The Frontline Nurse's Experience of Nursing Outlier Patients.

The frontline nurses' experience of nursing with overstretched resources in acute care setting can affect their health and well-being. Little is known about the experience of registered nurses faced with the care of a patient outside their area of expertise. The aim of this paper is to explore the phenomenon of nursing the outlier patient, when patients are nursed in a ward that is not specifically developed to deal with the major clinical diagnosis involved (e.g., renal patient in gynecology ward). Using a hermeneutic phenomenological approach, eleven individual face-to-face in-depth interviews were conducted with registered nurses in New South Wales, Australia. The study identified that each nurse had a specialty construct developed from nursing in a specialized environment. Each nurse had normalized the experience of specialty nursing and had developed a way of thinking and practicing theorized as a "care ladder". By grouping and analyzing various "care ladders" together, the nursing capacities common to nurses formed the phenomenological orientation, namely "the composite care ladder". Compared to nursing specialty-appropriate patients, nursing the outlier patient caused disruption of the care ladder, with some nurses becoming less capable as they were nursing the outlier patient. Nursing the outlier patient disrupted the nurses' normalized constructs of nursing. This study suggests that nursing patients in specialty-appropriate wards will improve patient outcomes and reduce impacts on the nurses' morale.

'Living the tightrope': The experience of maternal ovarian cancer for adult children in Australia.

PURPOSE: The purpose of this article is to explore and interpret the experience of maternal ovarian cancer (prior to recurrence) for adult children living in Australia. Although it is well recognised that cancer impacts upon the lives of family members, the experience of maternal ovarian cancer for adult children has been neglected in the literature. METHOD: Data for this qualitative study were collected via unstructured in-depth interviews with nine adults from three states of Australia. Participants' mothers had been diagnosed with ovarian cancer but not recurrent disease. Hermeneutic phenomenology provided a philosophical framework for data collection and analysis. RESULTS: Three themes were identified: living in a dread-full world; living in a solicitous world; and living in a terminable world. Children experienced ovarian cancer as an ongoing life-changing ontological phenomenon and Being-in-a-changed-world was revealed as the essence of the experience. CONCLUSIONS: The findings revealed that the lives of adult children are directly impacted by their mother's ovarian cancer. The themes and essence arising from the study provide a simple conceptual model with which health professionals might approach care of such children. Findings are not limited to ovarian cancer but may be directly applicable to other cancer experiences.

Liminal reproductive experiences after therapies for hematological malignancy.

In this article, we discuss the psychosocial health of young women related to fertility, pregnancy, and motherhood after therapies for hematological malignancies. We utilized a hermeneutical phenomenological approach to conduct in-depth interviews with 12 women who had previously received treatment for a hematological malignancy and had experienced uncertainty surrounding their ability to start or extend their biological family. Our presented findings are interpretations of the women's own words as they articulated how they inhabited a liminal space. We concluded that although fertility and motherhood possibly might not be immediate concerns when they received a diagnosis of hematological malignancy, young women could subsequently experience ongoing issues and concerns related to reproductive uncertainty and motherhood capabilities, which have the potential to affect emotionally and psychosocially on their lives. These issues might possibly require longer-term support, counseling, and informational resources. We also discuss the strengths, limitations, and implications of the study.

Mothering and self-othering: the impact of uncertain reproductive capability in young women after hematological malignancy.

We explored the experiences of uncertain fertility, pregnancy, and motherhood in 12 young women treated for hematological malignancy during their reproductive years. It is demonstrated how, through interpretations of the women's own words, these women lived and coped with a sense of "otherness" in relation to their peers. The concept of otherness is described and discussed in relation to relevant existing literature and it is concluded that, regardless of their cancer history, young women's uncertainty in this context has a broad impact on their psychosocial health and requires sensitive and empathic information, discussion, and support.

Knowledge, attitudes, and practices associated with menopause: a multi-ethnic, qualitative study in Singapore.

We explored knowledge, attitudes, and practices associated with the menopause transition particular to women in the multi-ethnic cultural context of Singapore. Fifty-eight Chinese, Malay, and Indian Singaporean women participated in interviews that were audiorecorded, transcribed verbatim, and analyzed using thematic analysis. Women from all three ethnicities described an attitude of acceptance surrounding menopause and the changes associated with it. While they thought it was important to be informed, they did not seek out information about menopause and did not view health professionals as useful sources of information. Management practices were diverse and rarely involved accessing health professionals.

The diagnostic journey of ovarian cancer: a review of the literature and suggestions for practice.

