Winsome St John

Maternal role development: The impact of maternal distress and social support following childbirth

OBJECTIVE to explore the relationship between maternal role development (MRD), maternal distress (MD) and social support following childbirth. DESIGN prospective longitudinal survey. SETTING three public hospital maternity units in Brisbane, Australia. PARTICIPANTS 630 pregnant women were invited to participate in the study, with a 77% (n=473) completion rate. MEASUREMENTS to measure MRD, the Prenatal Maternal Expectation Scale was used at 36 weeks of pregnancy, and the revised What Being the Parent of a New Baby is Like (with subscales of evaluation, centrality and life change) was used at six and 12 weeks post partum. At all three data collection points, the Edinburgh Postnatal Depression Scale was used to measure MD, and the Maternal Social Support Scale was used to measure social support. FINDINGS at 36 weeks of gestation, optimal scaling for MRD produced a parsimonious model with MD providing 39% of predictive power. At six weeks post partum, similar models predicting MRD were found (evaluation: r(2)=0.14, MD providing 64% of predictive power; centrality: r(2)=0.07, MD providing 11% of predictive power; life change: r(2)=0.26, MD providing 59% of predictive power). At 12 weeks post partum, MD was a predictor for evaluation (r(2)=0.11) and life change (r(2)=0.26, 54% of predictive power). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE there is a statistically significant but moderate correlation between MRD and MD. The transition to motherhood can be stressful, but may be facilitated by appropriate acknowledgement and support with an emphasis on MRD.

Recovery From Total Hip Replacement Surgery: “It’s Not Just Physical”

In this grounded theory study we explored the process of recovery following total hip replacement (THR) surgery from the perspective of the older adult. In-depth interviews were conducted with 10 patients aged more than 65 years who had been discharged from hospital for a period of 4 to 6 months following THR surgery. Findings showed that three distinct but interrelated processes constitute the physical, psychological, and social recovery process: reclaiming physical ability, reestablishing roles and relationships, and refocusing self. Intervening conditions affecting the recovery process include comorbid conditions, the personal outlook of the patient, patients’ relationships, and social support. The recovery process can lead to changes in personal and social functioning that patients might not anticipate. Awareness of potential changes will inform patient education and enable clinicians to develop strategies that facilitate THR patients’ return to health.

Understanding the process of patient satisfaction with nurse‐led chronic disease management in general practice

AIMS   To investigate the process of patient satisfaction with nurse-led chronic disease management in Australian general practice. BACKGROUND   Nurses working in the primary care context of general practice, referred to as practice nurses, are expanding their role in chronic disease management; this is relatively new to Australia. Therefore, determining patient satisfaction with this trend is pragmatically and ethically important. However, the concept of patient satisfaction is not well understood particularly in relation to care provided by practice nurses. DESIGN   A grounded theory study underpinned by a relativist ontological position and a relativist epistemology. METHODS   Grounded theory was used to develop a theory from data collected through in-depth interviews with 38 participants between November 2007-April 2009. Participants were drawn from a larger project that trialled a practice nurse-led, collaborative model of chronic disease management in three Australian general practices. Theoretical sampling, data collection, and analysis were conducted concurrently consistent with grounded theory methods. RESULTS   Patients undergo a cyclical process of Navigating Care involving three stages, Determining Care Needs, Forming Relationship, and Having Confidence. The latter two processes are inter-related and a feedback loop from them informs subsequent cycles of Determining Care Needs. If any of these steps fails to develop adequately, patients are likely to opt out of nurse-led care. CONCLUSION   Navigating Care explains how and why time, communication, continuity, and trust in general practitioners and nurses are important to patient satisfaction. It can be used in identifying suitable patients for practice nurse-led care and to inform the practice and organization of practice nurse-led care to enhance patient satisfaction.

Publication syndicates: in support of nursing scholarship.

