Biomedical subjects

Elizabeth Manias

Publications and source records attributed to Elizabeth Manias.

At least 19 recordsLinked to original sources

PubMed2007

Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement.

AIM: The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement. BACKGROUND: Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For example, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis. METHOD: A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005. FINDINGS: Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study. CONCLUSION: Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.

Aged↗

PubMed2006

Development and validation of the self-administration of medication tool.

BACKGROUND: Consumer participation in planning and implementing health care is actively encouraged as a means of improving patient outcomes. In assessing the ability of patients to self-medicate, health professionals can identify areas in which patients need assistance, education, and intervention to optimize their health outcomes after discharge. OBJECTIVE: To develop and validate a tool to quantify the ability of patients to administer their regularly scheduled medications while they are hospitalized. METHODS: Past research enabled us to develop the Self-Administration of Medication (SAM) tool. Using a Delphi technique of 3 rounds, a panel of expert health professionals established the content validity of the tool. For determining level of agreement in using the SAM tool, 56 patients were selected; for each patient, 2 randomly selected nurses completed an assessment. Construct validity and internal consistency were examined by testing the tool in 50 patients and comparing with other validated scales. RESULTS: The 29-item SAM tool had high content validity scores for clarity, representation, and comprehensiveness, with content validity index values ranging from 0.95-1.0. In testing the level of agreement between 2 nurses, out of 43 valid cases, 95.3% of nurses overwhelmingly agreed about the patients' competence to self-administer their drugs. The intraclass correlation coefficient was 0.819 (95% CI 0.666 to 0.902). Internal consistency for the SAM tool was high, with a Cronbach's alpha of 0.899. A moderate to strong correlation was obtained when comparing the SAM tool with other validated measures. CONCLUSIONS: The SAM tool is valid and reliable for quantifying patients' ability to manage their regularly scheduled medications in the hospital setting.

Adult↗

PubMed2006

Patients' decision-making strategies for managing postoperative pain.

UNLABELLED: Despite technological advances, many postoperative patients continue to suffer unrelieved pain. The aim of this study was to identify the strategies used by postoperative patients to bring about pain management decisions. A single-group noncomparative study design was chosen using observations as the means of examining pain activities in 2 surgical units of a metropolitan teaching hospital in Melbourne, Australia. A total of 52 nurses and 312 patients participated in the study, and 316 pain activities were observed. The most common strategy used was patients acting as a passive recipient for pain relief (60%), whereas problem solving (23%) and active negotiation (17%) were less commonly used. Patients in this study were admitted for surgical treatment of a particular condition, and their subsequent pain was specifically related to this acute event. Therefore, the lack of familiarity of the situation and the severity of pain experienced may have encouraged passivity. Patients may have also felt uncertain about how to approach the pain decision, preferring to defer to nurses. Because increased pain levels can be associated with fear, patients could have been unwilling to speak with nurses to discuss their need for pain relief. PERSPECTIVE: This paper shows that patient decision making for postoperative pain relief largely involves the use of passive requests, compared with problem solving and active negotiation. Effective communication must be supported between health professionals and patients if shared understandings about treatment options are to become a reality.

Adolescent↗

PubMed2006

Impact of the perceived public image of nursing on nurses' work behaviour.

AIM: This paper reports a study comparing nurses' perceptions of their public image with their self-image, and examining how the relationship between their perceived public image and self-image was associated with their job performance and turnover intentions. BACKGROUND: The stereotypical public image of nursing is a major concern to nurses. However, it is relatively unknown how this image affects nurses. A few studies have investigated how nurses' interpretations of their public image affect their self-image and work behaviour. METHODS: A convenience sample of 346 Australian nurses participated in a questionnaire study in 2003. The results were analysed by t-test, polynomial regression and response surface analysis. Six participants from the survey participated in a focus group to provide further interpretation of the findings. RESULTS: Nurses rated their aptitude for leadership more positively than they thought the public viewed them. In contrast, nurses rated their image as being caring less negatively than their perceived public image. Job performance was predicted by self-image relating to leadership aptitude. On the contrary, the relationship between self-image and perception of the public image as being caring predicted job performance. When nurses perceived their public image as caring less positively than their self-image, their job performance tended to improve. As for turnover intention, both self-image and perceived public images of having an aptitude for leadership and being caring were negatively related to intention to quit the job. CONCLUSION: To enhance nurses' job performance and reduce their turnover intentions, it is important to improve both the public image and self-image of nurses.

Adaptation, Psychological↗

PubMed2006

Role discrepancy: is it a common problem among nurses?

