Family members' retrospective stories of the treatment stage of an adolescent or young adult who subsequently died of cancer.

BACKGROUND: Adolescents and young adults (AYAs) with cancer have been recognized as being disadvantaged within the present healthcare system. This article is part of a major study that was motivated by the principal researcher's own experience of her 17-year-old son dying of cancer and from current literature that highlights the lack of support and understanding of AYAs and their families. OBJECTIVE: This article aimed to uncover from the stories of family members the experience after the treatment of an adolescent or young adult family member (aged 13-23 years) who subsequently died. METHODS: Narrative inquiry was determined to be the appropriate methodology for this study. The participants were a self-selected purposeful sample of 26 family members whose narratives spoke of experience of having an AYA family member live with and die of cancer. RESULTS: The meta-narrative of the families' stories in the treatment stage resulted in 6 themes. This article provides the insights of experience of the family members within the treatment stage. The family members speak of a health system unable to respond to the AYA and family member's needs and the suffering sacrifice and courage of the AYAs and the family members. CONCLUSION: There is evidence that AYAs and family members are lost in the system, with minimum understanding or support for this unique group of people. IMPLICATIONS FOR PRACTICE: Further research is required to assist the development of evidence-based best practice models of care for AYAs and their families.

Food for thought: enabling and constraining factors for effective rural eating disorder service delivery.

OBJECTIVE: This study examined the effectiveness of an assessment and referral model of eating disorder service delivery in the Northern Rivers of New South Wales and its potential as a model for rural service delivery. DESIGN: A qualitative evaluative research design used brief and extended semistructured interviews with clients, and surveys and semistructured extended interviews with service providers who either referred clients to the service or to whom clients were referred. SETTING: A sole practitioner service based in a small non-government women's health service in rural New South Wales. PARTICIPANTS: Clients of the service, all but one of whom was woman; service providers including general practitioners, private practice psychologists and social workers, dietitians, mental health service workers. MAJOR OUTCOME MEASURES: Participant identified enabling and constraining factors which contributed to the effectiveness of the service model. RESULTS: Whilst all service providers and most clients found the assessment process to be beneficial, they identified a number of constraining factors in the referral part of the service which undermined the effectiveness of the model of service delivery, especially for those with more complex or severe presentations. CONCLUSIONS: For a rural ED service to be effective, a number of enabling factors must be present including the capacity to provide: treatment services as well as assessment; a multidisciplinary team approach to assessment and treatment; and expert consultation and training to generalist practitioners, counsellors, hospital wards and other service providers.

Action learning enhances professional development of research supervisors: an Australian health science exemplar.

The worldwide academic workforce is ageing. At the same time, health and human services workforces are expanding. The preparation of educators to fill gaps in expertise and to position the health sciences for future growth is an urgent need. The findings from a recent action learning project that aimed to enhance the professional growth and development of higher degree researcher student supervisors in a School of Health and Human Sciences are presented. Seven early career researchers and the facilitator met for two hours every two to three weeks over 4 months between April and July 2010, in a rural and regional university in New South Wales, Australia. The processes initiated were a combination of experiential knowledge, referral to relevant published reports, use of an effective supervision checklist, and critical conversations. Learning outcomes centered on higher degree management and supervision pedagogy, communities of practice, knowledge translation, and the establishment of a research culture. The contextual barriers and implications of the methodology and learning outcomes for the professional development of health and human science practitioners, researchers and educators is also discussed.

Factors that influence physical activity for pregnant and postpartum women and implications for primary care.

