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Biomedical subjects

E Manias

Publications and source records attributed to E Manias.

At least 19 recordsLinked to original sources
PubMed2006

Nurse-led clinics reduce severity of childhood atopic eczema: a review of the literature.

BACKGROUND: The increasing prevalence and impact of atopic eczema in children in Western countries such as Australia substantiate the need to evaluate the current management of this illness. It has been well documented that the most important aspects in the management of atopic eczema are to allow adequate time for education and demonstration of treatments. However, current models of healthcare funding restrict the opportunity for patient education during medical consultation times. The contribution of nursing to patient care through nurse-led clinics has significant potential in the management of many common chronic illnesses, although atopic eczema has received minimal attention by researchers to date. OBJECTIVES: To discuss the current clinical management of atopic eczema, and to identify the evidence surrounding the benefits of nurse-led clinics in managing patients with chronic illnesses. METHODS: Systematic searches were undertaken using the Cochrane Library, MedLine, PUBMed and CINAHL from 1995 to 2005. Manual searches of references of retrieved articles identified two additional key studies from 1990 and 1993 which were also included in the review. RESULTS: In total, 22 relevant publications were identified. These included both primary research and descriptive studies that covered the medical management of eczema, patient education and improved patient outcomes. The evidence emerging from the literature indicates that the current management of eczema through doctor-led clinics could be improved, with doctors often lacking the time to offer sufficient patient education to manage chronic illnesses effectively. The literature supports the efficacy of nurse-led clinics in the management of chronic illnesses. The benefits of nurse-led clinics include increased patient satisfaction, longer consultations resulting in improved patient education and similar health outcomes when compared with care from a doctor. No studies were identified comparing nurse-led and doctor-led clinics in the management of eczema. CONCLUSIONS: The most effective way to manage atopic eczema is to provide adequate time for education and demonstration of treatments, which the literature suggests can be achieved through nurse-led clinics. The literature review supports an investigation researching the outcomes of a nurse-led clinic on reducing the severity of eczema in children.

Adolescent↗
PubMed2006

Governing the surgical count through communication interactions: implications for patient safety.

BACKGROUND: Intermittently, the incidence of retained surgical items after surgery is reported in the healthcare literature, usually in the form of case studies. It is commonly recognised that poor communication practices influence surgical outcomes. AIM: To explore the power relationships in the communication between nurses and surgeons that affect the conduct of the surgical count. METHODS: A qualitative, ethnographic study was undertaken. Data were collected in three operating room departments in metropolitan Melbourne, Australia. 11 operating room nurses who worked as anaesthetic, instrument and circulating nurses were individually observed during their interactions with surgeons, anaesthetists, other nurses and patients. Data were generated through 230 h of participant observation, 11 individual and 4 group interviews, and the keeping of a diary by the first author. A deconstructive analysis was undertaken. RESULTS: Results are discussed in terms of the discursive practices in which clinicians engaged to govern and control the surgical count. The three major issues presented in this paper are judging, coping with normalisation and establishing priorities. CONCLUSIONS: The findings highlight the power relationships between members of the surgical team and the complexity of striking a balance between organisational policy and professional judgement. Increasing professional accountability may help to deal with the issues of normalisation, whereas greater attention needs to be paid to issues of time management. More sophisticated technological solutions need to be considered to support manual counting techniques.

Adult↗
PubMed2004

Perspectives of a nurse, a social worker and a psychiatrist regarding patient assessment in acute inpatient psychiatry settings: a case study approach.

This case study explores what informs and organizes the assessment of patients, as undertaken by a nurse, a social worker and a psychiatrist in public, metropolitan, acute mental health service settings. The research data are the transcripts of in-depth interviews with three experienced practitioners, one from each of the three disciplines. The analysis draws on Foucauldian concepts: discourse as constructed through practices of discipline and the gaze. We explored examples of taken-for-granted assessment practices and their interplay with discourse. The findings suggest that participating practitioners use language in assessment in ways that support the powerful discourses of the professional disciplines. The competing discourse of management, associated with industry and economics, is evident in hospital admission processes, dictating the times and places of assessment. Professional and management discourses both effectively marginalize the perspective of another player in assessment, the patient.

