Discipline matters: embedding academic literacies into an undergraduate nursing program.

In recent years the higher education sector in Australia has been increasingly concerned with ensuring that the English language proficiency levels of students are commensurate with the academic and professional tasks that they must perform. In many universities, this heightened attention to language proficiency has driven changes to teaching and learning practices. This paper reports on a project to embed academic literacies development into a core first year subject within a Bachelor of Nursing program in a large, culturally and linguistically diverse, metropolitan university. Prior to the commencement of their nursing program 747 students completed a Post Enrolment Language Assessment. Students who required additional support were advised to enroll in tutorials which included an additional literacy focus. These tutorials were part of the normal tutorial program for this nursing subject. Students with lower level language skills who attended the streamed tutorial with additional literacy support showed a greater improvement in their written communication than those with similar language proficiency who attended non-streamed tutorials. Evidence suggests that this improvement was transferred into writing tasks in other non-streamed subjects. The findings reported in this paper highlights that discipline specific embedded strategies are an effective approach to the development of academic literacies.

Enhancing management of depression and type 1 diabetes in adolescents and young adults.

Anxiety, depression, and eating disorders are higher in adolescents and young adults with diabetes than in their unaffected counterparts worldwide. This descriptive qualitative research paper, using secondary analysis, described the experiences of adolescents and young adults living with depression and Type 1 diabetes. The study showed that depression negatively affected the participants physically, emotionally, and socially and impacted on their relationships. Negative dimensions of self had a flow-on effect for health management. A deeper understanding of these experiences may assist health professionals to enhance the management of affected adolescents and young adults, leading to better health outcomes.

Screening and intervention for domestic violence during pregnancy care: a systematic review.

Domestic violence (DV) against women during pregnancy affects many women and unborn infants worldwide. Pregnancy presents a window of opportunity for health care providers to identify DV and provide appropriate intervention. The aim of this systematic review was to appraise the effectiveness of DV screening and interventions for women identified for DV through screening in pregnancy. The Cochrane Library, EMBASE, MEDLINE, and PsycINFO were searched from January 1995 to November 2009 to identify potentially relevant studies. Studies using any comparative methodology from both national and international arenas were included but had to be in the English language. Nine studies (13 references) met the inclusion criteria, five for screening and four for interventions. Of the five screening studies, the identification of DV was significantly higher compared to studies that used a nonstandardized screen or no screen at all. There was also evidence that recurrent screening throughout the pregnancy further increased identification rates. There was some evidence that interventions for pregnant women who had experienced DV reduced the amount of violence experienced by these women, but the evidence is very limited by the small number of randomized studies with small participant numbers. Further research is required to establish the most effective interventions for women who are identified at risk of DV during pregnancy.

Against all odds: Australian women's experiences of recovery from breast cancer.

AIM: The aim of this study was to generate insight into younger women's experiences of recovery from breast cancer-related breast surgery and to contribute to the knowledge base for clinicians practising in this field. BACKGROUND: Despite the abundance of literature concerning the impact of breast cancer and breast loss on older women over 50 years of age, fewer studies have been conducted specifically with women younger than 50 years focusing on the recovery from breast cancer and related breast surgery. The effects of breast cancer on younger women differ to those of older women; younger women may have difficulty coming to terms with loss of fertility, perceived loss of femininity, sexuality and may experience body image disfigurement. Younger women may face these issues as a result of the treatment and surgery they have received to confine the breast cancer and attempt to improve their chances of survival. DESIGN: A phenomenological qualitative methodology was used to capture the true essence and lived experience of four Australian women under the age of 50, who had undergone surgery as a result of being diagnosed with breast cancer. METHODS: Tape-recorded semi-structured face-to-face interviews. RESULTS: Thematic analysis revealed four major themes. These were 'It absolutely encompassed me,''Being overwhelmed,''Living with fear and uncertainty' and 'Finding strength within.' CONCLUSIONS: Findings of this study shed light on the experiences of recovery from breast cancer-related surgery in women under 50. RELEVANCE TO CLINICAL PRACTICE: This research study will assist clinicians in understanding the needs of younger women undergoing breast cancer-related breast surgery, who may require counselling in relation to fertility and relationship issues and assistance in coping with the demands of work and home life.