Many pregnant women and women of child-bearing age do not engage in the recommended levels of physical activity despite the well known benefits. Pregnancy and the postpartum period can be a time when inactivity actually increases. Women who experience gestational diabetes mellitus (GDM) during their pregnancy are often advised to become more active in order to ameliorate their increased risk of developing type 2 diabetes. Health professionals have an influential role in promoting physical activity, which would be enhanced with an understanding of the factors that positively and negatively influence women's participation in physical activity during pregnancy and in the postpartum period. This research sought to explore these factors with pregnant and postpartum women including those who had experienced GDM and the attention given to physical activity during pregnancy. A survey was developed after a critical review of factors identified from previous studies. Women were recruited from the antenatal clinic, community health centres and the local media. Results from 72 women are reported from a predominately well educated, Caucasian population. Overall, the results were confirmatory of factors previously identified. Lack of child care, time constraints, no time and feeling unwell during pregnancy hindered activity and factors that facilitated activity included family support, enjoyment of activity and to prevent later health problems. It was also found that non-GDM women are given minimal advice about exercise during pregnancy. A checklist has been developed for health professionals, in partnership with women, to direct attention to the factors that enable and hinder participation in physical activity during and after pregnancy.

Gestational diabetes mellitus in Tonga: insights from healthcare professionals and women who experienced gestational diabetes mellitus.

AIM: To gain contextual insights from Tongan healthcare professionals and women who had developed gestational diabetes mellitus (GDM). METHOD: Qualitative, individual, semi-structured, face-to-face interviews were conducted during 2006 with 11 women who had developed GDM in the previous 12 months and 10 health professionals who worked in the GDM/diabetes area in Tonga. RESULTS: Due to funding issues glucose supplies were often scarce which precluded universal screening. GDM management which focused on encouraging behavioural change to diet and physical activity were reported to be effective in managing GDM in Tonga. Changes to physical activity levels were difficult because of 'laziness' (the participant's words). Preventative screening was perceived to be a foreign idea in Tonga which negatively influenced post-partum screening and monitoring. CONCLUSION: GDM was reportedly well-managed through lifestyle interventions. `Laziness', identified as a contributing factor to obesity and physical inactivity needs to be considered within a broader context of complex social and economic changes in Tonga. There are clear challenges to shift attitudes towards preventative screening in Tonga and for screening supplies to be adequately funded. Lifestyle intervention targeted towards modifiable risk factors of obesity and physical activity for GDM and Type 2 diabetes need to extend into the postpartum period.

Resisting gender-bias: insights from Western Australian middle-level women nurses.

An integrated feminist postmodernist ethnography was applied to explore the experiences of eight women nurses working in the corporate sector and/or management in public hospitals in Western Australia. Data were collected through participant observation, the researcher's field notes and journal and through semi-structured critical conversations. Data were analysed by the application of a trifocal analytic method (Glass & Davis, 2004; Savage, 2000b). This approach, consistent with the methodology, examined the data at multiple levels by applying realist, feminist and feminist postmodern lens which allowed the data to remain relevant to each participant, avoided objectifying the participants and uncovered knowledge relevant to the nursing profession. The findings revealed what it meant to be a nurse functioning within a corporate setting. Three culturally-constructed discourses emerged: values attributed to nursing, bureaucratic managerialism and medical science. The first was found to be empowering but the other two revealed evidence of patriarchal and oppressive behaviours by both medical staff and senior nurses. The findings also revealed that the nurses were sometimes unaware of the oppression they were subject to. The nurses avoided confronting their oppressors preferring strategies revealed as creep up/creep in. Discussion focuses upon the implications of the research project findings for senior and executive nurse leaders and managers and which may evoke a sense of commonality for women in general. The implications are that nurses could apply self-managing strategies in order to resist gendered oppression in senior-level workplace relationships. The authors recommend that more research and publications are needed that reveal and celebrate women's every-day exemplar empowering leadership practices.

Stories of resistance and healing in the process of leaving abusive relationships.

This article examines the unexpected outcomes of a research project that explored the informal support needs of women leaving abusive relationships. The women not only identified informal supports, they also appreciated the time the research offered them to talk about the violent situations, as well as their healing journeys of leaving relationships to sustain their lives without violence. The women's healing journeys were complex and unstable and the feminist approach used in this research empowered participants to acknowledge their abuse, resist the effects of that abuse, and begin their journeys of recovery. The implications of the findings for best nursing practice and models of service delivery are provided.

Reconceptualizing vulnerability: deconstruction and reconstruction as a postmodern feminist analytical research method.

