Biomedical subjects

Elizabeth Manias

Publications and source records attributed to Elizabeth Manias.

At least 37 records · Page 2Linked to original sources

PubMed2004

The uses of photography in clinical nursing practice and research: a literature review.

AIMS: The aim of this paper is to report a study to identify themes and provide a 'snap-shot' of the scope and uses of photography in clinical nursing practice and research. BACKGROUND: Despite the dominance of vision as a way of understanding the world in Western societies, the applications of photography in clinical nursing practice and research have not been well synthesized or reported in the literature. METHODS: A computerized search of CINAHL database was performed using the terms photographs, photography, photographic, photovoice, videorecording and videotaping. Hand searching for additional citations was also undertaken. FINDINGS: The identified papers on photography were categorized into broad themes that reflected the different applications to which photography had been applied: documentation and surveillance; therapeutic intervention; teaching, learning and evaluating performance; research methods; and descriptive and instructional literature. Approaches to the use of photography, as recorded in the nursing literature, are broad and include: wound surveillance, covert patient surveillance, photo essay, art therapy, self-portraits, life albums, simulated recall, participant observation, photovoice, photo hermeneutics, production of research scenarios, and video modelling. CONCLUSIONS: The most common applications of photography in nursing and related journals include photo elicitation to promote understanding in research, videorecording as a method of teaching and learning, and as a method of observation, with more creative approaches tending to be employed in health professions other than nursing. Few reports gave explanations of how researchers negotiated ethical concerns when seeking approval for studies in clinical settings, and few gave details of the processes of data analysis.

Humans↗

PubMed2004

Wanting to be heard: mental health consumers' experiences of information about medication.

The complexities accompanying the prescription of antipsychotic medication for people experiencing a mental illness have been extensively documented in the literature. The views and experiences of consumers of mental health services, however, are almost entirely absent. This paper describes the findings of a qualitative study undertaken to examine the experiences of consumers, specifically in relation to education and decision making with regards to medication. The findings from a focus group conducted with consumers (n = 9) revealed an overall dissatisfaction with information provided and the opportunity to participate in decision making. Data analysis revealed four major themes: information to consumers; acknowledgement and recognition of consumers; roles of health professionals; and the experience of wellness and adherence. The findings suggest the need for significant change if the goals of the Third National Mental Health Plan are to be realized.

Antipsychotic Agents↗

PubMed2004

The problem of postoperative pain: issues for future research.

Uncontrolled postoperative pain continues despite abundant research in the area. The purposes of the paper are to review how past research influences our understanding of pain in the postsurgery context and to argue for a methodological shift towards naturalistic inquiry. Such a shift incorporates the complexities of pain assessment and management in the clinical practice environment. Decisions regarding pain are often examined outside of the contextual concerns of clinical practice. Research approaches have involved analyses of nurse and patient-related factors associated with pain. These approaches do not account for complex interactions that occur between nurses, patients and the dynamic environment in which these interactions take place. The failure of research to address the context of pain decisions has several implications. It limits our understanding of why pain continues despite ongoing research and it does not enable evaluation of clinical strategies to improve pain decision-making and pain outcomes for patients.

Analgesia↗

PubMed2004

Medication management by graduate nurses: before, during and following medication administration.

The purpose of the present study was to explore graduate nurses' perceptions of their medication management activities in the acute care context. A qualitative research design with a semistructured interview schedule was used to elicit information from participants. The sampling population consisted of graduate nurses involved in direct patient care in medical and surgical wards of a Melbourne metropolitan teaching hospital, completing a graduate nurse program. Twelve graduate nurses participated in the interviews. Two major themes emerged: (i). monitoring medications and (ii). interventions for patient care. The findings indicate that graduate nurses are required to address several facets of the medication management role in their daily practice. It is pertinent to examine ward dynamics to ensure that graduate nurses have ready access to experienced health care professionals. Through collegial support, graduate nurses should also be encouraged to critically examine the different possibilities when making clinical judgments about monitoring patient medications.

