Nursing texts laud the role of nurses as advocates for patients. With increased acknowledgement of patient-centred care, is it appropriate or desired for nurses to presume this as their role? An ...examination of concepts of advocacy and autonomy highlight potential conflicts between the nurses' adoption of the roles of advocate and surveyor in renal care. There is no clear and definitive answer to 'who can speak for whom' when considering advocacy for people involved in renal replacement therapies. It is evident that what is required is clearer articulation of how renal nurses can act as advocates for patients within the context of their multiple roles and with a goal of partnerships in care.
A study exploring older people's participation in their care in acute hospital settings reveals both consumers' and nurses' views of participation. Using a critical ethnographic design, data were ...collected through participant observation and interviews from consumers in acute care settings who were over 70 years old and nurses who were caring from them. Thematic analysis identified that older people equated participation with being independent. Importantly, consumers highlighted the complexity of the notion of participation when describing situations where they were unable to participate in their own care. The difficulties in communicating with health professionals and an inability to administer their own medications in inpatient settings were identified as barriers to participation. Understanding what consumers believe participation means provides a starting point for developing meaningful partnerships between health professionals and people receiving care.
Renal nurses working in dialysis settings in Australian regional and rural locations face challenges in facilitating advance care planning (ACP) and providing quality physical and psychological ...symptom care at the end of life (EOL) for a growing population of older and sicker people with end-stage kidney disease (ESKD).
Following concerns raised by patients, families, renal and palliative care nurses early in 2009 in one regional setting, gaps in service delivery were identified. These identified gaps were supported by an emerging literature that identified the need for integrated, palliative, supportive care earlier in the disease trajectory. This care, provided on a needs basis, incorporates ACP, and identifies and addresses complex symptom and psychological issues to improve quality of life (QOL) and planning EOL care for patients and their families/carers. This approach to care, now called renal supportive care, is in varying stages of implementation across Australia for all renal patients, predominantly in metropolitan centres.
With limited financial resources, a successful multi-professional collaboration and coordinated approach was established in January 2009 in Ballarat, a large regional setting in Victoria. An implementation framework was developed, addressing the continuum of care from pre-dialysis to withdrawal/cessation from renal replacement therapy (RRT), with an integrated palliative supportive approach during active treatment or EOL care.
This project has provided a step forward in improving confidence and responsibility for palliative care by renal nurses working in dialysis settings, helping them to address the challenges faced in evaluating symptom burden, facilitating ACP and delivery of quality EOL care for patients, their families and carers with ESKD.
Self-management has become a key strategy for managing the health care of people with diabetes. This study explored issues people with type 2 diabetes experienced in their self-management practices ...and access to regional community based services. Using a qualitative interpretative design data was collected from four participants who were interviews about their perceptions of facilitators, barriers and issues they encountered in their diabetes care in a regional setting.The findings indicate difficulties participants experienced in gaining access to quality services in regional areas, including long waiting times, difficulties making appointments, and their perception that healthcare professionals fail to acknowledge patients self-management knowledge and practices. Additionally, participants reported food choices affected their family relationships and experience of social stigma. These issues compromised their self-management decisions. The findings support other studies that show a need for health professionals to develop strategies to improve community based services for people with type 2 diabetes and to increase public awareness of the scope of diabetes management.
Drawing on the findings from studies in Australia and Norway that explored the use of laboratories in the preparation of nursing students for entry to practice, this article identifies the ...pedagogical challenges for the undergraduate education of nurses. The findings from both countries are compared and, in spite of distinct differences in the level of financial investment, there are striking similarities between the ways in which laboratories are used in the two countries. The laboratories were designed to predominately represent acute care hospital environments. The participants demonstrated a high level of commitment and strongly held beliefs in the laboratory as a safe place to facilitate self‐paced learning and as an environment where students can practice until they become competent and confident. However, at the same time, there was a striking lack of evidence to support these views. The participants in both countries reported a common approach to instruction: a process of teacher demonstration, followed by student repetition and practice. Variability in students' motivation also was reported and the participants especially expressed concern for those students with a low level of interest in the basic skills associated with personal care. The possibilities and limitations of using skill laboratories as part of the practical preparation for nursing are discussed, using the metaphor of laboratories as “fiction”.