'I only give advice if I am asked': examining the grandmother's potential to influence infant feeding decisions and parenting practices of new mothers.

BACKGROUND: Australia has high breastfeeding initiation rates however, at 3 and 6 months exclusive breastfeeding rates fall below global recommendations. Research suggests significant others in a woman's life can influence infant feeding decisions and practices but how and why they do so needs investigation. RESEARCH QUESTION: This study explored grandmothers' perceptions of their role in supporting new families and examined the potential for grandmothers to influence infant feeding decisions and parenting practices of new mothers in an area of Sydney, Australia, with low breastfeeding maintenance rates. PARTICIPANTS AND METHOD: A qualitative, descriptive study was conducted in South Western Sydney, Australia. Eleven grandmothers participated in one to one interviews and three of these also participated in a group discussion. RESULTS: Analysis revealed three themes: 'Presence'; 'Position'; and 'Power versus Preservation' which provide insight into the complexity of the grandmother-new mother relationship and describe the potential influence that grandmothers may have on infant feeding and parenting. DISCUSSION AND CONCLUSION: The findings highlight challenges and dilemmas faced by grandmothers in their supportive role for the new mother in her breastfeeding and early parenting experience and the difficulties grandmothers face in balancing potential risks and rewards in their interactions with the new family.

Women's experiences of recovery from childbirth: focus on pelvis problems that extend beyond the puerperium.

AIMS: This study aimed to build understandings of women's recovery experiences in the presence of continued pelvic problems extending beyond the puerperium to provide nurses and other health care professionals with information to enhance current practice. BACKGROUND: Trauma to the pelvic floor during childbirth is a relatively common occurrence and can include damage to structures and nerves. A significant number of women will experience ongoing physical pelvic problems resulting from childbirth that extend past the puerperium; however, little is known about the experiential aspects of recovery for these women. DESIGN: A qualitative, phenomenological study. METHOD: Narrative data were collected during conversational interviews with 10 mothers who had sustained pelvic injury during the birth process that persisted past the puerperium. Recruitment was via media releases and brochures distributed through childcare facilities. The data was analysed using Van Manen's thematic analysis. RESULTS: The themes that arose from the analysis were: 'fearing intimacy', 'managing an unpredictable body', 'being resigned' and 'feeling devalued and dismissed'. CONCLUSIONS: Pelvic injuries that extend beyond the postpartum period are distressing for women. They negatively affect women's views of themselves and have an impact on various aspects of life including intimate relationships and social activities. RELEVANCE TO CLINICAL PRACTICE: Currently, postpartum care may have a focus on baby rather than mother and this focus may impede women making full disclosures of ongoing health needs arising from their delivery. Findings of this study suggest that women may have specific needs that extend beyond the puerperium, indicating a need for continued holistic assessments and extending practice to identify and support women experiencing persistent pelvic postpartum complications.

The impact of type 1 diabetes and eating disorders: the perspective of individuals.

AIM: To describe the perspective of individuals living with the chronic conditions of both type 1 diabetes (T1D) and eating disorders. BACKGROUND: The TID and eating disorders are major concerns in Western society with the consequence of more prevalent and severe health complications. This paper arose from research on the impact of T1D on the self of adolescents and young adults. DESIGN: In a larger longitudinal study (doctoral) of 27 participants (both male and females), data were collected from 1994 from 2001 using in-depth semi-structured interviews and a grounded theory approach; four female participants reported that they were experiencing T1D and an eating disorder. This subset of four participants from the original study was case analysed and the issues that arose for the participants are described using secondary analysis. CONCLUSIONS: Issues uncovered included the complexity of managing the interactions of the physical, emotional and social dimensions as well as personal relationships for the participants. These interrelated issues interfere with all-round management of T1D and eating disorders. Recognition and management of the comorbidity that exits in substantial numbers are of paramount importance in clinical practice. It is also necessary to incorporate the support of significant others in the health care partnership. RELEVANCE TO CLINICAL PRACTICE: Health professionals who treat individuals with T1D need to be aware of the incidence of eating disorders among people with TID. Unhealthy weight control practices are of particular concern because they lead to poorer metabolic control which has a flow on effect causing micro vascular complications.

Research priorities of NSW midwives.

