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Biomedical subjects

Lesley Wilkes

Publications and source records attributed to Lesley Wilkes.

14 recordsLinked to original sources
PubMed2006

Clinicians' responses to abnormal vital signs in an emergency department.

The importance of observing patient vital signs in emergency department (ED) practice has been stressed in the literature. Failure of clinicians to respond to abnormal vital signs (AVS) has been described as a potential reason for delayed management in ED practice, with a likelihood of increased morbidity. This study aimed to explore and describe clinicians' responses to AVS in a busy ED. A qualitative descriptive approach was used with three focus groups being conducted with 18 volunteer registered nurses (RNs) and medical officers (MOs) who worked in the ED of an area health service in Western Sydney. Transcribed focus group interviews were analysed using a process of constant comparison and contrast and a description of clinicians' responses to AVS written. An analysis of text from focus groups revealed three main categories of clinicians' responses to AVS: identification, reporting and implementing action. Clinicians in this study recognised, reported and acted on AVS. However, delays in responding to AVS occurred due to a variety of reasons. The main reasons identified were issues with documentation and the ability to seek advice of appropriate staff, ineffective communication, fear of reprimand, inexperience of working in EDs, workload, distractions and interruptions. In conclusion, environmental and human factors contribute to inappropriate delays regarding AVS in the ED. These factors can be acted on by initiating appropriate education programmes and establishing improved communication networks. Better use of the existing medical emergency team (MET) in the ED can act to alleviate situations associated with delays in managing AVS.

Adolescent↗
PubMed2006

Redesign of the model of nursing practice in an acute care ward: nurses' experiences.

OBJECTIVE: to describe nurses' experiences of the change associated with redesign of the model of nursing practice in an acute care ward in the preparatory and implementation phases. DESIGN: descriptive case study SETTING: a surgical ward in an acute care hospital in Greater Western Sydney SUBJECTS: fourteen registered and six enrolled nurses working on the surgical ward volunteered to be interviewed, eight in the preparatory phase and twelve six months into the implementation phase MAIN OUTCOME MEASURE: descriptions of nurses' experiences in the preparatory phase and six months into the implementation phase of the redesigned nursing practice model RESULTS: many nurses felt apprehensive in the preparatory phase, however, six months into implementation phase their willingness to trial the model was evident. Negativity pervaded both phases, as did their concerns for the quality of care being given. In the preparatory phase nurses described the clinical activities coordinator (CAC) role as having potential to be beneficial and this was realised to some degree six months into implementation phase. A preference for registered nurses over enrolled nurses as a dominant component of the staff was evident in both phases CONCLUSIONS: the struggle with the change that nurses experienced suggests redesign needs to be a more collaborative process involving strong communication and supportive education so nurses can empower themselves within the change.

Australia↗
PubMed2006

Workplace bullying in nursing: towards a more critical organisational perspective.

Workplace bullying is a significant issue confronting the nursing profession. Bullying in nursing is frequently described in terms of 'oppressed group' behaviour or 'horizontal violence'. It is proposed that the use of 'oppressed group' behaviour theory has fostered only a partial understanding of the phenomenon in nursing. It is suggested that the continued use of 'oppressed group' behaviour as the major means for understanding bullying in nursing places a flawed emphasis on bullying as a phenomenon that exists only among nurses, rather than considering it within the broader organisational context. The work of Foucault and the 'circuits of power' model proposed by Clegg are used to provide an alternative understanding of the operation of power within organisations and therefore another way to conceive bullying in the nursing workforce.

Attitude of Health Personnel↗
PubMed2006

'They stand you in a corner; you are not to speak': nurses tell of abusive indoctrination in work teams dominated by bullies.

This paper reports some of the findings from the first qualitative stage of a large national study of bullying in the nursing workplace currently being undertaken in Australia. The findings reported here reveal how relationships between bullies were embedded within informal organizational alliances, enabling bullies to control work teams and use emotional abuse and psychological violence as a means of enforcing bully-defined 'rules of work'. Within nursing teams, bullies controlled work roles, tasks, and status in the nursing hierarchy through enforcing their 'rules'. Bullies enforced these rules through a process of ritual indoctrination, destroying the self-confidence and self-image of those targeted, and forcing them to eventually resign their position or acquiesce to survive. The merciless, calculated and deliberate nature of the bullying resulted in profound harm for many of those targeted. The findings of this research have implications for the understanding and management of workplace bullying.