BACKGROUND Within the university sector, ones corporate worth is, to a great extent, measured by research output, including refereed publications. Currently, only 7% of nurse academics publish each year. If nurses are to be competitive in the university arena and close the research-practice gap, they must be encouraged to publish. METHOD This article examines publication rates within nursing, explores the role publication syndicates can play in supporting manuscript development, and offers a case study on the development of a publication syndicate within a School of Nursing at Griffith University, Australia. RESULTS Syndicate members increased their publication rates two-fold, engaged in additional collaborative ventures, and demonstrated a renewed interest in writing for publication. DISCUSSION Case study results confirmed that publication syndicates can decrease manuscript development time, increase the quality of work, influence productivity, and support collaborative faculty activities.

The Role of the Clinical Laboratory in Teaching and Learning Family Nursing Skills

This exploratory case study of the role of the clinical laboratory in teaching and learning family nursing skills was undertaken at the Family Nursing Unit (FNU), University of Calgary. Qualitative data were gathered from current graduate students, graduates of the Master of Nursing program, faculty members, and clients of the FNU using participant observation, in-depth interviews, and review of documents. Content analysis was used to identify key themes. The study found that the family nursing clinical laboratory provided a safe, structured learning environment where students had the opportunity to observe expert clinical practice in family nursing and undertake closely supervised practice. Graduates felt well prepared and confident in their advanced nursing practice with families. Key to the success of the clinical laboratory was the teaching faculty who were skilled clinicians in family systems nursing and who used this same theoretical orientation to guide the relational, strengths-based, and collaborative learning with students.

Relationship between Social Support and Quality of Life in Childbearing Women during the Perinatal Period

OBJECTIVE To explore demographic and social support predictors of health-related quality of life (HRQoL) (mental and physical) for childbearing women in the perinatal period. DESIGN Longitudinal. SAMPLE Three public hospitals in metropolitan Brisbane, Australia. PARTICIPANTS Four hundred seventy-three (473) women recruited at 36 weeks of pregnancy, and 6 and 12 weeks following childbirth. METHODS The Short Form-12 (SF-12) Version 2 Health Survey was used to measure the mental and physical domains of HRQoL. Social support was measured using the Maternal Social Support Scale (MSSS). RESULTS Mean scores for the mental and physical domains of HRQoL were lower than population norms. Social support was found to be a significant and consistent predictor of higher HRQoL scores, particularly in the physical domain at 12 weeks following child birth and mental domain during the perinatal period. The relationship between social support and HRQoL was found to be independent of other factors including education, length of relationship with partner, age, parity, and antenatal visit. The only other significant predictor was length of relationship with partner in the mental domain at 36 weeks of pregnancy. CONCLUSION Social support is a significant and consistent predictor of a mothers HRQoL during the perinatal period. Nurses and midwives need to assess social support, rather than making assumptions based on demographic factors.

The transition experience of Enrolled Nurses to a Bachelor of Nursing at an Australian university.

Abstract Endorsed Enrolled Nurses (EENs) articulating from diploma level to Bachelor of Nursing (BN) studies at university experience many transitional barriers. Flexible credit arrangements can create further difficulties because students may enter directly into the second year of a degree program, thus foregoing supportive interventions targeting first year students. This qualitative study explored the transitional barriers faced by EENs articulating to the second year of a BN program and the processes employed to adapt to the university learning environment. Lizzio’s (2006) Five Senses of Success Model provided a framework for data analysis. Lizzio’s model highlights how students’ success at university depends on their sense of purpose, capability, resourcefulness, connectedness and academic culture. This study revealed EENs grapple with their dual identity, have difficulty reconciling their academic and clinical competence, and struggle to assimilate to the academic learning environment. Findings illuminate the importance of tailoring orientation and engagement activities to the specific transitional needs of articulating students.

Daily-living management of urinary incontinence: A synthesis of the literature

This article is an integrative review of the research literature on daily-living management of urinary incontinence (UI) by people who live in the community. While most self-management literature investigates how people self-manage clinical treatments and therapies, this article focuses on how UI symptoms are managed in everyday living to maintain social functioning. Control of UI in everyday living is achieved using a range of strategies, which were identified and conceptualized as containing, restricting, concealing, and modifying. Understanding the strategies people use to manage UI in daily life will enable WOC and continence nurses to provide more appropriate and personally tailored advice.