Adult↗

PubMed2004

Assessment of patient pain in the postoperative context.

Because of its subjective nature, the assessment of pain requires the use of comprehensive practices that accurately reflect a patient's experiences of pain. The purpose of this study was to determine how nurses make decisions in their assessment of patients' pain in the postoperative clinical setting. An observational design was chosen as the means of examining pain activities in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were selected. Each 2-hour observation period was examined 12 times thus resulting in 74 observations. In total, 316 pain activities were determined. Five themes relating to assessment were identified from the data analysis: simple questioning, use of a pain scale, complex assessment, the lack of pain assessment, and physical examination for pain. The study identified how nurses' prioritization of work demands created barriers in conducting timely and comprehensive pain assessment decisions.

Adolescent↗

PubMed2003

Agency-nursing work: perceptions and experiences of agency nurses.

This paper explores agency-nursing work from the perspective of agency nurses to gain in-depth understanding of their clinical practice, their relationships with the employing agency, hospitals and permanent nurses, and their professional status. For this study, individual interviews were conducted with ten agency nurses who were registered with one of three nursing agencies in Melbourne, Australia. Five major themes emerged from interview data: orientation, allocation of agency nurses, reasons for doing agency-nursing work, experiences with hospital staff, and professionalism. The findings reveal that the primary reason for nurses engaging in agency-nursing work is for the flexibility it offers. While agency nurses described a commitment to professionalism, the findings emphasise the need to establish effective communication networks between agency nurses, nursing agencies and hospital institutions. Such communication between stakeholders is important to facilitate discussion of issues such as appropriate notification of shift availability, appropriate assignment of work and recognition of the agency nurse as a valuable member of the health care team. In particular, the findings highlight the importance of comprehensive orientation and education for agency nurses to shift the focus of their daily work from task completion to more comprehensive patient care.

Adult↗

PubMed2003

Achieving collaborative workplace learning in a university critical care course.

The purpose of this paper is to describe the development, implementation and evaluation of a new critical care curriculum based on the tenets of collaborative workplace learning. It also examines lecturers' and clinical educators' issues, and explores students' evaluations of the old curriculum compared with those of the new curriculum. Three data collection methods were used for this study. Comprehensive notes were maintained of the meetings conducted with lecturers, clinical educators and representative students during the development and implementation of the course. Three focus group interviews were conducted with students before the introduction of the new curriculum and three focus group interviews were conducted during first semester following implementation of the new curriculum. Quality-of-teaching surveys were also completed by two groups of critical care course students: one group before and one group following the introduction of the new curriculum. Major findings in this study included: developing a sense of ownership of the curriculum for clinical educators, clinical educators' difficulties with addressing their responsibilities, amalgamating theoretical learning with clinical practice, and tackling students' workload. This paper demonstrates the value of using the collaborative workplace learning approach in strategically addressing the challenges of developing and conducting a university critical care course.

Australia↗

PubMed2003

Pain and anxiety management in the postoperative gastro-surgical setting.

BACKGROUND: Despite increasing knowledge and technological advances, patients continue to experience pain and anxiety in the postoperative setting. AIM OF THE STUDY: The aim of this study was to examine how nurses managed patients' pain and anxiety within the gastro-surgical hospital setting. METHODS: An observational design was selected to examine nurses' management of postoperative patients' pain and anxiety. Six nurses who were involved in direct patient care in one of two gastro-surgical wards in a public teaching hospital in Melbourne, Australia, were randomly selected to participate. The observation period comprised a fixed 2-hour segment, and each nurse was observed on three different occasions. FINDINGS: Patient assessment was a major concern for participants, which was influenced by the modes of assessment used, patients' medical condition and operation procedure, and their self-reports of pain or anxiety. Communication with health care professionals and policy and protocol concerns also affected nurses' pain and anxiety management decisions. Formal communication through the multidisciplinary ward round tended to be somewhat fragmented, as the medical consultant did not seek out the bedside nurse. Nurses had good knowledge of unit policies and protocols and, while attempting to enforce them, spent considerable time encouraging medical colleagues to abide by these guidelines. Finally, nurses made complex clinical judgements which extended beyond the administration of analgesics or antianxiety drugs. STUDY LIMITATIONS: It is possible that nurses demonstrated a raised awareness of how they managed patients' pain and anxiety during observation periods. CONCLUSIONS: The study confirmed the importance of examining the complexities of the clinical context in determining how nurses manage pain and anxiety in the postoperative setting.