AIM: This paper reports a study of nurses' perceptions of the differences between ideal and actual nursing roles, how these perceptions differ according to length of experience and the factors that might contribute to these perceived differences. BACKGROUND: The literature suggests that nurses tend to experience role discrepancy or a mismatch between their ideal and actual roles. Although it has been assumed that experienced nurses perceive less role discrepancy than inexperienced nurses, either because the former adjust themselves to their actual practice or because they have the expertise to improve their practice, this assumption has not been tested. METHODS: A survey design was used and the data were collected in 2003. Selected items from the Jefferson Survey of Attitudes Toward Physician-Nurse Inventory and the Staff Nurse Role Conception Inventory were administered to 216 Registered Nurses in Victoria, Australia to measure their perceptions of ideal and actual nursing roles. Data were analysed using a t-test and regression analysis. RESULTS: Nurses with more clinical experience rated their ideal and actual nursing roles more positively than those with less experience. However, the results showed that both groups of nurses experienced the same degree of role discrepancy. Both groups perceived strong role discrepancy in the areas of organizational decision-making and provision of patient education. Experienced nurses also perceived moderate role discrepancy in developing nursing care plans and in the freedom to initiate referrals. CONCLUSIONS: Role discrepancy cannot be resolved by having more clinical experience. While clinical experience enhances nurses' conceptions of their ideal roles, it can also lead to role discrepancy if there are organizational barriers that prevent nurses from engaging in their ideal roles. It is important to find a way whereby nurses can actualize their ideal views of practice in the current healthcare environment.

Adult↗

PubMed2006

The impact of role discrepancy on nurses' intention to quit their jobs.

AIMS AND OBJECTIVE: The purpose of this study was to investigate the impact of role discrepancy on nurses' intention to quit their jobs. BACKGROUND: Nurses experience role discrepancy, which refers to incompatibility between the roles nurses desire and expect to take, and the roles they actually engage in at work. However, there is a paucity of information as to how this role discrepancy affects nurses' intention to quit their jobs. DESIGN: A correlational design was used to investigate the impact of role discrepancy on nurses' intention to quit their jobs. METHODS: A total of 346 Australian nurses participated in this study by completing questionnaires. The results were analysed by t-test, polynomial regression and response surface analysis. RESULTS: Nurses tended to experience role discrepancy, in particular, in decision making with hospital policies and provision of patient education. The overall results show that this role discrepancy contributes to nurses' intention to quit their jobs. Nurses' intention to quit their jobs also increased when they had a low desire to engage in nursing roles and when they only performed a few roles. When specific dimensions of nursing roles were examined, a role discrepancy in the use of nursing skills, such as participation in decision making and providing patient education and emotional support, had little impact on their turnover intention. On the contrary, a role discrepancy in task delegation practice showed a significant association with nurses' intention to leave their jobs. CONCLUSIONS: Role discrepancy has been experienced by many nurses, and this discrepancy partially contributes to nurses' intention to quit their jobs. RELEVANCE TO CLINICAL PRACTICE: To reduce nursing turnover, it is important to create a work environment where nurses are inspired to engage in various nursing roles and their work desires are reinforced by existing work opportunities.

Analysis of Variance↗

PubMed2006

Governing time in operating rooms.

AIM: This paper examines how time is controlled and governed in operating rooms through interpersonal communication between nurses and doctors. BACKGROUND: Time is a valuable commodity in organizations with improvements often directed towards maximizing efficiencies. As a consequence, time can be a source of tension and interpersonal conflict as individuals compete for control of its use. METHODS: The data in this paper emanate from an ethnographic study that explored a range of communication practices in operating room nursing. Participants comprised 11 operating room nurses. Data were collected over two years in three different institutional settings and involved participant observation, interviews and the keeping of a personal diary. A deconstructive analysis of the data was undertaken. RESULTS: Results are discussed in terms of the practices, in which clinicians are engaged in, to govern and control their use of time. The four practices presented in this paper include; questioning judgment and timing, controlling speed, estimating surgeons' use of time and coping with different perceptions of time. CONCLUSIONS: Time and speed were hotly contested by nurses. They used their personal knowledge of individual surgeon's habits of time to govern and control practice. Nurses thought about surgeons in terms of time and developed commonly accepted understandings about the length of surgical procedures. They used this knowledge to manage the scheduling of operations in the departments and to control the workflow in individual operating rooms. Knowledge of individual surgeons was a source of power for operating room nurses. RELEVANCE TO CLINICAL PRACTICE: Nurses have more power in the operating room than might be imagined but they exercise this power in subtle ways. If operating rooms are to work effectively, the operating room team must understand each others' work better.

