Culturally and linguistically diverse older adults relocating to residential aged care.

OBJECTIVE: To explore nursing home relocation experiences of overseas-born, culturally and linguistically diverse elderly. METHODS: Using a grounded theory approach, interviews were conducted with 20 residents of four nursing homes in the northern suburbs of Melbourne, Australia. RESULTS: Consistent with the grounded theory method, the initial objectives of exploring the participants' nursing home relocation experience focused on the pathways they had taken en route to nursing homes and the strategies used to bring their cultures with them. CONCLUSION: Participants made little suggestion that culture was an important consideration in their decision making about responding to loss or moving to the nursing home until they began discussing offers of care from their family. Cultural considerations are important factors in assessing the quality of a nursing home and in strategies used for settling into the home. Notably, many of the cultural practices and meanings described by residents were common to many cultures and were experienced by older adults as culturally meaningful.

Attitudes, beliefs, and practices of Sri Lankan nurses toward cancer pain management: an ethnographic study.

Cancer pain is a serious problem that requires specialized nursing knowledge. In the present ethnographic study, we sought to explore the experiences and cancer pain management practices of nurses working at a government hospital in Sri Lanka. Data were collected from October 2007 to January 2008, and were obtained by observing the nurses in a cancer ward, conducting semistructured interviews with 10 participants, and maintaining a research diary. To analyze the data, the data were coded, and an integrative process was implemented to develop categories. The results suggested that Sri Lankan nurses perform poor cancer pain management practices due to a lack of resources, a shortage of nurses, and poor workload allocation within the hospital. Additionally, the nurses are not autonomous, and are required to refer to medical staff for cancer pain management strategies. The nurses work in a task-oriented system that rarely acknowledges cancer patients' pain management needs. This study might improve nursing pain management practices for cancer patients and lead to changes in the curriculum of nursing courses in Sri Lanka.

Undergraduate midwifery students' first experiences with stillbirth and neonatal death.

While midwifery practice predominantly deals with happy experiences, unexpected and unpredictable events occur. This paper reports on a study that explored undergraduate midwifery students' first experiences of stillbirth and neonatal death. It sought to better understand their encounters to ensure curricula were responsive to students' needs. Semi-structured interviews were conducted with eight Bachelor of Midwifery students. Many were found to have been exposed to perinatal death early in their courses and were ill prepared for the confrontations. Furthermore, the existence of support services was varied. Dealing with these experiences appears to occur through a developmental process and resonates with previous research around compassion, fatigue and posttraumatic stress disorder. Overall, students require specific preparation prior to undertaking placements, as well as clearly identified support strategies if such experiences are encountered.

'Lending the space': midwives' perceptions of birth space and clinical risk management.

OBJECTIVES: to explore and describe midwives perceptions of birth space and clinical risk management and their impact on practice both before and after a move to a new facility. DESIGN: an exploratory descriptive study utilising a modified participatory approach and observation and focus groups for data collection. SETTING: a major metropolitan maternity hospital in Victoria, Australia. PARTICIPANTS: 18 midwives, including graduate year midwives, caseload midwives and hospital midwives working normal shifts, employed within a hospital. FINDINGS: the major themes identified were perceptions of birth space, perceptions of risk management, influence of birth space and risk management on practice and moving but not changing: geographical space and practice. Midwives desire to create the ideal birth space was hampered by a prevailing biomedical discourse which emphasised risk. Midwives in all three groups saw themselves as the gatekeepers, 'holding the space' or 'providing a bridge' for women, often in the face of a hierarchical hospital structure with obstetricians governing practice. This situation did not differ significantly after the relocation to the new hospital. Despite a warmer, more spacious and private birth space midwives felt the care was still influenced by the old hierarchical hospital culture. Caseload midwives felt they had the best opportunity to make a difference to women's experience because they were able, through continuity of care, to build trusting relationships with women during the antenatal period. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: although the physical environment can make a marginal contribution to an optimal birth space, it has little effect on clinical risk management practices within a major public hospital and the way in which this impacts midwives' practice. The importance of place and people are the key to providing an optimal birth space, as are women centred midwifery models of care and reasonable workloads.

Health-care system and nursing in Sri Lanka: an ethnography study.