Nursing research informed by postmodern feminist perspectives has prompted many debates in recent times. While this is so, nurse researchers who have been tempted to break new ground have had few examples of appropriate analytical methods for a research design informed by the above perspectives. This article presents a deconstructive/reconstructive secondary analysis of a postmodern feminist ethnography in order to provide an analytical exemplar. In doing so, previous notions of vulnerability as a negative state have been challenged and reconstructed.

Nurses' knowledge and learning experiences in relation to the effects of domestic abuse on the mental health of children and adolescents.

Nurse researchers are yet to direct substantial attention towards addressing and understanding nurses' experiences of learning about and caring for child and adolescent victims of domestic abuse. This lack of recognition has resulted in the marginalisation of this issue. This paper seeks to explore nurses' present understanding and experiences of learning about the effects of domestic abuse on the mental health of children and adolescents. The research utilised an interpretive case study approach within a naturalistic paradigm. Snowball sampling of nursing staff within two mental health units was used. Data were collected using semi-structured in-depth interviews with each participant. Using a constant comparative method and hermeneutic dialectical process both the commonalities and differences regarding participants' multiple realities were identified. Three major categories emerged within the data. These were education, resources and nurses' role. It was apparent that nurses' knowledge and education about the effects of domestic abuse on the mental health of children and adolescents negatively impacted on nurses' ability to provide appropriate care. The research has clear implications for mental health nursing education, practice and future research.

Women, Hepatitis C, and sexuality: a critical feminist exploration.

Sexuality is a neglected subject in nursing with nurses often exhibiting erotophobia. Furthermore Hepatitis C is a stigmatised disease and people living with HCV frequently experience stigmatisation by health professionals, including nurses. Erotophobia and HCV related stigmatisation is detrimental to the formation of an open and trusting nurse-client relationship and is potentially injurious to the health and well being of people living with HCV who come into contact with nurses in the course of their illness. This research explored the question of whether living with HCV affected the sexuality of HCV positive women and if so in what ways?

Safe sex and student nurses in rural Australia: nurses' knowledge and practices (Part 1).

This article is the first of a two-part series on a research study investigating student nurses' knowledge and attitudes to safe sex in a rural university in Australia. The article begins with a discussion of HIV/AIDS, particularly the current incidence and a discussion of the associated epidemiological data. Health care professionals responses to the disease and examples from relevant Australian literature are briefly explored. The authors then discuss the need for this current research study, reveal the associated ethical process, outline the instrument used and the sample population. The article concludes with a discussion of reliability and validity.

Safe sex and student nurses in rural Australia: nurses' knowledge and practices (Part 2).

In this article, the second in a two-part series on a research study investigating student nurses' knowledge and attitudes to safe sex in a rural university in Australia, the results are revealed. The major findings discussed in this article are focused on sexual preference, the need for safe sex, safe sex practices, the need for educational material regarding safe sex, exploration of sex/sexuality and, the need for study of conflict resolution, negotiation skills, and self esteem building. The article concludes with deliberations on educational recommendations associated with the research.

Voices from the margins part 2: narrative accounts of the support needs of Indigenous families experiencing violence.

Part 2 focuses on the needs of informal supporters of rural Aboriginal women experiencing family violence. The strategies for strengthening support for Aboriginal families are presented. The participants identified the barriers to help seeking by Aboriginal women, the needs of Aboriginal families experiencing violence, and healing models necessary to deal positively with the past and present trauma experienced by Indigenous people in Australia.

Voices from the margins Part 1: narrative accounts of indigenous family violence.

The needs of informal supporters of rural women surviving domestic violence from the supporter's perspective were explored through the use of storytelling. Eleven women were interviewed. Of those eleven, three informal supporters spoke about supporting Indigenous women in family violence. These three stories have been grouped as a separate cohort and are discussed in two papers. Of the women who told stories of supporting Aboriginal women, two were Indigenous and one was non Aboriginal, although her partner was Indigenous. It was clear from the stories told by these women that Indigenous family violence is situated in a context of a history and experience of colonisation and human rights abuses. Therefore, this article explores the context of Indigenous family violence and the second explores the strategies for strengthening support for Aboriginal families experiencing violence.