Ovarian cancer is the most lethal form of gynaecological cancer. It can be difficult to diagnose, with the majority of diagnoses made at a late stage of disease. An integrative literature review was conducted to explore the ovarian cancer diagnostic journey of women and to examine the potential contribution of using a person-centred approach. Factors associated with ovarian cancer diagnostic delay were described in terms of two phases. The principles of person-centred health care (PCHC) were identified. This paper proposes utilising the principles of PCHC to improve women's experience of the diagnostic journey. Specific strategies are suggested for each delay phase to enhance the experience for women. Whilst the challenges in diagnosing the disease are likely to remain until a screening test is available, it is hoped that by implementing strategies based upon PCHC, nurses may facilitate the ovarian cancer diagnostic process and improve the diagnostic experience for women.

Exploring the concept of uncertain fertility, reproduction and motherhood after cancer in young adult women.

Exploring the concept of uncertain fertility, reproduction and motherhood after cancer in young adult women The topics of uncertainty in illness and infertility--as separate entities--are well covered and critiqued in the literature. Conversely, no research has been identified that specifically relates to the uncertain fertility, reproduction and motherhood challenges faced by young women after cancer. Therefore, there has been no opportunity to extend understanding, adequately acknowledge or effectively manage the needs of young women who may face unique reproductive uncertainties after cancer. The objective of this article is to provide a descriptive review of the literature and present what is currently known about uncertainty in the context of cancer and in relation to fertility, reproduction and motherhood. This article sets out the need for an increased research focus into this aspect of cancer survivorship to minimise the unique psychosocial challenges these women often face. Raising awareness and acknowledging the significance and impact of uncertain reproductive capacity on younger women's psychosocial health will aid cancer co-ordinators, nurses and other health professionals to formulate and deliver timely and appropriate education, management and support.

Chemotherapy outpatients' unplanned presentations to hospital: a retrospective study.

GOAL OF WORK: This descriptive, retrospective study sought to identify the nature and magnitude of chemotherapy outpatients' unplanned presentations and admissions to the emergency department and/or cancer centre at a large metropolitan tertiary hospital, and to explore the antecedents to those presentations. PATIENTS AND METHODS: Retrospective data were collected for outpatients who made an unplanned presentation to a large metropolitan hospital in Sydney, Australia between October 1, 2006 and September 30, 2007. Detailed information was collected for those who had received cytotoxic chemotherapy at the hospital's cancer centre within the 6 months prior to the unplanned presentation to hospital. Demographic and explanatory variables were identified, including: reasons for presentation, cancer diagnosis, chemotherapy regimens, and position in the chemotherapy trajectory. MAIN RESULTS: The Cancer Institute NSW figures indicate that each year approximately 518 outpatients are treated with chemotherapy at the participating cancer centre. During the study period, 316 cancer outpatients made 469 unplanned presentations to either the Cancer Centre or the hospital emergency department. Of those outpatients presented, 233 (73.7%) had received chemotherapy in the previous 6 months and made a total of 363 presentations. Of these 363 presentations, 253 (69.7%) occurred within 4 weeks of receiving chemotherapy. The majority of presentations by those who had received chemotherapy in the previous 6 months resulted in hospital admission (87.6%) for a median length of stay of 5 days. The most frequent presentation symptoms were nausea and/or vomiting (45.2%), pain (27%), fever and/or febrile neutropenia (23.4%), shortness of breath (19.3%), dehydration (12.1%), anaemia (8.8%), fatigue (8.8%), diarrhoea (8.8%), and anxiety and/or depression (5.5%). CONCLUSIONS: Chemotherapy outpatients have significant unmet needs following treatment, indicating an urgent need for improved continuity of care and better integration of primary and tertiary health care services.

A tailored program of support for culturally and linguistically diverse (CALD) nursing students in a graduate entry Masters of Nursing course: A qualitative evaluation of outcomes.

This paper aims to firstly explain why a support program is necessary and describe briefly the support program for culturally and linguistically diverse (CALD) nursing students enrolled in a two year accelerated Master of Nursing program at the Faculty of Nursing and Midwifery, the University of Sydney. Secondly, it aims to address the underpinning pedagogical approach to delivery of the program and finally this paper reports the findings of a qualitative evaluation of the program. The program was introduced in semester 1, 2008 and aimed to facilitate improved student satisfaction by addressing the academic, communication and relational challenges identified as having a significant impact on both CALD students' academic achievement and their performance on clinical placement. Teaching and support strategies included interactive delivery, activities in small groups and the use of video clips, reflective feedback sessions, and open discussions. An evaluation, based on 13 semi-structured interviews explored the consequences of the program on student satisfaction and to determine whether the student learning experience had been enhanced.

Home alone: patient and carer uncertainty surrounding discharge with continuing clinical care needs.