Attitude of Health Personnel↗
PubMed2003

Segmental dynamics of polymers in nanoscopic confinements, as probed by simulations of polymer/layered-silicate nanocomposites.

In this paper we review molecular modeling investigations of polymer/layered-silicate intercalates, as model systems to explore polymers in nanoscopically confined spaces. The atomic-scale picture, as revealed by computer simulations, is presented in the context of salient results from a wide range of experimental techniques. This approach provides insights into how polymeric segmental dynamics are affected by severe geometric constraints. Focusing on intercalated systems, i.e. polystyrene (PS) in 2 nm wide slit-pores and polyethylene-oxide (PEO) in 1 nm wide slit-pores, a very rich picture for the segmental dynamics is unveiled, despite the topological constraints imposed by the confining solid surfaces. On a local scale, intercalated polymers exhibit a very wide distribution of segmental relaxation times (ranging from ultra-fast to ultra-slow, over a wide range of temperatures). In both cases (PS and PEO), the segmental relaxations originate from the confinement-induced local density variations. Additionally, where there exist special interactions between the polymer and the confining surfaces ( e.g., PEO) more molecular mechanisms are identified.

Computer Simulation↗
PubMed2002

The origins of fast segmental dynamics in 2 nm thin confined polymer films.

Molecular-Dynamics computer simulations were used to study 2 nm wide polystyrene films confined in slit pores, defined by inorganic crystalline surfaces. The simulated systems mimic experimentally studied hybrid materials, where polystyrene is intercalated between mica-type, atomically smooth, crystalline layers. A comparison between the experimental findings and the simulation results aims at revealing the molecular origins of the macroscopically observed behavior, and thus provide insight about polymers in severe/nanoscopic confinements, as well as polymers in the immediate vicinity of solid surfaces. Pronounced dynamic inhomogeneities are found across the 2 nm thin film, with fast relaxing moieties located in low local density regions throughout the film. The origins of this behavior are traced to the confinement-induced density inhomogeneities, which are stabilized over extended time scales by the solid surfaces.

Journal Article↗
PubMed2001

The interplay of knowledge and decision making between nurses and doctors in critical care.

This paper explores the complex interrelationships between knowledge and decision making as nurses and doctors interacted with each other in a critical care unit, which comprised a combined general intensive care and cardiothoracic surgical unit. The critical ethnographic study upon which this paper is based, involved a research group of six nurses who worked in the unit. Nurses differentially valued their knowledge, depending on the situation, experience and level of medical input. They were also involved in decision making based on their differential visibility in the process. Nurses' specialised knowledge of the critical care unit played a major role in influencing how they interacted during decision making.

Adult↗
PubMed2001

Nurses and doctors communicating through medication order charts in critical care.

The structure and content of written forms of communication dynamically interact with the social and historical conditions underlying critical care nursing activities. One important form of documentation regularly used in the critical care area is the medication order chart. This paper considers the ways in which medication order charts are used to structure interactions among nurses and between nurses and doctors. The critical ethnographic study upon which this paper is based involved a research group of six nurses who worked in one critical care unit. Data collection methods involved professional journalling, participant observation and individual and focus group interviews. Data analysis identified four major issues for consideration: imbalance between medical knowledge and legal authority; the nurse as go-between and medication expert; coaching the doctor; and the self policing nurse. The critical care nurse's role extends beyond the traditional passive activity of medication administration. By exploring the power relations underlying this role, there is greater opportunity for improved nursing relationships and patient care.

Clinical Competence↗
PubMed2001

Rethinking ethnography: reconstructing nursing relationships.

