"There is always something missing inside ...": A response to Elaine Arnold's paper "Separation and loss through immigration of African Caribbean women to the UK.".
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Adult↗
Biomedical subjects
Kate White
Publications and source records attributed to Kate White.
Fatigue in frail elderly people.
Many frail older people are likely to suffer from fatigue, but tools to measure fatigue in this population are lacking. Stage one of this study explored and described the experiences of fatigue of 12 older people from Australian residential aged care facilities. Themes identified were pacing yourself, battling on, hitting rock bottom, feeling safe, and moving on. Findings indicated that, with support, frail elders may be able to manage fatigue effects themselves. A measure of fatigue was developed from stage one findings, with reference to the literature. In stage two of the study, the Frail Elder Fatigue Assessment Tool was subjected to panel review, piloting, and refinement. The refined tool comprises 20 items in three subscales: fatigue effects; fatigue resources; and adaptation to fatigue. Further work is required to establish the tool's psychometric properties, but it should then be useful for both research and clinical assessment purposes.
Activities of Daily Living↗
Accessing metropolitan cancer care services: practical needs of rural families.
This study explored the practical needs of patients and their families travelling from rural areas in New South Wales, Australia to cities for cancer treatment. Practical needs were information, accommodation, transport, and economic impact. A cross-sectional design was employed; data were collected by questionnaire and focus group interviews. Findings showed that practical needs impacted on the ability of the patients and families to cope with diagnosis and treatment for cancer. The greatest unmet practical need of the patients and their families was for comprehensive information that is provided before travelling and by someone, for example, nurse or social worker who can help them decipher it if required.
Communication↗
Cancer remains a leading cause of death in Australia.
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Australia↗
The role of the neonatal intensive care nurse in decision-making: advocacy, involvement in ethical decisions and communication.
Neonatal intensive care unit (NICU) nurses are often faced with complex clinical and ethical problems. Little is known about the role of the NICU nurse in ethical decision-making, or processes that inform decision-making in this setting. The purpose of this study was to explore and describe nurses' perceptions of their role as patient advocate, clinical situations that cause them concern and the extent of their involvement in ethical decision-making. A combined quantitative and qualitative research design was used. A questionnaire was administered to nurses working in the NICU of the sole perinatal tertiary referral centre of Western Australia, Australia. Findings showed that NICU nurses saw their role in ethical decision-making primarily as advocating for the best interests of the infant and family, that they used clinical knowledge and experience to guide ethical decision-making, they were able to clearly articulate ethical problems and respond to them according to the clinical scenario and, while being primarily assertive in presenting their views, some nurses took a more passive approach. These findings support the need for development of a multidisciplinary model for ethical decision-making, where the view of all team members are considered.
Australia↗
The family and nurse in partnership: providing day-to-day care for rural cancer patients.
OBJECTIVE: To explore demands made on family members in managing symptoms and providing for the day-to-day care of relatives with cancer in rural New South Wales and how specialist palliative care nurses support these family members. DESIGN: Cross sectional qualitative study. SETTING: Seven health centres across rural New South Wales that cover a broad geographical area and reflect the diversity in economic conditions, population density and distance from three major urban centres in New South Wales. SUBJECTS: The study involved two groups of participants. The first group consisted of one or more members of families of oncology patients who were accessed through health workers at the seven centres. Nineteen family members from 17 families were interviewed. The second group comprised 10 nursing staff working as specialist palliative care nurses across the same geographical area as the families. MAIN OUTCOME MEASURES: Physical care and symptom management were the two main areas of interest. RESULTS: The rural experience of caring for palliative care patients was challenging, with support nurses needing to take into consideration all aspects of the patients' and families' living environments. CONCLUSION: There is a need for equipment and basic resources to be readily available to practitioners, funding for ongoing education and 24-h care.
Aged↗
Sexuality and attachment from a clinical point of view.