Adult↗

PubMed2003

Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers.

There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers. This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work. Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate. Three major themes emerged from interview data: planning for ward allocation, communication and professionalism. In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff. Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses. For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration. A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles. The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled--with the aim of providing quality patient care.

Attitude of Health Personnel↗

PubMed2003

Snap-shots of live theatre: the use of photography to research governance in operating room nursing.

The use of photography is an underreported method of research in the nursing literature. This paper explores its use in an ethnographic research project, the fieldwork of which was undertaken by the first author. The aim was to examine the governance of operating room nursing in the clinical setting and the theoretical orientation was the work of Michel Foucault. The focus of this paper is on how photography was used as a means of data generation. To establish some context we begin by drawing on writers from sociology and anthropology to provide an overview of the status of vision and visual research methods in contemporary social research. We then move to a brief discussion of the uses of photography in social research and the limitations imposed by ethical considerations of its use in clinical nursing settings. As well, the process and approach involved in this research project, and issues of analysis are discussed. Three 'snap-shots' of operating room nursing, taken by participants, are presented. Each is analysed in terms of its contributions to the research process as well as its substantive contribution to the theoretical framework and the research aims.

Anthropology, Cultural↗

PubMed2003

Medication trends and documentation of pain management following surgery.

The purpose of the present study was to examine prescribing and administering activities for sedative and analgesic medication in postoperative patients, and to describe nurses' documentation practices for pain management in nursing notes. A prospective audit was undertaken of medication order charts and nursing notes of 100 patients on the operation day and over the first four days following surgery. Almost all patients received some form of infusion, while the use of 'as required' analgesics varied from one-third to over two-thirds of patients during the postoperative period. Few patients were prescribed fixed-order analgesics or sedative medications. An audit of nursing entries found that nurses had documented inadequately in four major areas: pain assessment, use of non-pharmacological interventions, use of pharmacological interventions, and outcome of interventions. The findings contribute to improving our understanding of nurses' pain management and identify the need to use clinical judgement that is individualized to patients' needs.

Analgesia↗

PubMed2003

Transcultural nursing in Australian nursing curricula.

As a result of the fact that Australia is a multicultural society with many people who come from non-English speaking backgrounds (NESB), the objective of the present study was to discuss the extent to which transcultural nursing education is incorporated into undergraduate nursing curricula. A survey was undertaken to determine the availability of nursing modules for undergraduate nursing students through Australian university websites on "transcultural nursing" or related modules. Although the inclusion of these modules into nursing education provide an opportunity for nurses to perceive and respond to different patient behaviors in multicultural societies, it is not sufficient to understand the complexity of the health care needs of a multicultural society. The survey findings suggest that many universities have not included transcultural nursing modules in their nursing curricula. To address this problem, more transcultural nursing modules need to be introduced into nursing curricula and nursing academics need to refine their attitudes about the importance of cultural aspects of patient care within nursing education.

Attitude of Health Personnel↗

PubMed2002

The educational preparation of undergraduate nursing students in pharmacology: clinical nurses' perceptions and experiences of graduate nurses' medication knowledge.