As a result of advances in anaesthesia and surgical procedures, increasing numbers of patients in Australia are being discharged 'early' into the home environment with residual care requirements. As many of these patients have undergone surgery that in the past would have required a period of hospitalisation and care from qualified staff lasting several days, this situation has the potential to create problems for both patients and their carers. A total of fourteen interviews were conducted with seven patient/carer dyads. Analysis identified three themes related to the uncertainty both patients and carers experienced attributed to a lack of sufficient discharge preparation and information, pointing to gaps in continuity of care and also in discharge planning and home-health care. It is suggested that the identified issues have applicability for the development of patient education in a day surgery/acute context and that the use of evidenced-based and innovative interventions among health professionals might improve both patient and caregiver outcomes.

Premature menopause: exploring the experience through online communication.

The authors explored the experience of premature menopause by analyzing 1350 posted messages by 98 women, with unique usernames, to an online discussion board over a 90 day period between December 2005 and March 2006. Four particularly problematic aspects emerged that related to the following themes: legitimizing the symptoms, the impact of diagnosis ("losing me"), treatment ("regaining me"), and feeling alone. It appeared that premature menopause, regardless of the cause, was a largely negative experience, compounded by the often lengthy process of confirming a diagnosis based on ambiguous and often vague symptoms, the scarcity of suitable information about the condition, and the subjective lack of perceived support that the women received. Furthermore, a feeling of being different, through the lack of menstruation and fertility choices, often led to relationship problems and generally a loss of well-being. Women with premature menopause would benefit from the development of tailored information and support that addresses these problematic aspects of the condition.

Development and psychometric testing of the Nursing Workplace Relational Environment Scale (NWRES).

AIMS AND OBJECTIVES: The aim of this study was to develop and test the psychometric properties of the Nursing Workplace Relational Environment Scale (NWRES). BACKGROUND: A positive relational environment in the workplace is characterised by a sense of connectedness and belonging, support and cooperation among colleagues, open communication and effectively managed conflict. A poor relational environment in the workplace may contribute to job dissatisfaction and early turnover of staff. DESIGN: Quantitative survey. METHOD: A three-stage process was used to design and test the NWRES. In Stage 1, an extensive literature review was conducted on professional working relationships and the nursing work environment. Three key concepts; collegiality, workplace conflict and job satisfaction were identified and defined. In Stage 2, a pool of items was developed from the dimensions of each concept and formulated into a 35-item scale which was piloted on a convenience sample of 31 nurses. In Stage 3, the newly refined 28-item scale was administered randomly to a convenience sample of 150 nurses. Psychometric testing was conducted to establish the construct validity and reliability of the scale. RESULTS: Exploratory factor analysis resulted in a 22-item scale. The factor analysis indicated a four-factor structure: collegial behaviours, relational atmosphere, outcomes of conflict and job satisfaction which explained 68.12% of the total variance. Cronbach's alpha coefficient for the NWRES was 0.872 and the subscales ranged from 0.781-0.927. CONCLUSION: The results of the study confirm the reliability and validity of the NWRES. Replication of this study with a larger sample is indicated to determine relationships among the subscales. RELEVANCE TO CLINICAL PRACTICE: The results of this study have implications for health managers in terms of understanding the impact of the relational environment of the workplace on job satisfaction and retention.

Juggling multiple temporalities: the shift work story of mid-life nurses.

AIM: To explore the theme of multiple temporalities revealed through a phenomenological study of the experience of mid-life shift-working nurses. BACKGROUND: There are few data on the experience of mid-life women working rotating shift systems that change frequently. Concomitantly, the age profile of the current nursing workforce demands exploration of such issues. METHOD: This phenomenological study sought the perspectives of 13 shift-working mid-life women. RESULTS: Sociological discussion of the temporal nature of work describes temporality as the clock time associated with an individual as determined by the constraints of their life. Transcript analysis identified the numerous temporalities surrounding a shift-working mid-life woman and a sense of disjunction between the temporalities of individuals important to them which resulted in feelings of regret and guilt. The concept of juggling is introduced to illustrate the participants' need to 'keep everything going' for important individuals in their lives. CONCLUSION: The personal cost of effective juggling may be high for the jugglers themselves but also for health systems that provide the mid-life shift-working nurse with no alternative than a reduction in working hours. IMPLICATIONS FOR NURSING MANAGEMENT: The development of a personal 'time map' framed within the concept of multiple temporalities is suggested for use as a staff development tool to assist with staff retention by facilitating both group and individual discussions of rostering and the complexities of managing an intergenerational work force undertaking shift work.

A challenge to the menopause stereotype: young Australian women's reflections of 'being diagnosed' as menopausal.

