'I've got no idea': an ethnography of Critical Care Nurses' nuanced and ambiguous professional identities in regional Australia.

Historical sociological perspectives posit professional identity to emerge from socialisation and attainment of 'traits' considered unique to and distinguishing of a profession. Such essentialist understandings, however, cannot account for group heterogeneity, nurses' lived experiences, nor the fluidity of professional and personal identity. This article conceptualises professional identity as being both individual and collective, influenced by context, involving subjective meaning-making, and membership to a specific professional group. Drawing on ethnographic data gathered through participant observation and semi-structured interviews with Critical Care Nurses in an Intensive Care Unit in regional Australia, we identify four themes that reveal different aspects of professional identity: conceptualising professional identity; professional identity as a title and legislative requirement; professional identity as qualifications and training; and professional identity as a social performance. The findings demonstrate that Critical Care Nurses hold multifaceted perceptions of professional identity. While they collectively distinguish their nursing training, knowledge, and practice from other nurses, they struggle to articulate what professional identity is, while creating boundaries between different forms of nursing education and qualifications to construct their professional identity. These uncertain and diverse meanings of professional identity contribute to nurse identity ambiguity, while also reflecting the necessity of flexible individual and collective nursing identities.

Development and psychometric evaluation of the Dementia Public Stigma Scale.

OBJECTIVES: Dementia is a stigmatised condition and dementia-related stigma is associated with low self-esteem, poor psychological wellbeing, social isolation and poor quality of life in people living with dementia and their families. There is, however, a lack of valid measures that accurately quantify dementia-related stigma in the general public. This study reports the initial psychometric evaluation of a new tool designed to measure dementia-related public stigma amongst community dwelling adults. METHODS: A sample of 3250 individuals aged 18 and over completed an online survey on their beliefs and feelings regarding dementia and people living with dementia, and their behavioural intentions towards people living with dementia. Exploratory factor analysis (EFA) using Maximum Likelihood with oblique rotation was performed to extract factors. Confirmatory factor analysis (CFA) was used to confirm the factor structure using goodness-of-fit index (GFI), the comparative fit index (CFI), and the root mean square error of approximation (RMSEA) to evaluate the model fit. Internal consistency was measured for the final scale version. RESULTS: EFA resulted in a 16-item, 5-factor model (Fear and discomfort, Negative perceptions, Positive perceptions, Burden, and Exclusion) that explained 50.43% of the total variance. The CFA-estimated model demonstrated a good fit; all fit indices were larger than 0.95 (GFI = 0.967, CFI = 0.959) and smaller than 0.05 (RMSEA = 0.048). The final scale showed moderate to high reliability scores ranging from α = 0.738 to 0.805. CONCLUSIONS: The Dementia Public Stigma Scale is a tool with reliability, and some demonstrated validity. This scale can be used to measure the public stigma of dementia amongst adults and may be used in the development and evaluation of interventions aimed at dementia-related stigma reduction.

Confronting ageism: The potential of intergenerational contemporary art events to increase understandings of older adults and ageing.

OBJECTIVE: To explore the impact of an innovative intergenerational art event showcasing retirement village life on attendees' understandings of older adults and ageing. METHODS: A survey of 93 art event attendees was conducted immediately after 16 sessions of the event (78% response rate). Respondents reported on their event experience and its impact on their understandings of older adults and attitudes towards ageing. Analysis of Variance (ANOVA) used to test for differences between age groups (18-34, 35-64 and 65+ years). RESULTS: Over 90% of attendees reported the art event helped them develop an understanding of the lives of older people, with the greatest impact on young and middle-aged adults. The majority of young and middle-aged adults, however, expressed concern about their own ageing. CONCLUSION: Results suggest that intergenerational art events have the potential to increase understandings of older adults and their lives, but this may not translate into personalised comfort with ageing.

Self-reported student confidence in troubleshooting ability increases after completion of an inquiry-based PCR practical.