The clinical experience of five attachment-based psychoanalytic psychotherapists is pooled in an exploration of how issues in relation to sexuality and attachment emerge in the consulting room. Our clinical experience shows that sexuality, far from being a powerful instinctual drive that invariably needs to be explored clinically, is far more a reflection of early attachment histories. Instead of the standard pressure cooker of sexuality, which if not expressed leads to pathological emotional conflict we identify a melancholy sexuality, a cold arctic-like desert unwarmed by human relationship that barely achieves expression. We find that a broader and more fluid conception of sexuality as not just genitally focused but as erotic helps us relate to difficulties around sexuality as having to do with conflicts in relation to or associated with desire for contact and connection linked to past histories of loss, abandonment and sexual abuse. We argue theoretically that the psychological dimension of the biological system of human reproductive capacities, that is to say, the actually lived experience of human sexuality cannot be separated from the psychological dynamics of attachment within a social and cultural context. We discuss clinical issues including the sequelae of primary erotic attachments and working with sexual fantasies and working with erotic transference/countertransference re-enactments. A clinical example illustrates in some detail how we work with an adult survivor of sexual abuse troubled by intrusive sexual fantasies.
Adult↗
Developing a secure-enough base: teaching psychotherapists in training the relationship between attachment theory and clinical work.
I present an account of a post-graduate training module I have developed for psychotherapy training students at The Centre for Attachment-based Psychoanalytic Psychotherapy entitled From Attachment Theory to Clinical Practice. I situate my interest in this work in my own life and my background in education. In describing the curriculum content, I focus in particular on an educational process that enables students to engage with the concepts from attachment theory which are both relevant to their own lives and their future work as psychotherapists. I show how the findings of the Adult Attachment Interview can be understood more deeply through a project the students are asked to present and evaluate. The article also includes some personal reflections on my experience of attachment research training from a clinician's perspective as a way to think about the divide between these two worlds. I conclude with a consideration of the strengths and limitations of attachment theory to understanding the effects of inequalities of power relations on the formation of intimate bonds.
Adult↗
Evaluating the health-related quality of life effects of cochlear implants: a prospective study of an adult cochlear implant program.
This paper prospectively documents the health-related quality of life (HRQoL) and social participation benefits of adult patients receiving cochlear implants in Australia and New Zealand. Thirty-four consecutively implanted patients completed the Assessment of Quality of Life (AQoL) and Hearing Participation Scale (HPS) instruments before implantation, and at 3- and 6-month follow-ups. Implantation resulted in significant improvements in AQoL and HPS scores, The effect size was 1.09 for both measures. Those in the top socio-economic tertile obtained the greatest gains. The HRQoL and social participation benefits were slightly larger than those reported elsewhere. This may be because participants used more recent technology (Nucleus 24 rather than Nucleus 22) and received auditory and self-efficacy training as part of their rehabilitation. The results suggest that cochlear implants have a large beneficial effect. They show that social and HRQoL outcomes can be parsimoniously measured using the HPS and AQoL instruments.
Cochlear Implantation↗
Evaluation of an after hours telephone support service for rural palliative care patients and their families: A pilot study.
OBJECTIVE: To report on the introduction and evaluation of an after hours telephone support service for palliative care patients and their families at home. DESIGN: Descriptive evaluation using an audit of telephone logbook, text analysis of reflective journals, questionnaire and interviews. SETTING: Palliative care call service in Grafton, New South Wales, Australia. SUBJECTS: The participants were health professionals using the Palliative Care Service in Grafton (48 in total) and nurses providing the palliative care service (21 in total). RESULTS: Twelve calls were taken by the nurses during the pilot study. Three major themes emerged from the analysis: preparation involving publishing the after hours telephone support service (AHTSS) and nurse workshop; benefits such as support to families and health service resourcing; and nurses' experiences regarding personal impact and building support for each other. CONCLUSION: It appears from the evaluation responses of health professionals and nurses that knowing the service was there was a great security and reduced the sense of isolation predominant in the experience of rural families caring for a palliative care patient at home. Based on the positive evaluation, the area health service provided ongoing funding for the service and is exploring avenues to extend the program into other areas. The service now requires a re-evaluation at 18 months and will form the second phase of the study that is currently being organised.
After-Hours Care↗
Evaluation of a night respite community palliative care service.
A three-phase project was undertaken to develop and evaluate a community night respite palliative care service for patients and family carers. An assessment tool to identify those most in need of night respite was developed and tested. The tool was reliable and feasible for use in practice. Care aides were trained to provide night respite. Fifty-three patients participated over 11 months. Findings revealed the types of patients and families most in need of night respite, the amount of respite needed, and location of death. There is evidence that patients who would have been transferred to an inpatient setting for end-of-life care were able to die at home with the support of the night respite service. Families were extremely appreciative of the service and a limited cost comparison suggested costs were lower than if patients had been transferred to hospital and/or inpatient hospice care. Recommendations for practice are offered.