This paper reports on a qualitative study designed to examine (i) possible explanations for difficulties young Australian women (under 40 years) encountered in the process of gaining a diagnosis of premature menopause and (ii) to address issues underpinning this aspect of menopause. Drawing on hermeneutic phenomenology, face-to-face interviews were carried out with 35 women who consented to share their experiences of 'being diagnosed' with premature menopause. The participants responded to an advertisement in a newspaper article, a radio announcement or through a menopause support centre. While all participants were located in Australia, larger numbers were from the metropolitan areas of Sydney, New South Wales, and Perth, Western Australia. This research reports that the process of finding an explanation for the physical and emotional symptoms the women were experiencing was very complex. The findings varied regarding the psychological and physical symptoms experienced, described feelings, and reasons that led to a diagnosis of menopause. This paper suggests that the age of the women and the non-specific symptoms experienced by them contributed significantly to the delay and uncertainty surrounding the experience of being diagnosed with premature menopause. There was uncertainty of the origin of symptoms, which led the women to feel as though they were 'going insane' or that it was 'all in their heads'. This frequently led to symptoms of menopause being attributed (by health professionals) to a psychiatric basis and menopause being overlooked for varying lengths of time.

A sense of security for cancer patients at home: the role of community nurses.

The present paper reports on a qualitative research project designed to expose the presently unrecognised minutiae of community nurses' work with cancer patients at home, and to identify the ways in which these, combined to form comprehensive care episodes, contribute to physical and psychosocial well-being. The project was conducted in two locations in New South Wales, Australia, one metropolitan and one rural. The research model focused on particular nurse-patient encounters, and involved pre- and post-encounter interviews with nurses, post-encounter interviews with patients and carers, and observation of the encounters themselves. Participants included generalist community nurses, cancer patients being cared for at home, and their primary carers where appropriate. This research demonstrates that regular contact with generalist community nurses is associated with a strong sense of security about the immediate situation for home-based cancer patients and their primary carers. This sense of security is a significant component of patient and carer physical and psychosocial well-being, and may have implications for health services utilisation. In the present paper, the authors outline the factors underpinning this sense of security, and argue that these findings contribute important new knowledge that is vital for contemporary debates about role responsibilities and continuity of care for cancer patients.

Intraprofessional relations in nursing.

AIM: This paper is a report of a study to explore the way in which Registered Nurses relate to and interact with each other in the workplace, and to identify factors that influence nurses' interactions with each other. BACKGROUND: Intraprofessional relations are an important topic both for nurses and nursing as we face the ongoing challenges of nurse shortages. Poor colleague relationships, together with workplace conflict, cause job dissatisfaction. As a consequence, some nurses leave the profession while others continue working but remain chronically unhappy. METHOD: An explanatory multiple case study design was adopted. Data were collected from multiple sources on three different wards within one hospital in Australia between July 2005 and January 2006. FINDINGS: The workplace can be a difficult place for both very experienced and less experienced nurses, regardless of the clinical environment. Nurses navigate their way in the workplace through a series of complex negotiations with each other and develop skills to assess the potential success of an interaction before approaching another nurse. Some also develop a resilience to conflict in their workplace, accepting it as part of working life. CONCLUSION: Creation of a more positive work environment requires increased understanding of the way nurses relate to each other and appreciation of the factors in the environment that contribute to conflict and a negative atmosphere. This appreciation is a necessary prerequisite to developing a more satisfying and productive workplace enhancing the recruitment of new nurses and the retention of experienced nurses.

Premature menopause: multiple disruptions between the woman's biological body experience and her lived body.

AIM OF THE STUDY: The aim of this phenomenological study was to find out what menopause was like as an experience for women who were not yet 40 years old. BACKGROUND: Women's bodies have naturally occurring rhythms and expected transitions related to their menstrual cycle. One transition that all women will experience, provided they live long enough, is menopause. Menopause involves hormonal changes that result, on average (for Australian women), in the cessation of menstruation around 51 years of age. When women experience menopause prior to the age of 40 years it is defined (medically) as premature. While there is abundant literature on menopause as a biological event, the experience of premature menopause has been paid little attention and dismissed as a 'mystery'. This study intended to uncover some of the so-called 'mystery' of the experience from the perspective of the women. RESEARCH METHODS: Hermeneutic phenomenology and feminist philosophy informed this study involving 35 women, all of whom volunteered to participate. They responded to newspaper articles, a radio announcement and through a midlife and menopause support centre. Thirty women engaged in separate face-to-face conversational style interviews. The remaining five women participated in a collaborative interview after some themes were identified through preliminary analysis of the transcripts of the one-on-one interviews. With the consent of participants, all interviews were audio-taped and later transcribed. FINDINGS: This study revealed that the experience of menopause came as a shock for the women--it was perceived as a major epiphany in their lives and they were confronted with a multitude of issues related to the timing of the event and their embodied understanding of menopause. The experience of menopause resulted in multiple disruptions in the women's lives. The women discussed many aspects of their lives that now seemed to be 'out of synchrony'.