This article stems from a larger ethnographic study that primarily explored nurses' cancer pain management in Sri Lanka. The findings presented in this article report on two aspects revealed in that study: the Sri Lankan health-care system and nursing. The findings indicate that the Sri Lankan health-care system is under considerable strain. Poor hospital management allows doctors to admit too many patients, resulting in chaotic and overcrowded work environments with unsustainable resources. This then impacts on the role of the nurse. This study highlights the adverse conditions under which nurses in Sri Lanka try to administer care, within a powerless and unchanging professional situation. Although this study extends the level of understanding of the situation for nurses in a government hospital, it also offers directions for policy-makers and international nursing organizations to improve nursing education and governance in Sri Lanka.

Women's experiences of a Follow Through Journey Program with Bachelor of Midwifery students.

The purpose of this study was to explore the experiences of women involved with Bachelor of Midwifery students enrolled at Australian Catholic University (ACU), Victoria in a Follow Through Journey Program. The study incorporated an exploratory descriptive design utilising semi-structured interviews. Seven women participated in the study. Data analysis identified four major themes. These are as follows: women and students in partnership; the student was for me; making a difference, and the system. Women were very satisfied with the Bachelor of Midwifery student Follow Through Journey Program because the outcome for them was an empowering pregnancy, birth and early parenting experience.

Nurses on the move: evaluation of a program to assist international students undertaking an accelerated Bachelor of Nursing program.

This paper reports on an evaluation of a Teaching and Learning Enhancement Scheme (TALES) program designed to meet the unique need of the 2005 cohort of international nursing students undertaking an accelerated Bachelor of Nursing (BN) program at the Victorian campus of Australian Catholic University (ACU) National. The program involved a team approach with three academic mentors and the international students working together to produce satisfactory learning outcomes through fortnightly meetings and provision of additional assistance including compiling a portfolio, reflective writing, English, including colloquial English and pronunciation, as well as familiarisation with handover and abbreviations common in the clinical field, general communication, assistance with preparing a resume and participation in simulated interviews. This relatively small group of international students (20) confirmed the findings of other studies from other countries of international nursing students' in terms of concerns in regard to studying in a foreign country, namely English proficiency, communication difficulties, cultural differences and unfamiliarity with the health care environment. The assistance provided by the program was identified by the completing students as invaluable in helping them settle into study and successfully complete the theoretical and clinical components of the course.

Bachelor of Midwifery: reflections on the first 5 years from two Victorian universities.

Bachelor of Midwifery programs in the state of Victoria, Australia commenced in 2002 through an affiliation of three universities in Melbourne named the 'Werna Naloo Bachelor of Midwifery consortium'. The approach allowed for collaborative synergies in program delivery through offering online 'consortium' units each semester in addition to on-campus content at each university. It is now 5 years since the first cohort of students commenced the course. During those years, members of the consortium have experienced a range of challenges and tensions. This paper provides a reflection by the course coordinators from two remaining members of the consortium, Australian Catholic University and Monash University. It explores issues confronted, regulation and registration, educational and clinical practice issues. In addition, the authors discuss course outcomes in terms of employment of graduates and their integration into the workforce, career development pathways and demand for the course. The authors conclude that the consortium has been successful and course outcomes positive with graduates successful in securing employment. Overall, the future for the Bachelor of Midwifery at both universities appears positive.

The challenge of implementing an undergraduate midwifery course within a three university consortium.

The Werna Naloo Bachelor of Midwfery Consortium was formed between three universities in Victoria in 2000 to deliver a three-year Bachelor of Midwifery course. This paper describes the challenges experienced in implementing a multi-university consortium course, some of the steps taken to address course issues, as well as identifying the positive aspects of working within a consortium. Challenges related to administration of the course within the three universities and on-line subject delivery. Steps take to address challenges included establishment of a committee structure, including a curriculum implementation committee, ongoing dialogue between the course coordinators involved and being pro active in ensuring smooth delivery of the on-line content of the course. Some of the concerns expressed by the academics involved in the consortium reflected the findings of other reports of consortium education courses. These were insufficient time for ongoing sharing of ideas because of geographical distance resulting in some overlap of subject content, as well as the time taken to travel between institutions for meetings. Consortium benefits were the collegial sharing of ideas and resources, and the conversion of competition into alliance.