The evaluation of tailored and web-based information for new fathers.

BACKGROUND: Information and advice on infant health and development have been shown to be well received by new parents and to lead to more confident and nurturing parenting. However, in spite of the accumulating evidence highlighting the importance of fathers to the well-being of their families, fathers rarely access and utilize 'parenting' information. Tailored information for fathers delivered via email and Internet may provide an alternate route for support for fathers. This study aimed to assess father's readiness to utilize electronic information tailored to father's role. METHODS: Two hundred and fifty-three fathers from antenatal classes in two Australian cities were offered email and web-based information on seven topics: baby play, breastfeeding, post-natal depression, father-infant bonding, sex after birth, work-family balance and fussy babies. Of 137 who completed consent forms, a total of 105 fathers selected three topics and 67 fathers provided 149 topic evaluations. RESULTS: Most respondents were from managerial, professional or skilled occupations and had higher educational qualifications than the general population of fathers. The most popular topics were those that related to father-infant interaction (baby games and father-infant bonding), and the least popular were breastfeeding and sex after the birth. Respondents rated the information as satisfactory and most (78%) indicated that it changed their approach to fathering. Although the websites provided were available through the Internet, few fathers had previously accessed them. CONCLUSIONS: Information tailored to new father's perspectives provided through email or Internet may increase new fathers' access to useful knowledge and support. Important health topics such as breastfeeding may not currently be perceived as particularly relevant to fathers in the antenatal period. Portals designed to filter existing websites could facilitate the use of parenting information by new fathers.

Children with disruptive behaviours I: service utilization.

OBJECTIVE: To describe the demographic characteristics and patterns of service utilization in the Hunter region (NSW, Australia) of families caring for a child manifesting disruptive behaviour. METHODOLOGY: Families were eligible to participate in the survey if they had at least one child known to have one of the DSM-IV disruptive behaviour disorders, autistic spectrum disorders, behaviour problems associated with rarer forms of brain disease, brain injury or mild intellectual disability, or identified by school personnel as having significant behaviour problems. Families were recruited to the survey via schools, early education centres and clinical services. Parents completed a mail survey about demographic details and service utilization. RESULTS: In total, 1412 families responded to the survey, a participation rate of approximately 65%. The demographic characteristics of respondent families were similar to those of the regional population. A high proportion (85%) of children from respondent families were receiving treatment. Nearly half those children attending clinical services were attending two or more services. Approximately one-third each of the sample was attending public clinics, private clinics or a combination of both. Children were more likely to be treated by a paediatrician (64%) than a child psychiatrist (39%) or a psychologist (23%). Compared with a normative Australian sample, parents of children manifesting disruptive behaviour reported a high level of family stress. CONCLUSIONS: Families of children manifesting disruptive behaviour are a highly stressed group who often access several clinical services. Paediatricians make a significant contribution to the management of children with disruptive behaviours and need to be considered in service planning.

Children with disruptive behaviours II: clinical and community service needs.

OBJECTIVE: To assist in health service planning by determining the perceived clinical and community service needs of families resident in the Hunter region who care for a child manifesting disruptive behaviour. METHODOLOGY: Families were eligible to participate in the survey if they had at least one child known to have one of the DSM-IV disruptive behaviour disorders, autistic spectrum disorders, behaviour problems associated with rarer forms of brain disease, brain injury or mild intellectual disability or were identified by school personnel as having significant behaviour problems. Families were recruited to the survey via schools, early education centres and clinical services. Parents completed a questionnaire, mailed to them by educational and/or clinical services. Parents were asked to prioritize options for improving or expanding clinical services and for reducing their treatment costs. RESULTS: A total of 1412 families responded to the survey. The highest-ranked clinical service options involved the expansion of mainstream community treatment services for children with disruptive behaviour problems and their families, with a particular emphasis on counselling services. Respite care and in-patient services were given relatively low priority. Subgroup analyses showed that disadvantaged and stressed families gave higher rankings to out of home options, such as respite care, in-patient care and subsidised holiday camps, than the aggregate sample. CONCLUSIONS: Enhancement of community based counselling services would meet the needs of the greatest number of participating families. Resource-intense residential services are required by a small but important group of families who experience disadvantage and high levels of stress.

Challenges of recruiting a vulnerable population in a grounded theory study.

Recruitment is a crucial and fundamental part of research and one that poses various degrees of difficulty. This is particularly so when the area of research is one that is either highly sensitive, or that involves participants who are deemed to be particularly vulnerable. This article explores the inherent tensions in matters of participant recruitment among meeting the demands of institutional ethics committees, satisfying the concerns of clinicians in the field and the need to maintain methodological rigor. A postgraduate research student's experience of these tensions underpins the discussion. The article concludes with an outline of the student's strategies and resolution of these issues.

Assessment and documentation of bowel care management in palliative care: incorporating patient preferences into the care regimen.

