self-awareness, and negotiated meaning and identity.