PURPOSE: Research is vital to achieve optimum health outcomes for pregnant women, children and families. Recently, the benefit of setting research priorities to effectively utilize limited resources has been identified. Currently there is a lack of published Australian research data relevant to the practice of midwifery. Consultation with current practitioners is important to fulfill the National Health and Medical Research Council (NHMRC) key priority for a healthy start to life, ensure limited resources are expended appropriately and promote evidence-based midwifery practice. The aim of this study was to ascertain the perceived research priorities and the research experience of midwives in NSW, Australia. PROCEDURES: Postal questionnaire sent to the 1000 subscribers of Australian Midwifery, of whom 90% (900) are midwives, in March 2005 with key open-ended questions to ascertain midwifery research priorities and research experience of participants. FINDINGS: Respondents were all midwives with 95% indicating they were currently practising as a midwife. They identified six priority areas: professional practice; clinical issues; education and support; breastfeeding; psychosocial factors; rural/indigenous issues. PRINCIPLE CONCLUSIONS: Priorities for research were identified and the need for a link between research and professional midwifery practice was highlighted. Midwives were positive about the possibility of becoming more actively involved in research and/or advocates for evidence based practice. The opportunity exists to take the broad priority areas from this study and develop research questions of relevance for the midwifery profession.

Accessing metropolitan cancer care services: practical needs of rural families.

This study explored the practical needs of patients and their families travelling from rural areas in New South Wales, Australia to cities for cancer treatment. Practical needs were information, accommodation, transport, and economic impact. A cross-sectional design was employed; data were collected by questionnaire and focus group interviews. Findings showed that practical needs impacted on the ability of the patients and families to cope with diagnosis and treatment for cancer. The greatest unmet practical need of the patients and their families was for comprehensive information that is provided before travelling and by someone, for example, nurse or social worker who can help them decipher it if required.

Impact of eating disorders on family life: individual parents' stories.

AIMS AND OBJECTIVES: The aim of this study was to consider the impact that an eating disorder had on the family, particularly the parents. The objective was to give a voice to parents in order to develop new understandings of their experience leading to more appropriate clinical decision-making. BACKGROUND: The impact of an eating disorder on family life has not been well-documented in the published literature. There are numerous articles from the sufferer's perspective and treatment modalities. The following paper describes a component of a larger study that explored the parent's perspective of having a child with an eating disorder. DESIGN: Nineteen mothers and three fathers from Sydney, Australia, volunteered to be interviewed as the result of advertisements placed in parent support organization newsletters and by using the snowballing technique. METHODS: A qualitative approach using semi-structured interviews was used to explore parents' experiences of having a child/adult child with an eating disorder. Themes were identified through in depth analysis. RESULTS: Themes that were extrapolated from this research included, family unification or disintegration, parent's inability to cope, inconsiderate comments from significant others, social isolation and financial impacts. CONCLUSIONS: This study reports five overarching effects on family life. The authors conclude that one way in which the life of parents and families could be improved would be increased involvement and integration into the treatment process. For this to happen, health professionals would need to acknowledge the family as a resource. RELEVANCE TO CLINICAL PRACTICE: This research documents the family struggle and highlights the current omissions concerning the family's role. The need for changes to clinical practice is substantiated. It requires health professionals to scrutinize their own clinical practice and consider modification of the treatment process.

Aunties & Uncles Co-operative Family Project Ltd: volunteers making a difference in the lives of children and parents.

This paper reports an evaluation of the Aunties and Uncles Co-operative Family Project Ltd, founded 30 years ago, that connects community volunteers (aunts and uncles) with disadvantaged children in the Sydney area, New South Wales, Australia. A postal survey was used which included both open and closed questions regarding the volunteer aunts, uncles, parents, coordinators, nieces and nephews' satisfaction with the project. Demographic data was also collected. Responses from the survey were statistically analysed using SPSS software. Responses to the open ended questions were transcribed and coded. The findings from the study indicated that the experiences were positive for all stakeholders with volunteers and coordinators finding the project personally rewarding and parents receiving respite and support. The children enjoyed new experiences by going to different places and undertaking activities. Recommendations include increased volunteer training and guidelines for difficult situations, increased support for coordinators and more structured activities for all participants. The findings indicate the reciprocal benefits to all participants. These significant benefits reflect the philosophy of the Aunties & Uncles Co-operative Family Project Ltd.