Aggression↗
PubMed2005

Fieldwork in nursing research: positionality, practicalities and predicaments.

AIMS: This paper draws on the literature to explore some of the issues of concern to nurses undertaking fieldwork in contemporary healthcare settings. BACKGROUND: The emergence of poststructuralist and postmodern perspectives has raised questions about ethnographic approaches, and problematized the role of researchers in the construction of plausible and credible ethnographic accounts. As a practice discipline, nursing needs to negotiate a thorny path between methodological purity and practical application, with nurse researchers required to take account of both philosophical and pragmatic concerns. DISCUSSION: There is general agreement that researching with an individual or group rather than researching on an individual or group is the more effective way to approach fieldwork. Feminist writers appear to have dealt with this issue best, advocating intimacy, self-disclosure, and reciprocity in encounters with research participants. The duality of the nurse researcher role; power and politics and the moral implications of fieldwork are acknowledged as factors influencing nurses in the planning and conduct of fieldwork. Nurses as researchers may be better equipped than other social researchers to deal with contingencies in the field. CONCLUSIONS: Laying the epistemological ground for the participant observer role during fieldwork and understanding its impact on the resultant ethnographic account is essential to methodological rigour in field research. Consideration of some of the practicalities and predicaments experienced by nurses as researchers when conducting fieldwork prior to going out into the field is an important research strategy and will facilitate methodological potency.

Anthropology, Cultural↗
PubMed2005

Role conflict: appropriateness of a nurse researcher's actions in the clinical field.

This study aimed to judge the appropriateness of a particular nurse researcher's actions in a vignette from the clinical field, and to explore frameworks used to determine the appropriateness of actions. Twelve experienced nurse researchers were interviewed by telephone. They were given four vignettes of actual research situations and asked to comment and explain their judgement on the appropriateness of the nurse researcher's actions. The findings confirmed blurring of boundaries between professional and research roles for nurses. Nurses appear to use a mixture of frameworks, including scientific/rigour method, ethics, nursing competencies and their own personal-moral values. Frameworks need to be discussed and debated so that neophyte researchers are well-prepared before they enter the field to conduct research.

Attitude of Health Personnel↗
PubMed2004

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↗
PubMed2004

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↗
PubMed2003

Ethics on the floor.

The work of the 'Human Research Ethics Committee' (HREC) is expanding as the dimensions of ethical practice and research grow in the clinical arena. Over the past five years, the demands on practitioners and ethics committee members have expanded, as the general public demands accountability on the part of clinical and other researchers. This paper presents a case study of an ethics committee in an Area Health Service in Sydney. It represents the views of the members as to why they see their job as important, what aspects are difficult, how they delineate between ethical/legal and scientific issues, and what are the major stumbling blocks for them in enacting their membership of a HREC. The data for the case study was collected using interviews with nine out of eleven members. The audio taped interviews were transcribed, the text thematically analysed for commonalities and contrasts, and a description of the members' perspective on various issues written. Issues emerging include: amount of material members read prior to the committee meeting, the difficulty in educating practitioners (all researchers) to write information sheets that are simple and comprehensible to laypersons, the payment of subjects for their time, the appropriate amount of monitoring to be applied on each project, the difficulty in letting researchers know that the ethics committee is committed to encouraging research and that its questions are intended to ensure the best possible project answering the researchers' questions/aims is conducted, and the slow or no response by researchers to ethics committee questions. The findings imply that reviewing research proposals for their ethical value is individual and members of human research ethics committees need to synthesise these in a committee context to make informed decisions.

Humans↗
PubMed2002

Measuring the outputs of Australian nursing research published 1995-2000.