Adolescent↗
The impact of unrelieved patient suffering on palliative care nurses.
AIM: to describe the impact of unrelieved patient suffering on nurses working with palliative care patients. DESIGN: This was a qualitative descriptive design using semi-structured interviews. SAMPLE: nine experienced palliative care nurses were interviewed. RESULTS: nurses acknowledged that the term 'suffering' generally was not used in the workplace. The nurses identified that only a small group of patients died with suffering that could be classified as 'unrelieved' but that the impact of these patients' suffering on themselves was enormous. Nurses describe the impact in terms of perceptions of suffering (difficult situation), feelings (helplessness, distress, feelings of failure), bearing the burden (alcohol consumption, headaches) and effects on their relationship with family. The nurses identified several factors that increased the personal impact of unrelieved patient suffering. The most important strategy for ameliorating the impact of unrelieved patient suffering was informal support from work colleagues. CONCLUSION: the nurses' stories indicate that the personal impact of unrelieved patient suffering could be reduced through acknowledgement of this suffering and better formal and informal support mechanisms.
Adaptation, Psychological↗
An evidence-based specialist breast nurse role in practice: a multicentre implementation study.
The objective of this study was to examine the feasibility, implementation, acceptability and impact of an evidence-based specialist breast care nurse (SBN) model of care in Australia. Primary data were collected from four diverse Australian breast cancer treatment centres over a 12-month period. The design was a multicentre demonstration project. Information about the provision of care and patient needs was collected through prospective logs. Structured interviews were conducted with women who received the SBN intervention (N = 167) and with a control group of women treated prior to the intervention period (N = 133). Health professionals (N = 47) were interviewed about their experience of the SBN. Almost all women had contact with an SBN at five scheduled consultations and 67% of women in the intervention group requested at least one additional consultation with the SBN. Women in the intervention group were more likely to receive hospital fact sheets and to be told about and participate in clinical trials. Ninety-eight per cent of women reported that the availability of an SBN would affect their choice of hospital, with 48% indicating that they would recommend only a hospital with a SBN available. Health professionals reported that SBNs improved continuity of care, information and support for the women, and resulted in more appropriate referrals and use of the time of other members of the team. In conclusion, the SBN model is feasible and acceptable within diverse Australian treatment centres; there is evidence that some aspects of care were improved by the SBN.
Adolescent↗
Intrathecal catheters: developing consistency in filter use and dressings in Perth, Australia.
The use of opioids presents practitioners with many challenges, such as the variation in responses and side effects seen with traditional methods of administration. This has prompted an increase in the consideration of the intrathecal route for the management of patients with refractory cancer pain. Although this has increased the therapeutic options available to patients, it has also led to more complicated pain management strategies. In Perth, Western Australia, it was identified that clinical variations, especially in the programming of the pump maintenance of the filters and associated dressings, occurred between service providers, causing confusion and anxiety for patients, families and practitioners. This article discusses a review of nursing management of patients receiving intrathecal analgesia and the collaboration of all services in the development of evidence-based policy.
Analgesia, Epidural↗
Assessing the practical and psychosocial needs of rural women with early breast cancer in Australia.
The purpose of the current study was to assess the practical and psychosocial needs of rural women with early breast cancer in Australia and recommend strategies to ensure equity in availability and access to cancer treatment for all women. A random sample of 204 rural women diagnosed with early breast cancer was recruited to participate in a telephone survey via state and territory cancer registries. Although the majority of women were satisfied with their provision of information overall, less than a third of participants were provided with specific information on assistance for rural women. Findings also revealed that only 47% of the women who had to travel for treatment received financial assistance, and 13% of these women had difficulty organizing or claiming financial assistance. Furthermore, only 10% of women found social workers to be a source of support.
Adult↗
Life after breast cancer: Australian women's stories of support.
Quality support is crucial to the care of women diagnosed with breast cancer. Little qualitative research has been conducted in this area. Semi-structured interviews were conducted with six women in New South Wales, Australia, to explore their experiences of breast cancer. Specifically the study focused on the support the women felt they needed at different times during their illness experience, how this was given and by whom. The qualitative data from the interviews supported previous research in that the diagnosis of breast cancer was devastating. Their primary source of support was family and friends with their surgeon and general practitioner providing some support. Overall the women felt they received physical support. However, emotional support was lacking, especially from nurses.
Breast Neoplasms↗
Nursing within Australia is currently the focus of attention at both state and national levels.
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Communication↗