In Australia and Norway final examinations to determine eligibility for registration as a nurse were discontinued during the period when nurse education moved into the higher education sector. In ...response to recent calls for the reintroduction of final examinations we explore the range of knowledge needs for the practice of nursing. These various forms of knowledge demand different forms of mediation and acquisition as well as assessment. There are numerous problems identified in the literature about the shortcomings of examinations as the foundation of assessing clinically based professions. There is a need to develop systems of appropriate assessment to ensure that graduates of nursing demonstrate adequate knowledge and competence to enter their profession.
Customarily patient advocacy is argued to be an essential part of nursing, and this is reinforced in contemporary nursing codes of conduct, as well as codes of ethics and competency standards ...governing practice. However, the role of the nurse as an advocate is not clearly understood. Autonomy is a key concept in understanding advocacy, but traditional views of individual autonomy can be argued as being outdated and misguided in nursing. Instead, the feminist perspective of relational autonomy is arguably more relevant within the context of advocacy and nurses’ work in clinical healthcare settings. This article serves to highlight and problematise some of the assumptions and influences around the perceived role of the nurse as an advocate for patients in contemporary Western healthcare systems by focusing on key assumptions concerning autonomy inherent in the role of the advocate.
Home based dialysis treatments were among the earliest high technology treatments widely adopted in Australia for home use. Advances in membrane technology together with the development of access ...devices and delivery systems provided the opportunity of extending dialysis as a treatment to a wider group of patients. The evolution of home dialysis was influenced by serendipity. The right people and technology came together at the same time. Dr John Dawborn, supported by Sue Evans, trained with the first home haemodialysis patient Peter Morris in Melbourne, who subsequently transferred to Sydney. Key words: History, Australia, home dialysis
Clinical preparation for practice is a vital part of undergraduate education in nursing. This study explored contemporary constructions of clinical skills laboratories in two nursing undergraduate ...programs in Norway using qualitative collective case study methods. Data were gathered using individual and group interviews and observation during site visits. The data revealed slightly different ways of organizing teaching and experimenting with use of pedagogical methods to facilitate learning of technical skills as well as encouraging students to activate relevant theoretical knowledge. While there was a lively and striking enthusiasm among staff about the way learning was managed within the laboratories, the pedagogical underpinnings for their particular approaches were less certain amongst participants. The paper concludes with the necessity to provide evidence for the outcome of laboratories learning and investigate suitable pedagogical methods for effective teaching and learning of practice skills. Hence, a need for research on transfer of knowledge and skills between the different sites (academy, clinical settings, and laboratories) is identified.
Abstract
Preparation for clinical practice is arguably a vital component of undergraduate nursing education with clinical laboratories widely adopted as a strategy to support student development of ...clinical skills. However, there is little empirical evidence about the role laboratories play in students' learning or how they assist in linking theory to practice. This study aimed to explore the current clinical laboratory practices in Schools of Nursing in regional Victoria, Australia through site visits, interviews and review of curricula. Findings revealed that approaches to laboratory learning are based on traditions rather than evidence, and have evolved in response to fiscal and environmental challenges. The predominance of teacher talk in the laboratory, has lead to acute care over other areas of practice. This study indicates a need for rigorous investigation of pedagogies that can support nursing students in preparation for clinical practice. It remains unclear if laboratory learning experiences assist students in the translation of theoretical knowledge to practice.
Submitted: October 23, 2006 · Accepted: November 24, 2006 · Published: February 8, 2007
Recommended Citation
Wellard, Sally J.; Woolf, Rhonda; and Gleeson, Lynne
(2007)
"Exploring the Use of Clinical Laboratories in Undergraduate Nursing Programs in Regional Australia,"
International Journal of Nursing Education Scholarship:
Vol. 4
:
Iss.
1, Article 4.
DOI: 10.2202/1548-923X.1355
Available at: http://www.bepress.com/ijnes/vol4/iss1/art4
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