AIMS: To analyse the research published in refereed nursing journals by Australian authors from 1995 to 2000. BACKGROUND: Analysis of the research topics and types of methodologies used by Australian nurse researchers has not been recently undertaken. The study was similar to an analysis of United Kingdom (UK) nursing research between 1988 and 1995 to allow comparison between the two countries. DESIGN: A quantitative approach analysed the research abstracts for the topic researched, source of data, location of data collection, paradigm and methodology used and funding source. RESULTS: A total of 509 articles from 11 generalist Australian and UK nursing journals were analysed. The highest numbers of articles were published in Australian Journal of Advanced Nursing and Journal of Advanced Nursing. The most popular topics were education of nurses (18.7%, n=95) and practice issues relating to patient care (15.3%, n=78). However, scant attention was paid to major Australian health issues. Most research was undertaken in the hospital setting (55.8%, n=247). Data were most often drawn from nurses themselves (40.7%, n=206), followed by patients (25.5%, n=129). Both quantitative (41%, n=203) and qualitative approaches (47%, n=230) were employed. A minority of studies acknowledged any funding (14.9%, n=76). CONCLUSIONS: Research findings need to be applied in practice to improve patient care. Nurse researchers need to publish their findings and align their research interests to meet national health priorities. They need to be involved in setting these health priorities to ensure that nursing has a place in health research.

Australia↗
PubMedDate not supplied

Managing family life while studying: single mothers' lived experience of being students in a nursing program.

Evidence suggests that single parent families are more likely to be affected by social problems associated with poor health and poverty. Single parent families are growing in number and are overwhelmingly headed by women. Despite their increasing number and their level of vulnerability, the lived experiences of single mothers have attracted little attention in the literature. Still little is known about many aspects of life as experienced by single mothers. Nursing is a profession that is dominated by women, and every year a number of single mothers enroll in undergraduate nurse education programs. Currently, there is little information about the experiences of women who are single mothers, undertaking a nursing degree in a university. This paper reports a study that explored the lived experiences of five single mother undergraduate nursing students. van Manen's phenomenological method informed the design and conduct of the study. Findings were grouped into the following themes: being exhausted all the time; being overwhelmed with worries; and being hopeful of the future. Findings of this study revealed that the single mothers' major health concerns were chronic tiredness and overwhelming worries. However, their being in the university was perceived as being health promoting and restoring to their self-esteem. Implications for educators, health providers and women's health services are drawn from the findings.

Adaptation, Psychological↗
PubMedDate not supplied

Current state of knowledge on child-to-mother violence: a literature review.

Child-to-mother violence is a common aspect of family violence, and presents nurses and health workers with continuing challenges. Though noted in the literature as early as the 1950's, this phenomenon remains poorly understood. A number of reasons for the lack of research scrutiny are proposed, the most compelling being that child-to-mother violence has been framed within the discourse of juvenile delinquency rather than family violence. Thus, unlike other forms of family violence, it has escaped close examination by health and welfare workers. A literature review was conducted to examine current knowledge of child-to-mother violence. Study of the literature reveals only partial understandings of this neglected aspect of family pathology. Directions for research to address these gaps in knowledge are drawn from the findings of this literature review.

Adolescent↗
PubMedDate not supplied

Measuring the outputs of nursing research and development in Australia: the researchers.

It is vital for nurses to publish in order to provide evidence of their practice and to increase the knowledge base of their discipline. This paper is one of two that reports on an investigation of the nursing research published by Australian authors from 1995-2000 in 11 nursing journals based in Australia, the UK and the USA. The focus of this article is on the researchers drawn from a total of 509 articles that were content analysed and categorised according to topics of research, paradigm, methods used and funding acknowledgment. The researchers were analysed on the basis of gender, discipline, employment base and location. Publications had from one to 10 authors, averaging two, with 26 authors claiming 23.6% of research articles. The most common discipline area was nursing and universities were the leading area of employment. Authorship was not limited to capital cities reflecting the spread of university campuses in rural areas. Research papers made up 12.5% of possible articles, supporting the notion that few nurses publish research papers in the refereed general nursing journals we focused on.

Australia↗