Adaptation, Psychological↗

PubMed2006

'She's manipulative and he's right off': a critical analysis of psychiatric nurses' oral and written language in the acute inpatient setting.

Remarks such as 'she's manipulative' and 'he's right off' are familiar to psychiatric nurses. This paper critiques the language nurses use in acute inpatient psychiatry services, highlighting the diverse discourses implicated in nurses' writing and speaking about patients. Based on a review of the literature, this paper examines ethnographic studies and discourse analyses of psychiatric nurses' oral and written language. A prominent debate in the literature surrounds nurses' use of standardized language, which is the use of set terms for symptoms and nursing activities. This review of spoken descriptions of patients highlights nurses' use of informal and local descriptions, incorporating elements of moral judgement, common sense language and empathy. Research into written accounts in patient files and records show nurses' use of objectifying language, the dominance of medicine and the emergence of the language of bureaucracy in health services. Challenges to the language of psychiatry and psychiatric nursing arise from fields as diverse as bioscience, humanism and social theory. Authors who focus on the relationship between language, power and the discipline of nursing disagree in regard to their analysis of particular language as a constructive exercise of power by nurses. Thus, particular language is in some instances endorsed and in other instances censured, by nurses in research and practice. In this paper, a Foucauldian analysis provides further critique of taken-for-granted practices of speech and writing. Rather than censoring language, we recommend that nurses, researchers and educators attend to nurses' everyday language and explore what it produces for nurses, patients and society.

Acute Disease↗

PubMed2005

Governance in operating room nursing: nurses' knowledge of individual surgeons.

This paper explores governance and control in operating room nurses' clinical practice. Traditionally, operating room nurses have been portrayed as "handmaidens" to the surgeons, a position which implies that nurses' bodies and the knowledge they use in practice are sites of discursive control by others. This paper unsettles this understanding by showing how operating room nurses studied ethnographically in an Australian setting are both disciplined by and actively shape practice through knowing surgeons' technical requirements for surgery, through inscribing them in discourses of time, and through having deep knowledge of the surgeons' "soul". We argue that as a form of governance, nurses' knowledge of surgeons is a subjugated form of knowledge, located low down on a hierarchy of knowledges. Furthermore, as a form of governance that has previously been unarticulated in the literature, it transcends the traditional lines of authority and control in the nurse-doctor relationship. The data in this paper are drawn from an ethnographic study that explored a range of nurse-nurse and nurse-doctor communication practices in operating room nursing.

Anthropology, Cultural↗

PubMed2005

Explaining nurses' work behaviour from their perception of the environment and work values.

The present study examined how the relationship between nurses' perception of their environment and their work values could explain their job performance and whether they intended to quit their jobs. A survey (N=346) and a focus group (N=6) were used to collect data. The results revealed that nurses' job performance was maintained in an environment where they received few professional incentives due to their professionalism. In contrast, negative environmental characteristics directly impacted on nurses' intention to quit their jobs. The present study provides new insights into nurses' work behaviour.

Adult↗

PubMed2005

Nurses' strategies for managing pain in the postoperative setting.

Acute pain is a significant problem in the postoperative setting. Patients report a lack of information about pain-control measures and ineffective pain control. Nurses continue to rely on pharmacologic measures and tend to under-administer analgesics. The purpose of this study was to determine the strategies nurses used to manage patients' pain in the postoperative setting. It also sought to examine the effect of context, including organization of care, nurses' prioritization of work activities, and pressures during a working shift, on their pain-management strategies. An observational design was used in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were identified as key periods for pain activities, each comprising a 2-hour duration. An observation period was examined at least 12 times, resulting in the completion of 74 observations and the identification of 316 pain cases. Fifty-two nurses were observed during their normal day's work with postoperative patients. Six themes were identified: managing pain effectively; prioritizing pain experiences for pain management; missing pain cues for pain management; regulators and enforcers of pain management; preventing pain; and reactive management of pain. The findings highlighted the critical nature of communication between clinicians and patients and among clinicians. It also demonstrated the influence of time on management strategies and the relative importance that nurses place on nonpharmacologic measures in actual practice. This research, which portrays what happens in actual clinical practice, has facilitated the identification of new data that were not evident from other research studies.

Adolescent↗

PubMed2005

Graduate nurses' communication with health professionals when managing patients' medications.