AIMS OF THE STUDY: Critical ethnography is being adopted increasingly by nurses as a legitimate form of research methodology. This paper explores the research practices and dilemmas that emerge from this methodology using a recently completed ethnographic study of nurse-nurse and nurse-doctor interactions in a critical care hospital setting. BACKGROUND: Critical ethnography provides a useful methodology that facilitates mutual dialogue among participants. It may be limited, however, by the central role of researchers and by a tendency to negotiate participants' realities according to a particular 'truth'. These concerns have been strongly critiqued by poststructuralists using concepts such as discourse, subjectivity and power. By incorporating the notion of a poststructural analysis into critical ethnography, researchers are in a position to examine critically the tensions in their own practices, and their struggles with documenting and analysing ethnographic accounts. DESIGN: Six registered nurses comprised the participants of the research group. Through the method of professional journalling, the first author of this paper explored her professional interactions with doctors and other nurses in her role as a nurse in the critical care setting under investigation. Other methods included participant observation, and individual and focus group interviews with nurse participants. ISSUES OF METHODOLOGICAL CONCERN: This paper considers three issues of methodological concern: researcher/participant subjectivity; the movement from empowerment to reflexivity and the construction of one form of ethnographic 'truth'. These issues are discussed in reference to the research relationships with the nurse participants and the process of analysing ethnographic accounts. CONCLUSIONS: In working with critical ethnography using a poststructural analysis, we were able to generate valuable insights about previously hidden areas of relationships among nurse participants in a research group during all stages of the research process. It also provided a means of informing the analysis of ethnographic texts.

Anthropology, Cultural↗
PubMed2001

Nurse-doctor interactions during critical care ward rounds.

This paper describes the participation of critical care nurses in ward rounds, and explores the power relations associated with the ways in which nurses interact with doctors during this oral forum of communication. The study comprised a critical ethnographic study of six registered nurses working in a critical care unit. Data collection methods involved professional journalling, participant observation, and individual and focus group interviews with the six participating nurses. Findings demonstrated that doctors used nurses to supplement information and provide extra detail about patient assessment during ward rounds. Nurses experienced enormous barriers to participating in decision-making activities during ward round discussions. By challenging the different points of view that doctors and nurses might hold about the ward round process, the opportunity exists for enhanced participation by nurses.

Anthropology, Cultural↗
PubMed2001

Acute pain management: implications of scientific evidence for nursing practice in the postoperative context.

Unrelieved acute pain remains prevalent in hospitalized patients despite advances in pain management. A decade after the Australian National Health and Medical Research Council called for improved pain management practices by health professionals, it released clinical guidelines to provide clinicians with current scientific evidence to augment their clinical decision-making. This paper examines the implications of national guidelines on nursing practice and highlights the inadequacies of current implementation policies. Pain management guidelines have failed to decrease patients' postoperative pain because organizations and researchers have ignored the impact of contextual influences on clinicians' decision-making. It is recommended that for successful implementation of national guidelines to occur at the local level of practice, organizations must assist clinicians to identify local influences on their decision-making, to address the issues specific to their own work environment and to evaluate any changes in practice.

Acute Disease↗
PubMed2000

Nanoscopic-confinement effects on local dynamics

The segmental dynamics of 1.5-2.0 nm polymer films confined between parallel solid surfaces is investigated with dielectric spectroscopy in polymer/silicate intercalated nanocomposites. The confinement effect is evident by the observation of a mode, much faster than the bulk-polymer alpha relaxation and exhibiting much weaker temperature dependence. This is discussed in relation to either the interlayer spacing restricting the cooperative volume of the alpha relaxation or to the dominance of the more mobile interphase regions as predicted by simulations; the data qualitatively support the former.

Journal Article↗
PubMed2000

Legitimation of nurses' knowledge through policies and protocols in clinical practice.

Health care professionals use policies and protocols in varying ways to guide their clinical activities and to promote quality patient care. The critical ethnographic case study upon which this paper is based, involved a research group comprising six registered nurses who worked in a critical care setting. Research methods included professional journalling, participant observation, and focus group and individual interviews. This paper examines the power relations at play between doctors and nurses, and among nurses, and the ways in which nurses used policies and protocols as a means of mediating communication. While policies and protocols provided nurses with legitimacy of their knowledge in the clinical arena, doctors tended to rely on their past experience and background to inform their knowledge and activities. For nurses to believe that they provided valued and collaborative input in patient decisions, they actively sought out written evidence through policies and protocols to confirm and support their knowledge. Policies and protocols of critical care activities provided nurses with expected standards of care, which they used to legitimize their knowledge and to communicate with doctors about 'undesirable' medical decisions. The doctors valued their professional authority and autonomy over policies and protocols, while nurses used these written guidelines to assert power and demonstrate resistance. Policies and protocols do not exist in isolation; they occur within a complex network of power relations that create tensions in clinical practice. In challenging these tensions, it is important that nurses and doctors establish a fine balance between using policies and protocols to provide directions for practice, and to allow sufficient latitude and flexibility in addressing the complexities of patient care.

