The easy option? Australian findings on mothers' perception of elective Caesarean as a birth choice after a prior Caesarean section

As the rate of primary and repeat Caesareans around the world increases, obstetricians, midwives and primary care providers are being expected to provide counsel to women seeking information regarding birth choices for delivery after a prior emergency Caesarean. This article seeks to contribute to the knowledge on this topic by presenting research findings from a qualitative study designed to explore, from the mothers' perspective, the decision-making experience with regards to subsequent birth choice for women who have previously delivered by Caesarean section. Specifically, the findings in this article present the perspective of the mothers who opted for elective Caesarean. Eighty per cent of mothers in this study chose elective Caesarean for reasons of fear and the desire to retain some control over the birthing process. For many, this decision is made prior to or early in pregnancy without any openness to consider other possibilities. Thus, the findings strongly emphasize the importance of understanding and taking into consideration the mothers' psychosocial perspective on birth choices as a key to providing counsel and support.     

Medication management: an exploratory study into the role of community mental health nurses

The recent emphasis on community care for those with mental illness has changed working patterns and modified inter-professional role boundaries within multi-disciplinary teams. Clients with serious mental illness are usually prescribed medications, which have a wide range of side effects. However, it is uncertain who is responsible for monitoring clients for the side effects of their medications, ensuring clients' and carers' understandings of their prescribed medications and optimizing compliance with medication. This paper discusses the findings of the first phase of an ongoing study designed to assess the role of community mental health nurses (CMHNs) in managing clients' medication and the provision of appropriate continuing professional education. Our respondents were 14 CMHNs, seven of whom were preparing to undertake a pharmacology module as part of a higher education diploma, and seven who were to act as comparators. Data from questionnaires, interviews and clinical observations were triangulated. All respondents felt that issues surrounding clients' medication were not accorded a sufficiently high profile and that it was, in part, their responsibility to expand their roles to meet these unmet needs of clients. Administering and managing clients' medications were considered to be the main area of 'occupational territory' which distinguished CMHNs from social workers. However, the nurses felt that their practice was limited by lack of appropriate educational preparation.     

An exploration of psychiatric nurses'' and patients'' opinions regarding in-patient care for suicidal patients

This study explores psychiatric nurses' and patients' opinions regarding the care provided for in-patients who were admitted following: (i) depression as a result of psychosocial difficulty, (ii) suicidal ideation, or (iii) an overt suicidal behaviour. It also explores how care for such patients could be improved. A total of 20 psychiatric nurses and 17 in-patients were interviewed. The results show that nurses and patients believe that communicating with patients about their difficulties is the most important skill in psychiatric nursing. Most nurses were disappointed with the limited time they had available to communicate with patients and they were constructively critical of their pre-registration training in communication skills. Patients suggested that nurses should spend more time in helping to problem-solve their difficulties. Both nurses and patients suggest that situational factors impinge on the time available for psychotherapeutic care. Findings have implications for pre- and post-registration education and practice. Responses from both cohorts suggest how care could be improved.     

A Community Population Survey of Prevalence and Severity of Dyspnea in Adults

Given the progress in the symptomatic treatment of breathlessness, and the physical and psychological morbidity associated with chronic breathlessness, estimates of the size of the population that may benefit from better support become imperative. Prevalence estimates have varied widely (0.9% of clinical encounters to 32%) and have largely relied only on respondents who used clinical services. Whole-of-population approaches may be able to define better the “true” prevalence of chronic breathlessness and quantify exertion limited by breathlessness. The aim of this study was to estimate population levels of chronic breathlessness, severity of limits to exercise, and demographic predictors of the presence of breathlessness. A whole-of-population face-to-face survey method (n = 8,396) in South Australia was used, directly standardized for age, gender, country of birth, and rurality. Respondents were asked about breathlessness and levels of exertion causing breathlessness for at least three of the last six months using a modified Medical Research Council dyspnea scale. Univariate and multivariate analyses identify the demographic characteristics of people more likely to experience chronic breathlessness. With a participation rate of 65.3%, 8.9% of respondents had breathlessness that chronically limited exertion. Significant associations with chronic breathlessness in multivariate analysis included female sex (P < 0.001), not working full time (P < 0.001), low income (P = 0.007), and older age (P = 0.031). There are significant levels of chronic breathlessness in the community. Given the prevalence, it is feasible to explore the onset of breathlessness, the underlying etiologies and subsequent health service utilization, and health consequences.     

Twenty-four hour care: implications for the role and developmental needs of nurses in acute and community settings

Aim(s)  The aim of this study was to explore the challenges of providing continuity within the 24-hour nursing service. It explored why nurses work at night and what issues this raises for them.
Background  The manner in which new ways of working affect the work or CPD (Continuing Professional Development) requirements of ward-based nurses or their community counterparts has received little attention. The aim of this study was to explore these issues with a diverse sample of practitioners.
Method(s)  Twenty-seven staff from four settings (two acute trusts and two community teams) participated in this qualitative study employing focus groups and interviews.
Results  The nature of night nursing is changing; expanded roles and responsibilities are common. However, CPD remains problematic, as a result of constraints around time and access. Context-specific issues shape the nature of night working in acute and community settings and should be considered when planning CPD.
Conclusion(s)  There is a need to re-examine what CPD is available for practitioners providing care around the clock. Traditional forms of CPD may not reflect the evolving reality of practice at night.
Implications for Nursing Management  There is a need to ensure CPD opportunities are reviewed regularly to reflect changing 24-hour service demands in all settings.     

In whose interests? The best interests principle under ethical scrutiny

This paper critically examines the best interests principle and its role in making decisions about intensive care treatment. In current practice the best interests principle is sometimes relied upon to guide decision making in circumstances when the patient is incompetent, although it is intrinsically linked to inconsistent assumptions about what is meant by quality of life. This situation means that there is potential that moral errors will be made that may result in an unwanted extension of life for some individuals or the premature death of others.

It is difficult to justify such decision making on ethical grounds. A greater understanding of the best interests principle, and consequently the concept of quality of life, is needed in order to ensure that decision making about intensive care is ethically defensible. It is argued that an ideal theory of quality of life provides an appropriate framework for best interests decisions, and that the decision making process ought to, whenever possible, involve the patient's close family.     

''Coming out'' as a life transition: homosexual identity formation and its implications for health care practice

This paper explores the formation of homosexual identity through the complex transitional process of 'coming out'. Linear developmental models are discussed as is the influence of societal norms on identity formation. In considering the implications for professional practice the author challenges the heterosexism in health care and suggests ways in which health care professionals can provide a supportive environment for gay men and lesbians.     

Non-response in survey research: a methodological discussion and development of an explanatory model

This paper demonstrates that the different sources of non-response in survey research must be considered by researchers in order to minimize the potential for bias, and that careful planning and management during sample selection, sample recruitment and data collection can control the extent of response failure. The findings of an interview survey of nurses and nurses' aides illustrate, however, that the success of strategies designed to reduce the loss of data in survey research depends upon researchers acknowledging the complex relationships that exist between non-response phenomena throughout the research process.