AIM AND OBJECTIVES: The aim was to examine how graduate nurses communicated with other health professionals about their medication management activities in the acute care context. The objectives were to determine the types of information communicated about patients' medications and the communication processes used during interactions with other nurses, doctors and pharmacists. BACKGROUND: Graduate nurses are challenged with enormous responsibilities and their competence is constantly tested in an ever-changing arena. One of their responsibilities involves communicating with other health professionals about patients' medications. DESIGN: A qualitative exploratory research design was used for this study. METHODS: Participant observation and semi-structured interviews were conducted to elicit information from 12 graduate nurses with university degrees employed in a metropolitan public hospital, in Melbourne, Australia. Graduate nurses were observed once for two hours and interviewed on the same day of the observation at a mutually convenient time. The purpose of these interviews was to clarify activities observed and to obtain further information. RESULTS: The results highlighted how work dynamics of the clinical setting had an impact on the ability of graduate nurses to communicate effectively with other nurses, doctors and pharmacists. These work dynamics included the availability of doctors and the structure of ward rounds. The results also demonstrated the value graduate nurses placed on communicating particular information such as evaluating the effect of medication changes and organizing discharge medication. CONCLUSIONS: Graduate nurses were effective in communicating about medication management activities when they initiated or were prepared for such interactions. When graduate nurses were not prepared, such as during impromptu ward rounds, they did not participate effectively and important information was not communicated. RELEVANCE TO CLINICAL PRACTICE: It is important to understand how collegial communication facilitates accurate exchange of information and effective decision-making to achieve optimal health care outcomes for patients.

Adult↗

PubMed2005

How graduate nurses use protocols to manage patients' medications.

AIMS AND OBJECTIVES: The aim of the study was to determine how graduate nurses use protocols in their medication management activities. The objectives were to: examine the extent of adherence to various protocols in relation to medication activities and determine how the ward environment impacts on graduate nurses' use of protocols to manage patients' medications. BACKGROUND: Protocols help newly qualified nurses integrate new knowledge into practice and promote effective decision-making Design. A descriptive prospective qualitative design was used. Methods. Twelve graduate nurses involved in direct patient care in medical, surgical and specialty wards of a metropolitan teaching hospital participated in the study. Participant observations were conducted with the graduate nurses during a two-hour period when medications were being administered to patients. In-depth interviews were conducted with each nurse immediately after observations and demographic data were collected on participating nurses and patients in their care, including all medications prescribed. Protocols associated with medication management activities for the clinical settings were also transcribed. RESULTS: Six themes were evident from the data: availability and use of protocols, scrutinizing patients' identity before medication administration, double-checking certain medications before administration, writing incident reports, following specific policies and timing the administration of medications. CONCLUSION: Graduate nurses adhered to protocols if they were perceived not to impede with other nursing activities. Participants were also more likely to follow protocols if they felt encouraged to make their own decisions and if there was a decreased likelihood that disciplinary action would be involved. RELEVANCE TO CLINICAL PRACTICE: Experienced health professionals should encourage graduate nurses to comply with medication protocols and to make clinically reasoned decisions about medication activities. By providing peer support and acting as role models, experienced health professionals can also demonstrate to graduate nurses how effective protocol use is an important component of quality patient care.

Adult↗

PubMed2005

Mental health nurse practitioner: expanded or advanced?

The role of the nurse practitioner has been described as the apex of nursing practice. Such a statement has significant implications for the professional status of nursing in its own right. The aim of this paper is to discuss the nature of the nurse practitioner role in Australia and the importance of distinguishing between advanced and expanded practice. Evaluations of the nurse practitioner role suggest that specifically nursing contributions lead to a high level of consumer satisfaction. If nursing in general, and mental health nursing in particular, is to maintain and further develop their professional status, debate about the implications of the nurse practitioner role, and the terminology used to describe its scope, is crucial.

Australia↗

PubMed2005

Rethinking theatre in modern operating rooms.

Metaphor is a means through which a widely accepted meaning of a word is used in a different context to add understanding that would otherwise be difficult to conceive. Through etymological and metaphorical associations, we contend that aspects of "theatre" are still relevant in the modern operating rooms and that the use of dramaturgical metaphors can add another layer of understanding about the social reality in this setting. We begin by exploring the historical roots and derivation of the word theatre as it applied to anatomical dissection and surgery. Briefly, we touch on the work of Erving Goffman and examine how his work has been used by others to explore aspects of operating room nursing. Then, drawing on data from a postmodern ethnographic study that has been used to examine communication in operating room nursing, four dramaturgical metaphors are used to illustrate the argument. They are drama, the script and learning the lines, the show must go on, and changing between back stage and front stage. To conclude, the small amount of previously published literature on this topic is compared and contrasted, and the relevance of using dramaturgical metaphors to understand modern operating rooms is discussed. Being able to distinguish between the inherent drama in operating room work and the dramatic realisation of individuals who work within, can help operating room nurses to think differently about, and perhaps re-evaluate their social situation and how they function within it.