This paper explores clinical nurses' perceptions and experiences of graduate nurses' pharmacology knowledge. Six focus group interviews were conducted with clinical nurses of various appointment levels at two metropolitan public and two regional public hospitals in Victoria, Australia. Four major themes emerged from the study. First, participants indicated that graduate nurses had an overall lack of depth of pharmacology knowledge. While clinical nurses indicated that graduate nurses had enormous deficits in their pharmacology education, these deficits were not confined to graduate nurses--all nurses experienced difficulties in understanding and demonstrating pharmacological concepts in the clinical practice setting. Second, there was an unstructured approach to addressing the continuing education needs of graduate nurses. Third, theoretical and clinical principles of pharmacology knowledge were perceived to be important for practice. Fourth, improvements for nursing education involved the need for undergraduate students to take greater responsibility in monitoring and administering medications and the need for more structured learning experiences. The ultimate goal of consolidating pharmacology knowledge for graduate nurses is to optimise medication use, thereby improving the health outcomes of patients. Current teaching and learning opportunities appear to be inadequate in their efforts to enhance and improve graduate nurses' pharmacology knowledge. These inadequacies need to be addressed if the ultimate goal is to become a reality.

Adult↗

PubMed2002

The educational preparation of undergraduate nursing students in pharmacology: perceptions and experiences of lecturers and students.

This paper explores the perceptions and experiences of lecturers and undergraduate nursing students relating to teaching and learning issues in pharmacology. A total of 14 focus group interviews were conducted at 10 university settings, which involved seven academic staff and seven student interviews. The focus group interviewing method was used because it enabled all participants to have 'a say', facilitated the expression of diverse views, and allowed participants to express themselves without fear that their views would be openly criticised. Student participants comprised second and third year undergraduate nurses while lecturer participants involved course coordinators, subject coordinators, and bioscience and nursing lecturers. The 'framework' method was used for data analysis, which involved the following stages: familiarisation, identifying a thematic framework, indexing, charting, and finally, mapping and interpretation. Four major themes emerged from discussions with lecturers and students: teaching considerations, learning considerations, the relationship between pharmacology knowledge and clinical practice, and the features of an 'ideal' programme in pharmacology. The findings highlighted that potential conflicts existed among academic staff relating to the balance of pharmacology and nursing content in curricula, which often led to over-laden curricula. Potential conflicts also existed between lecturers and students about the value placed on a separate pharmacology subject as opposed to an integrated pharmacology programme. In summary, there is still much scope for educational initiatives to improve students' knowledge of pharmacology and medication management.

Adult↗

PubMed2002

Foucault could have been an operating room nurse.

BACKGROUND: Operating room nursing is an under-researched area of nursing practice. The stereotypical image of operating room nursing is one of task- and technically-orientated aspects of practice, where nurses work in a medical model and are dominated by constraints from outside their sphere of influence. This paper explores the possibility of understanding operating room nursing in a different way. AIM: Using the work of Michel Foucault to analyse the work of operating room nursing, this paper argues the relevance of the framework for a more in-depth analysis of this specialty area of practice. CONTENT: The concepts of power, discipline and subjectivity are used to demonstrate how operating room nursing is constructed as a discipline and how operating room nurses act to govern and construct the specialty. Exemplars are drawn from extensive professional experience, from guidelines of professional operating room nursing associations, as well as published texts. The focus is predominantly on the regulation of space and time to maintain the integrity of the sterile surgical field and issues of management, as well as the use of the ethical concept of the 'surgical conscience'. CONCLUSIONS: This form of analysis provides a level and depth of inquiry that has rarely been undertaken in operating room nursing. As such, it has the potential to provide a much needed, different view of operation room nursing that can only help to strengthen its professional foundations and development.

Ethics↗

PubMed2002

The educational preparation of undergraduate nursing students in pharmacology: a survey of lecturers' perceptions and experiences.