Women's management of urinary incontinence in daily living.

PURPOSE: We investigated strategies used by older and working-aged women to manage urinary incontinence (UI) in their daily lives. DESIGN: Cross-sectional, descriptive study. SUBJECTS AND SETTING: The sample comprised 103 older (>65 years; mean = 74.6 years) and 104 working-aged (18-65 years; mean = 50.3 years) community-dwelling Australian women with self-reported UI. They had experienced UI for an average of 5 years and a majority rated their UI severity as moderate to severe. INSTRUMENT: Based on a comprehensive literature review, a 93-item author-developed questionnaire was developed and pilot tested to identify the type and frequency of strategies used by participants to manage UI. Items were developed that queried demographic and lower urinary symptom characteristics (type, severity, duration). METHODS: Participants were recruited via public and privately funded continence clinics and an advertisement in a local newspaper, with a 66% retention rate following recruitment. Questionnaires were posted to participants with a reply paid envelope for return. RESULTS: The women used a range of strategies to manage UI in their daily lives. A large proportion of women from both groups chose to (1) go to the toilet immediately after urge (older 94%; working-aged 92%); (2) integrate urine loss management a normal part of everyday life (older 81%; working-aged 78%); (3) stopping activities that make them leak (older 85%; working-aged 83%); and (4) using pads and aids for urinary containment (older 87%; working-aged 73%). Older women were more likely to use most of the strategies identified in the questionnaire. These strategies included the following: stop drinking in the evening (older 64%; working-aged 43%; P = .003); organize their bedroom close to the toilet (older 61%; working-aged 36%; P = .001); limit travel (older 45%; working-aged 18%; P = < .001); limit socializing (older 30%; working-aged 11%; P = .001); and limit new relationships (older 25%; working-aged 11%; P = .01). Respondents engaged in a variety of hygiene measures such as washing (older 86%; working-aged 60%; P ⩽ .001), changing pads frequently (older 76%; working-aged 58%; P = .008), and using deodorisers (older 68%; working-aged 50%; P ⩽ .008). Working-aged women were more likely to modify (older 17%; working-aged 70%; P < .001) or avoid (older 8%; working-aged 32%; P = .001) sexual activity. CONCLUSION: Both older and younger women aimed to normalize UI in their daily lives, using strategies designed to keep the bladder empty, maintain secrecy, and preserve social continence. Knowledge of these strategies and the difference between older and working-aged women will enable health care professionals to initiate more targeted support and advice for women with UI.

Outcome evaluation of a multi-disciplinary community-based continence service for Australian women.

ABSTRACT This longitudinal study evaluated the effectiveness of a multi-disciplinary community-based service offering conservative treatment for Australian women suffering urinary incontinence and living independently in the community, in terms ofurinary incontinence symptom severity, impact on quality of life and knowledge outcomes. One hundred and twenty-three women attending The Waterworx Centre, a multi-disciplinary, publicly funded community-based continence service in South East Queensland Australia participated in the study. They received multi-disciplinary conservative treatment for urinary incontinence, including comprehensive assessment and an individually-tailored plan of care. All the women were also linked back to their own generalist health professional for ongoing care and management. Data were collected over a one-year period: at first consultation, and at three months and six months following the first consultation. The International Continence Society Urinary Symptom Index Short Form-Female was used to measure urinary symptoms and impact on quality of life, and a researcher-developed test was used to measure changes in knowledge. Results showed that the women experienced an improvement in urinary symptoms and continence-related knowledge at three months following first consultation, and a decreased impact on quality of life, with these improvements either being sustained or increasing at six months. This study demonstrated that multi-disciplinary community-based services offering specialist conservative treatment for women suffering urinary incontinence can be effective in achieving improvements in urinary symptoms and continence-related knowledge and reducing the impact of urinary incontinence on quality of life.