Clinical Protocols↗
PubMed2000

Possibilities for critical social theory and Foucault's work: a toolbox approach.

The benefits and constraints of philosophical frameworks using the work of Michel Foucault and critical social theorists, such as Fay, Giroux and McLaren, are examined in the light of their traditions. The reasons nurse researchers adopt these frameworks are explored, as are the tensions between the respective theories. A complementary 'toolbox' approach to the research process addresses some of the theoretical and methodological challenges presented by each framework. Such an approach provides distinctive insights into nursing practice that the other has ignored or missed. It is argued that by converging the two frameworks into a toolbox approach, it is possible to examine or deconstruct existing practices, whilst also providing an avenue for nurses to reconstruct or change such practices.

Humans↗
PubMed2000

Professional journalling over time: position of the inside nurse-researcher in intensive care.

The purpose of this paper is to examine the use of professional journalling in an intensive care unit. In particular, this paper explores the power and contextual relations that shaped nurse-nurse and nurse-doctor decision-making, from the author's perspective as the inside nurse-researcher. A variety of research methods were used for this study, including professional journalling, participant observation, and individual and focus group interviews. The author also worked as a clinical nurse specialist, as the inside nurse-researcher, in the unit under investigation. The results indicated that the power and contextual relations constructing nurse-nurse and nurse-doctor decision-making focused on two major issues. These concerned: drawing on particular forms of knowledge and acquiring differential visibility by the nurse in decision-making. The study demonstrated that professional journalling is an effective research method for helping nurses to question decision-making critically, not for examining the position of an inside nurse-researcher, and for supporting data obtained from other research methods.

Attitude of Health Personnel↗
PubMed2000

The handover: uncovering the hidden practices of nurses.

This paper considers the ways in which the nursing handover involves a complex network of communication that impacts on nursing interactions. The critical ethnographic study upon which this paper is based involved a research group of six nurses who worked in one critical care unit. Data-collection methods involved professional journalling, participant observation, and individual and focus group interviews. The nursing handover took on many forms and served different purposes. At the start of a shift, the nurse coordinator of the previous shift presented a 'global' handover of all patients to oncoming nurses. Nurses proceeded then to the bedside handover, where the intention changed from one that involved a broad overview of patients, to one that concentrated on a patient's individual needs. Data analysis identified five practices for consideration: the global handover serving the needs of nurse coordinators; the examination; the tyranny of tidiness; the tyranny of busyness; and the need to create a sense of finality. In challenging nurses' understanding of these practices, they can become more sensitive to other nurses' needs, thus promoting the handover process as a site for collaborative and supportive communication.

Anthropology, Cultural↗
PubMed1999

A computer-assisted learning program in pharmacology: integrating scientific and nursing knowledge.

The integration of nursing and scientific knowledge presents challenges to students grappling with the difficulties encountered in learning pharmacology. This paper outlines a collaborative project developed to assist undergraduate nursing students to learn and understand pharmacology. The innovative approach taken included the development of a CD-ROM incorporating clinical scenarios and animated graphics, with an accompanying teaching guide.

Attitude of Health Personnel↗
PubMed1999

Can we get it right? Barriers to effective acute pain management with opioid analgesics.

Acute pain management is a complex process that requires nurses to rethink current practices. This paper details the barriers confronting nurses as they attempt to provide effective, acute pain management. An exploration of these barriers reveals the misconceptions commonly associated with opioid analgesic use and factors affecting pain assessment.

Acute Disease↗