Nurses in a palliative care unit (PCU) recognized that there were several inconsistencies relating to assessment and documentation of patient preferences in bowel care management. Although bowel care is recognized as of key importance to the wellbeing of palliative care patients, there is little evidence in current literature about accommodation of patient preferences in bowel care management. A questionnaire was developed to assess whether patient preferences were elicited on admission to the PCU, were documented, and were included in the bowel care regimen. Data were collected from 100 patients in two PCUs in Australia. The findings suggested that little was assessed or documented about bowel care management on admission except functional or pharmacological information. According to patients in the study, their preferences were seldom incorporated into the bowel care regimen. Lack of documentation of bowel care preferences was also found following an audit of patient notes. Techniques for eliciting information, awareness of alternative or complementary methods of bowel care and better documentation procedures are all recommended for inclusion in nursing practice in the palliative care setting.

The manifestation and nursing management of agitation in institutionalised residents with dementia.

This participatory action research study is the first formal research study undertaken by nurses in a nursing development unit. The study emerged as the result of nurses brainstorming issues that they perceived to be problematic in their nursing practice and their unit environment. The nurses of the psycho-geriatric nursing development unit, Wallsend Aged Care Facility, New South Wales, Australia identified that the management of agitated behaviour manifested by their severely demented clients was a major challenge in their practice. As a result, a pilot participatory action research study was designed to measure how agitation manifested, to measure the severity of agitation and to identify current nursing practices used to manage it and their outcome. Results of the study demonstrated that nurse actions triggered the majority of most highly rated episodes of agitated behaviour in this group of elderly residents, and that the majority of these nurse actions related to those involved in carrying out activities of daily living for the residents.

Nurses' use of patient notes to chart bowel care management for the palliative care patient.

Little is known about nurses' knowledge base and practice in the provision of Bowel Care Management (BCM). Recently, a study designed to investigate both factors was conducted in two hospices, one in New South Wales and the other in South Australia. Twenty-four nurses and 100 palliative care patients participated in the study. The audit of patients' medical records, one of several research methods used in the study, will be discussed here. The research identified that in all but two cases, patients' information about their BCM practices used in the home environment was not documented on their admission to the hospice. Further, the considerable number of charts used in each hospice to record BCM generally asked for information related to bowel function and the use of pharmaceutical preparations, to the exclusion of other methods of management.

Creating a nursing development unit in a dementia care context.

This paper describes the process through which a Nursing Development Unit (NDU) was created in a 29-bed unit in which nurses care for severely demented residents. The question about whether or not ethics clearance is required for the development phase of NDUs is discussed, and the framework in which to develop the NDU described. The benefits of using Participatory Action Research as the basis for undertaking a continuous process of reflection and change is highlighted. It is also suggested that two key elements necessary for NDUs are that they are 'owned' by the staff who work in them and that they are supported by senior management of the organisations in which they exist.

Negotiated care--fundamental to nursing practice.

This paper focuses on negotiation in nursing. It suggests that negotiation, in the form of negotiated care, is a key element of nursing practice in the many contexts in which it takes place. To support this statement the process of negotiated care is illustrated by three examples. These examples portray negotiated care as it occurs between nurse manager (or leader) and nurse clinicians, in an interdisciplinary context, and between nurses, other health practitioners and patients/relatives. These examples demonstrate that negotiation which is aimed at achieving quality patient care pervades nursing practice. Nevertheless, it is suggested that nurses often do not recognise the centrality of negotiation in their nursing practice, nor are its implications for long-held beliefs about the role of the nurse considered. This paper also suggests that the successful outcome of negotiation in the context of nursing is dependent on nurses' confidence in, and their ability to articulate their knowledge about, nursing practice. It also relies on their commitment to the therapeutic nature of nursing practice and nurses' awareness that their practice is an essential component to patient care. The specialist nature of negotiation in nursing care, and its fundamental role in the care process, suggests that negotiation in nursing is more accurately termed negotiated care.

Shared care: a partnership between parents and nurses.

Shared care refers to the formalisation of parents' participation in the care of their hospitalised children. In this paper the planning, implementation and evaluation of a pilot study of shared care in a New South Wales paediatric unit is described. Surveys conducted before and during the pilot study showed that nurses' attitudes to shared care were mostly positive. Parents who participated in shared care also responded positively to the initiative although most had chosen to limit their participation to basic care activities. According to State Trait Anxiety Inventory scores, 50% fewer parents who had experienced shared care were very anxious at the time their children were discharged than parents whose children were hospitalised prior to the introduction of shared care.

A customer focus to paediatric health care: John Hunter Hospital.

The Department of Paediatrics at John Hunter Hospital, Newcastle, was invited to represent paediatric services in the New South Wales Department of Health's customer focus initiative. Six health care organisations were selected to be pathfinder centres in customer focus under this initiative. The aim of these pathfinder centres was to trial customer-oriented projects that would be applicable to other health care organisations. This article will discuss the process through which three customer-focused projects were identified and implemented, and discuss some of the outcomes of these projects.

Hypoprothrombinemia in naproxen overdose.

Transient prolongation of the prothrombin time was observed in the setting of a 10-g overdose of naproxen. The patient reported was previously healthy, without chronic liver disease, bleeding disorders, or malnutrition. The most likely mechanism for this effect is direct inhibition of the synthesis of vitamin-K-dependent clotting factors, possibly via production of "abnormal" prothrombin.