Patients' anticipated actions following transient ischaemic attack symptoms: a qualitative vignette-based study.

BACKGROUND: Transient Ischaemic Attack (TIA) requires urgent investigation and management. Urgent management reduces the risk of subsequent stroke markedly, but non-presentation or delays in patient presentation to health services have been found to compromise timely management. We aimed to explore general practice patients' anticipated responses to TIA symptoms. METHODS: This was a qualitative study employing semi-structured telephone interviews. Participants were recruited from respondents in an earlier quantitative study based in Australian general practices. Maximum variation purposive sampling of patients from that study (on the basis of age, rurality, gender and previous experience of stroke/TIA) continued until thematic saturation was achieved. After initial interviews explored knowledge of TIA and potential responses, subsequent interviews further explored anticipated responses via clinical vignettes containing TIA and non-TIA symptoms. Transcribed interviews were coded independently by two researchers. Data collection and analysis were concurrent and cumulative, using a process of iterative thematic analysis and constant comparison. A schema explaining participants' anticipated actions emerged during this process and was iteratively tested in later interviews. RESULTS: Thirty-seven interviews were conducted and a 'spectrum of action', from watchful waiting (only responding if symptoms recurred) to summoning an ambulance immediately, was established. Intermediate actions upon the spectrum were: intending to mention the episode to a general practitioner (GP) at a routine appointment; consulting a GP non-urgently; consulting a general practitioner (GP) urgently; and attending an Emergency Department urgently. The substrate for decision-making relating to this spectrum operated via three constructs: the 'individual set' of the participant (their inherent disposition towards action in response to health matters in general), their 'discriminatory power' (the ability to discriminate TIA symptoms from non-TIA symptoms) and their 'effective access' to health-care services. CONCLUSIONS: Policies to improve patients' accessing care (and accessing care urgently) post-TIA should address these three determinants of anticipated action.

The experiences of nurses with mental health problems: colleagues' perspectives.

A 3-stage qualitative study conducted in 2008 aimed to explore the issues to inform a mental health education program to deliver to nurses. This article presents the findings of Stage 1. Data were collected from semistructured interviews conducted with 14 Australian nurses. The interviews explored nurses' knowledge and understanding of mental health problems and their workplace experiences of working with nurses with mental health problems. The interviews were audiotaped, transcribed, and analyzed for the main themes: textbook knowledge, day-to-day support, and workplace considerations. These nurses' narratives guided the implementation of a mental health education workshop targeting nurses (Stage 2).

Nurses' perceptions of a mental health education programme for Australian nurses.

In the present study, we present qualitative findings of study of nurses' perceptions of a mental health education programme for Australian nurses. Many nurses avoid disclosing their mental health problem/illness because of the stigmatization by health workers. Mental health education is a successful means to address workplace stigma; thus, it can be anticipated that such education can address workplace difficulties experienced by nurses with mental health problems. During 2008, a qualitative study was conducted to obtain nurses' perceptions of a short mental health education programme for nurses. The workshop purpose was to improve mental health literacy in order to improve support to colleagues with mental health problems. Semistructured, audio-taped interviews were conducted with 13 nurses and then transcribed. A framework analysis approach guided interpretation of the data. The education programme had limited effect on the participants' attitudes towards colleagues with mental health problems. This was likely due to their high level of mental health literacy and experiences prior to the workshop. Participants felt that a more focused nurse-specific programme might have been more efficacious. Implementing a nurse-specific education session is potentially an effective means to improve support to nurses who experience mental health problems.

Migration of nurses in Australia: where and why?

The Australian health care workforce has benefited from an increasing migration of nurses over the past decades. The nursing profession is the largest single health profession, making up over half of the Australian health care workforce. Migration ofnurses into the Australian nursing workforce impacts significantly on the size ofthe workforce and the capacity to provide health care to the Australian multicultural community. Migration of nurses plays an important role in providing a solution to the ongoing challenges of workforce attraction and retention, hence an understanding of the factors contributing to nurse migration is important. This paper will critically analyse factors reported to impact on migration of nurses to Australia, in particular in relation to: (1) globalisation; (2) Australian society and nursing workforce; and (3) personal reasons. The current and potential implications of nurse migration are not limited to the Australian health care workforce, but also extend to political, socioeconomic and other aspects in Australia.

General practice as a fortress - occupational violence and general practice receptionists.