Towards sustainable models for clinical education in nursing: An on-going conversation.

This paper grew from a series of conversations about the challenges associated with clinical education for undergraduate nurses. In it we consider clinical education for undergraduate nurses within the current context of increasing resource and industry constraints. Beginning level clinical competence is the major aim of undergraduate nurse education, and therefore clinical education is central to nursing curricula. However, almost 20 years after the transfer of nurse education to the tertiary sector in New South Wales, Australia, concerns about the clinical learning opportunities in undergraduate nursing curricula continue to be raised. Many educational providers have adopted various permeations of the sessional clinical facilitator model. However, this model has inherent problems that threaten its sustainability and usefulness for undergraduate nurse education. We call upon the discipline to explore alternative pathways for undergraduate clinical education, and present sustainable options for future development in this area.

Role conflict: appropriateness of a nurse researcher's actions in the clinical field.

This study aimed to judge the appropriateness of a particular nurse researcher's actions in a vignette from the clinical field, and to explore frameworks used to determine the appropriateness of actions. Twelve experienced nurse researchers were interviewed by telephone. They were given four vignettes of actual research situations and asked to comment and explain their judgement on the appropriateness of the nurse researcher's actions. The findings confirmed blurring of boundaries between professional and research roles for nurses. Nurses appear to use a mixture of frameworks, including scientific/rigour method, ethics, nursing competencies and their own personal-moral values. Frameworks need to be discussed and debated so that neophyte researchers are well-prepared before they enter the field to conduct research.

Impact of in-depth interviews on the interviewer: roller coaster ride.

The authors investigated the experiences of parents with children/adult children in metropolitan Sydney, Australia who were living with, or had recovered from, an eating disorder. During regular team meetings, the research assistant who conducted the interviews had described her reactions which led the research team to investigate her experience in more depth. The aim of the present paper was to explore the impact on the research assistant who conducted 22 in-depth interviews with the parents. One of the members of the research team interviewed the research assistant to elicit her reactions. The interview was content analyzed and the following themes were identified: (i). appreciation of an egalitarian model of research; (ii). the emotions expressed by the research assistant; (iii). making sense of the inexplicable and (iv). reflections and comparison to her own life role. The research team would like to advance the theory that the adoption of a formal debriefing mechanism be integrated into the qualitative research process.

The parent experience of eating disorders: interactions with health professionals.

The experiences of parents with a child with anorexia nervosa and/or bulimia nervosa were explored and this article aims to present one component of that study: parents' interactions with health professionals. The research was initiated after anecdotal stories from parents led the authors to undertake a literature review, which revealed a paucity of published research on this topic. Twenty-two interviews were conducted with volunteer parents from New South Wales, Australia. A descriptive qualitative design was used and themes were identified through in-depth analysis. Six themes were identified: finding help, feeling shut out, engagement, images portrayed, being resourceful and parents not prepared to give up. The implications for health professionals include that they acknowledge parental involvement in recovery. We urge the nursing profession, particularly mental health nurses, to work towards establishing collaborative partnerships between families & health professionals in order to achieve a better health outcome for all.

Eating disorders: a qualitative analysis of the parents' journey.

Eating disorders are a major concern in Western society. The journey that parents undertake when their child has suffered from an eating disorder has been rarely reported. The aim of this research was to explore the parents' journey using in depth interviews. Twenty-two parents from New South Wales, Australia, volunteered to be interviewed as a result of advertisements placed in parent support organisation newsletters and by using a snowballing technique. Four aspects of the journey that the parents took when their child was ill are reported in this paper. The research findings are taken directly from the accounts provided by parents. These parents' stories will be of interest to health professionals working with families in the area of eating disorders.

Life after breast cancer: Australian women's stories of support.

Quality support is crucial to the care of women diagnosed with breast cancer. Little qualitative research has been conducted in this area. Semi-structured interviews were conducted with six women in New South Wales, Australia, to explore their experiences of breast cancer. Specifically the study focused on the support the women felt they needed at different times during their illness experience, how this was given and by whom. The qualitative data from the interviews supported previous research in that the diagnosis of breast cancer was devastating. Their primary source of support was family and friends with their surgeon and general practitioner providing some support. Overall the women felt they received physical support. However, emotional support was lacking, especially from nurses.