BACKGROUND: Nurses have key responsibilities in the administration and management of medication therapy and client education. It is of some concern therefore that the literature indicates that nurses are inadequately prepared in this area. AIMS: This paper explores the perceptions and expectations of lecturers about teaching and learning pharmacology in preregistration nursing courses. RESEARCH METHODS: Questionnaires were distributed to lecturers involved in teaching pharmacology to undergraduate nursing students during 2000. The questionnaire was distributed to all university campuses (n = 13) in Victoria, Australia, that are involved in undergraduate nursing education. The questionnaire was an adaptation of the survey instrument used in the Nursing and Medication Education [NAME] project and examined in this questionnaire: the integration of pharmacology teaching into nursing, range and depth of classroom-based pharmacology teaching, approaches to teaching and learning, nursing practice in a clinical context, related importance of patient education and communication skills, and the appropriate professional background of academics teaching pharmacology to preregistration nursing students. RESULTS: There was great variation between institutions as to the number of hours devoted to pharmacology and when it was offered. A number of respondents indicated that they were dissatisfied with the preparation of graduates and their knowledge base in pharmacology. LIMITATIONS: The study was limited by a low response rate of 34%. CONCLUSIONS: A review of nursing curricula is required to improve the knowledge base of nurses in pharmacology and to facilitate their skills in life-long learning.

Attitude of Health Personnel↗

PubMed2002

Agency nursing in Melbourne, Australia: a telephone survey of hospital and agency managers.

BACKGROUND: Agency nursing is a poorly understood and under-researched phenomenon. Despite the considerable costs and possible benefits of using agency nurses, little is known about the nature of agency nursing from different perspectives, including hospital and agency managers. AIM: To describe the professional relationship between hospitals and nursing agencies, utilization trends of agency nurses, and institutional policies relating to the employment of agency nurses. METHODS: A telephone survey was conveyed to managers of 70 acute hospitals (service purchasers) and 26 agencies (service providers) to provide baseline information on the utilization of agency nurses in acute hospitals in Melbourne, Australia. Introductory telephone calls were made to the chief nursing officers of the hospitals and the chief executive officers of nursing agencies in order to explain and seek approval for the proposed project. Approval to conduct telephone interviews was obtained from 30 acute hospitals and six agencies, representing a response rate of 43% and 23%, respectively. Separate questionnaires were used for the two categories of respondent. In some cases the questionnaire could not be completed using the telephone and a copy was then sent by post for completion. RESULTS: Findings revealed the high utilization of agency nurses in hospitals, the limited nature of continuing education for agency nurses, tensions between matching agency nurse qualifications with acute specialty needs and the notion that agencies preferred nurses to be flexible in their work assignments. CONCLUSIONS: The study was limited by the fact that the final sample was small (30 hospitals and six agencies), and therefore may not be representative of the wider population of Melbourne hospitals or agencies. However, it provided evidence on the utilization of agency nurses in public and private hospitals that will help shape policy on the regulation of the agency nursing workforce.

Attitude of Health Personnel↗

PubMed2002

Observation of pain assessment and management--the complexities of clinical practice.

Pain assessment and management are complex issues that embrace physiological, emotional, cognitive, and social dimensions. This observational study sought to investigate nurse-patient interactions associated with pain assessment and management in hospitalized postsurgical patients in clinical practice settings. Twelve field observations were carried out on Registered Nurses' activities relating to pain with their assigned patients. All nurses were involved in direct patient care in one surgical unit of a metropolitan teaching hospital in Melbourne, Australia. Six observation times were identified as key periods for activities relating to pain, which included change of shift and high activity periods. Each observation period lasted 2 hours and was examined on two occasions. Four major themes were identified as barriers to effective pain management: nurses' responses to interruptions of activities relating to pain, nurses' attentiveness to patient cues of pain, nurses' varying interpretations of pain, and nurses' attempts to address competing demands of nurses, doctors and patients. These findings provide some understanding of the complexities impacting on nurses' assessment and management of postoperative pain. Further research using this observational methodology is indicated to examine these influences in more depth. This knowledge may form the basis for developing and evaluating strategic intervention programmes that analyse nurses' management of postoperative pain and, in particular, their administration of opioid analgesics.

Adult↗