BACKGROUND: Occupational violence is well documented among general practice receptionists, who are singularly vulnerable because they are placed in the general practice 'frontline'. One response to this threat has been to physically isolate reception staff from waiting room patients by having a perspex shield at the reception desk and a locked door between waiting room and staff areas. METHOD: A qualitative study employing semistructured interviews, an inductive approach and a thematic analysis. The study explored the experiences and perceptions of three receptionists who work in a practice with a perspex and lockdown system, and 16 who work in practices without these. RESULTS: Receptionists were universally positive about the safety measures for reducing risk. But there was also a view that these safety measures potentially compromise the feeling of a practice being patient centred by alienating patients from staff and, paradoxically, increasing levels of patient violence and staff fearfulness. DISCUSSION: These safety measures, while viewed positively by receptionists, may have adverse effects on patient-staff relationships and exacerbate violence and increase staff fearfulness.

The workplace and nurses with a mental illness.

A qualitative approach was used to explore workplace experiences of nurses who have a mental illness. Interview transcripts from 29 nurses in New South Wales, Australia were subjected to discourse analysis. One significant finding was a theme depicting the need for support and trust. This superordinate theme encompassed four subelements: declaring mental illnesses, collegial support, managerial support, and enhancing support. Most of the participants portrayed their workplace as an unsupportive and negative environment. A number of colleagues were depicted as having little regard for the codes for professional nursing practice. This paper shows how nurses in the study dealt with the workplace support associated with mental illness.

Receptionists' experiences of occupational violence in general practice: a qualitative study.

BACKGROUND: The significance of occupational violence in general practice is well established, but research has focused almost exclusively on the experiences of GPs. Only limited research has examined the role of general practice receptionists despite their acknowledged vulnerability to violent patient behaviour. No qualitative research has explored this problem. AIM: To explore the experiences of general practice receptionists regarding occupational violence and the effects of violence on their psychological and emotional wellbeing and on their work satisfaction and performance. DESIGN OF STUDY: Qualitative study. SETTING: Constituent practices of an Australian network of research general practices. Practices were located in a range of socioeconomic settings. METHOD: Semi-structured interviews were conducted with practice receptionists. The interviews were audiotaped, transcribed, and subjected to thematic analysis employing a process of constant comparison in which data collection and analysis were cumulative and concurrent. Qualitative written responses from a cross-sectional questionnaire-based study performed concurrently with the qualitative study were similarly analysed. RESULTS: Nineteen interviews were conducted and 12 written responses were received. Violence was found to be a common, sometimes pervasive, experience of many receptionists. Verbal abuse, both 'across the counter' and telephone abuse, was the most prominent form of violence, although other violence, including assault and threats with guns, was reported. Experiences of violence could have marked emotional and psychological effects and could adversely affect job satisfaction, performance, and commitment. CONCLUSION: It is apparent that occupational violence is a whole-of-practice problem and strategies for GP and staff safety will need to take a whole-of-practice approach.

The immediate needs of relatives during the hospitalisation of acutely ill older relatives.

The main aim of this study was to explore the immediate needs of the relatives of acutely ill older people during hospitalisation. The research question posed was: 'What are the immediate needs of the relatives1 of acutely ill older people in the hospital setting?' A descriptive qualitative approach was utilized, with ethnographic data collection methods and thematic data analysis. Unstructured interviews were conducted with relatives of older people who were admitted for acute care. The setting for the study included two large tertiary referral hospitals located in two area health services in New SouthWales,Australia. Analysis of data revealed two themes: being informed and being there. Being informed describes the nature of the information that relatives need and why this is so important to them. Being there illustrates how relatives perceive their roles and responsibility during hospitalisation. It highlights the importance of this and the impact it has on individuals The findings highlight the importance of appreciating the family's experiences in relation to the care of their older family member. They point to the need for education of stakeholders to focus on relatives as well as the older patient, improved assessment incorporating a whole of family approach on admission to hospital, and finally, facilitating positive relationships between ward staff and families.

Nurses with mental illness: their workplace experiences.

This qualitative study explored the workplace experiences of nurses who have a mental illness. The ultimate goal of the study was to gain insights that would lead to the development of more supportive environments for these nurses. Interviews were conducted with 29 nurses in New South Wales, Australia. The interview transcripts were subjected to discourse analysis. One significant finding was the theme 'Crossing the boundary - from nurse to patient'. This encompassed three sub-themes: 'Developing a mental illness', 'Hospital admission', and 'Being managed'. For most of the participants, being a nurse with a mental illness was largely a negative experience. Often, nurses without a mental illness actively sought to reform the participants' behaviour to enforce what was seen as appropriate conduct for a professional nurse. This paper shows how nurses in this study dealt with the early concerns associated with mental illness.