Anthropology, Cultural↗

PubMed2005

Nurses' job dissatisfaction and turnover intention: methodological myths and an alternative approach.

Job dissatisfaction and turnover are recurring themes in nursing. The current international nursing shortage has resulted in increased interest in investigating the causes of nurses' job dissatisfaction and turnover, and in developing countermeasures to address these issues. This paper involves a review of quantitative nursing studies, which investigated the causes of nurses' job dissatisfaction and turnover intention, and identifies commonly held myths that may inhibit more nurse-centered strategies from being developed. These myths are based on an assumption that a nurse-environment relationship is a one-way interaction in which nurses passively respond to their environment. The paper introduces the person-environment fit theory as an alternative framework, which challenges the assumption by suggesting it is the relationship between person and environment, rather than environmental characteristics alone, that affects nurses' occupational behavior. This theory enables nurse researchers to develop a more mutual approach involving the nurse and environment.

Attitude of Health Personnel↗

PubMed2004

Self-administration of medication in hospital: patients' perspectives.

BACKGROUND: Little information is available about patients' perspectives on self- or nurse-related administration of medication. AIM: The aim of the study was to determine patients' perspectives about self-medication in the acute care setting. METHODS: A qualitative approach, using in-depth semi-structured interviews, was taken. Ten patients with a chronic medical illness who had experienced multiple hospital admissions for treatment were interviewed about their experiences of medication administration in the acute care setting. Participants were recruited from two cardiovascular wards in a private, not-for-profit hospital in Melbourne, Australia. Data collection occurred between August and September 2002. FINDINGS: Four major themes were identified from the interviews: benefits of self-administration, barriers to self-administration, assessing appropriateness of self-administration and timing of medication administration. Seven participants had previously experienced self-administration of medications and six were in favour of this practice in the clinical setting. Nine managed their own medications at home, and one self-administered with some assistance from his family. Participants were very concerned about how nurses' heavily regulated routines affected delivery of medications in hospital and disrupted individualized plans of care maintained in the home setting. CONCLUSIONS: In planning and implementing self-administration programmes, it is important to consider patients' views. Medication regimes should be simple and flexible enough to adapt to patients' lifestyles and usual routines. Nurses should also take advantage of opportunities to support and facilitate patient autonomy, to enable more effective management of health care needs when patients return home.

Activities of Daily Living↗

PubMed2004

Decision-making models used by 'graduate nurses' managing patients' medications.

BACKGROUND: Nurses in a graduate programme in Australia are those who are in the first year of clinical practice following completion of a 3-year undergraduate nursing degree. When working in an acute care setting, they need to make complex and ever-changing decisions about patients' medications in a clinical environment affected by multifaceted, contextual issues. It is important that comprehensive information about graduate nurses' decision-making processes and the contextual influences affecting these processes are obtained in order to prepare them to meet patients' needs. AIM: The purpose of this paper is to report a study that sought to answer the following questions: What are the barriers that impede graduate nurses' clinical judgement in their medication management activities? How do contextual issues impact on graduate nurses' medication management activities? The decision-making models considered were: hypothetico-deductive reasoning, pattern recognition and intuition. METHODS: Twelve graduate nurses who were involved in direct patient care in medical and surgical wards of a metropolitan teaching hospital located in Melbourne, Australia participated in the study. Participant observations were conducted with the graduate nurses during a 2-hour period during the times when medications were being administered to patients. Graduate nurses were also interviewed to elicit further information about how they made decisions about patients' medications. RESULTS: The most common model used was hypothetico-deductive reasoning, followed by pattern recognition and then intuition. The study showed that graduate nurses had a good understanding of how physical assessment affected whether medications should be administered or not. When negotiating treatment options, graduate nurses readily consulted with more experienced nursing colleagues and doctors. STUDY LIMITATIONS: It is possible that graduate nurses demonstrated a raised awareness of managing patients' medications as a consequence of being observed. CONCLUSIONS: The complexity of the clinical practice setting means that graduate nurses need to adapt rapidly to make sound and appropriate decisions about patient care.

Adult↗