Inquiry-based learning (IBL) activities are complementary to the processes of laboratory discovery, as both are focused on producing new findings through research and inquiry. Here, we describe the results of student surveys taken pre- and postpractical to an IBL undergraduate practical on PCR. Our analysis focuses primarily student perceptions of knowledge acquisition and their ability to troubleshoot problems. The survey results demonstrate significant self-reported gains in knowledge related to DNA structure and PCR, and an increase in confidence with "troubleshooting problems during scientific experiments." We conclude that the IBL-based approach that combines PCR primer design with wet laboratory experimentation using student-designed primers, provides students a sense of confidence by imparting workplace and research skills that are integral to diverse forms and applications of laboratory practices.

Engineering the fitness of older patients for chemotherapy: an exploration of Comprehensive Geriatric Assessment in practice.

Clinicians often report that currently available methods to assess older patients, including standard clinical consultations, do not elicit the information necessary to make an appropriate cancer treatment recommendation for older cancer patients. An increasingly popular way of assessing the potential of older patients to cope with chemotherapy is a Comprehensive Geriatric Assessment. What constitutes Comprehensive Geriatric Assessment, however, is open to interpretation and varies from one setting to another. Furthermore, Comprehensive Geriatric Assessment's usefulness as a predictor of fitness for chemotherapy and as a determinant of actual treatment is not well understood. In this article, we analyse how Comprehensive Geriatric Assessment was developed for use in a large cancer service in an Australian capital city. Drawing upon Actor-Network Theory, our findings reveal how, during its development, Comprehensive Geriatric Assessment was made both a tool and a science. Furthermore, we briefly explore the tensions that we experienced as scholars who analyse medico-scientific practices and as practitioner-designers charged with improving the very tools we critique. Our study contributes towards geriatric oncology by scrutinising the medicalisation of ageing, unravelling the practices of standardisation and illuminating the multiplicity of 'fitness for chemotherapy'.

Compliance in peritoneal dialysis: a qualitative study of renal nurses.

End-stage renal failure is a life-threatening condition, often treated with home-based peritoneal dialysis (PD). PD is a demanding regimen, and the patients who practise it must make numerous lifestyle changes and learn complicated biomedical techniques. In our experience, the renal nurses who provide most PD education frequently express concerns that patient compliance with their teaching is poor. These concerns are mirrored in the renal literature. It has been argued that the perceived failure of health professionals to improve compliance rates with PD regimens is because 'compliance' itself has never been adequately conceptualized or defined; thus, it is difficult to operationalize and quantify. This paper examines how a group of Australian renal nurses construct patient compliance with PD therapy. These empirical data illuminate how PD compliance operates in one practice setting; how it is characterized by multiple and often competing energies; and how ultimately it might be pointless to try to tame 'compliance' through rigid definitions and measurement, or to rigidly enforce it in PD patients. The energies involved are too fractious and might be better spent, as many of the more experienced nurses in this study argue, in augmenting the energies that do work well together to improve patient outcomes.

A delicate balance: negotiating renal transplantation, immunosuppression and adherence to medical regimen.

Despite the volume of biomedical and psychosocial discourse surrounding both renal transplantation and the immune system, there is a limit to current understandings of immunosuppression in the context of kidney transplantation. For example, we do not know how the immunosuppressed renal transplant recipient experiences and understands their immune system and body. In addition, we do not know if the patient is as fixated on ;graft survival' as their healthcare team or whether other concerns are more relevant. What is missing is the discourse of those who actually 'live' the medically altered immune system in the context of renal transplantation. We propose that this gap in knowledge is bound to an acknowledged problem among renal transplant recipients and their healthcare teams--a lack of compliance with recommended medical regimens. Our argument here is that an exploration of patient intimacy with transplant-related immunosuppression might illuminate a different understanding of this experience that could enhance health professionals' understanding and their subsequent approach to treatment. We contend that the embodied and contextual experience of the patient needs to be equally valued in order to enhance patient outcomes.