Publications by authors named "Michelle DiGiacomo"

106 Publications

A qualitative study exploring the career mindset of a group of early career academic nurses as they deployed 'Habits of Mind' to sustain their career journey.

Nurse Educ Pract 2021 Aug 14;55:103149. Epub 2021 Jul 14.

Vice-Chancellor and Principal, The Vice-Chancellor's Unit, Building 36, University of Wollongong, Australia. Electronic address:

Aim: This study aimed to explore the qualities that sustain a career mindset in a group of early career academics in one Australian university.

Background: Building an academic career is a lengthy, convoluted and complex journey requiring a mindset prepared to make informed and timely decisions. Success is predicated to a large extent on the ability of persons to process information effectively before actions are taken. Employing 'Habits of Mind' supports growth in intelligent behaviours through acquiring a composite of skills, attitudes, cues and past experiences that maximises appropriate choice of one pattern of thinking over another. A level of skill is required to employ 'Habits of Mind', suggesting that reflection and evaluation of experiences are critical to the process. In this, the third phase of a four-phase sequential study, the career mindset of a group of early career academic nurses were studied during 2019. A cluster of 'Habits of Mind' emerged as having value for an academic career mindset, allowing the individuals to meet challenges of negotiating a career terrain and deepening their learning about those situations. Time and energy could therefore be appropriated to engage with the academic global community in new and career challenging health related research.

Design: A qualitative descriptive approach.

Methods: The study applied the epistemology and constructivist thinking of John Dewey and the self-directed learning theories of Mezirow and Knowles. Set in a large metropolitan university in Sydney, Australia. A purposive sample of nine early career academic nurses were interviewed using semi-structured, one-to-one audio-taped interviews. Data were analysed thematically using Braun and Clarke (2006) six phase process.

Results: Findings revealed that deployment of the cluster of the five distinctive themes or 'Habits of Mind': Rely on self; take responsible risks; think with colleagues; keep an open mind and possess curiosity into the novice nurses' mindset, expedited self-directed learning processes, resulting in sharpening of their learning power to enable a more productive career journey.

Conclusions: It is argued that 'Habits of Minds' can provide a valuable learning framework when directing a career mindset and, that inclusion by providers of leadership, career or mentorship programs can sustain an academic environment where a culture of learning can flourish and where ECANs are equipped with attributes and behaviours necessary to address global demands.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.nepr.2021.103149DOI Listing
August 2021

The Role of Lifestyle and Cardiovascular Risk Factors in Dropout From an Australian Cardiac Rehabilitation Program. A Longitudinal Cohort Study.

Heart Lung Circ 2021 Jul 1. Epub 2021 Jul 1.

Western Sydney University, Sydney, NSW, Australia.

Background: Cardiac rehabilitation (CR) programs reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. However, many people who experience a cardiac event do not attend or fail to complete their CR program. Little is known about the characteristics of people who drop out compared to those who complete CR.

Aims: To identify subgroups of patients attending a cardiac rehabilitation program who are more likely to dropout prior to final assessment by (1) calculating the dropout rate from the program, (2) quantifying the association between dropout and socio-demographic, lifestyle, and cardiovascular risk factors, and (3) identifying independent predictors of dropout.

Methods: The study population is from a large metropolitan teaching hospital in Sydney, Australia, and consists of all participants consecutively enrolled in an outpatient CR program between 2006 and 2017. Items assessed included diagnoses and co-morbidities, quality of life (SF-36), psychological health (DASS-21), lifestyle factors and physical assessment. Dropout was defined as failure to complete the outpatient CR program and post CR assessment.

Results: Of the 3,350 patients enrolled in the CR program, 784 (23.4%; 95%CI: 22.0-24.9%) dropped out prior to completion. The independent predictors of dropout were smoking (OR 2.4; 95%CI: 1.9-3.0), being separated or divorced (OR 2.0; 95%CI: 1.5-2.6), younger age (<55 years) (OR 1.9; 95%CI: 1.6-2.4), obesity (OR 1.6; 95%CI: 1.3-2.0), diabetes (OR 1.6; 95%CI: 1.3-2.0), sedentary lifestyle (OR 1.3; 95%CI: 1.1-1.6) and depressive symptoms (OR 1.3; 95%CI: 1.1-1.6).

Conclusion: To improve the CR program completion rate, clinicians need to consider the impact of socio-demographic, lifestyle, and cardiovascular risk factors on their patients' ability to complete CR. Tailored strategies which target the independent predictors of dropout are required to promote adherence to CR programs and thereby potentially reduce long-term cardiovascular risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hlc.2021.05.103DOI Listing
July 2021

A qualitative study of experiences of asylum-seeker women of living in detention centres: confinement versus safety.

Contemp Nurse 2021 Feb-Apr;57(1-2):51-64. Epub 2021 May 28.

John Hopkins University, 525 N Wolfe St, Baltimore, MD 21205, USA.

Background: Iranian asylum seekers are amongst the highest number of boat arrivals to Australia who have been subject to compulsory detention. Women face more health-threatening problems rather than men in detention, yet, remain understudied in health research. This study aimed to inform healthcare providers about the experiences of living in immigration detentions, which might affect asylum seekers' mental health.

Method: A qualitative study using semi-structured interviews and thematic analysis.

Results: 17 participants shared their experiences: Living in a prison-like environment was a punishment for their boat arrival and violated their privacy and dignity. In contrast, a sense of security, free access to healthcare services, and building social networks were positive aspects of short-term detention.

Conclusion: To prevent further trauma, living conditions in detention must be conducive to promoting coping and adjustment. The length of detention should be minimised and limited to preparing asylum seekers for facing a new socio-cultural environment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10376178.2021.1927771DOI Listing
May 2021

"Ask parents what they want to do" - Mothers seeking help with parenting and their perspectives on barriers and potential enablers for help with smoking cessation: A qualitative study.

J Pediatr Nurs 2021 Apr 24. Epub 2021 Apr 24.

IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, P.O. Box 123, Broadway, New South Wales 2007, Sydney, Australia.

Purpose: To describe parents' perceptions of opportunities and barriers to smoking cessation in early parenting and the support needed to achieve this.

Design And Methods: A qualitative approach, using semi-structured interviews with mothers, and inductive thematic analysis.

Results: Barriers to cessation intervention included readiness to quit, lack of knowledge, and the shame and stigma of seeking help. Mothers' perceived opportunities for support from early parenting services included approaches to effecting change, leveraging opportunities to explore smoking cessation, and tailoring interventions to family strengths, with a focus on promoting attachment.

Conclusions: Mothers may be struggling with parenting, but are also open to opportunities to explore smoking behaviours and intervention. Nurses and other health care professionals working in this setting may be well situated to support parents with their decisions to consider smoking cessation and avoid smoking relapse.

Practice Implications: The findings can assist nurses and other early parenting service clinicians to consider their approach to parents who continue to smoke or are at risk of smoking relapse.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pedn.2021.04.016DOI Listing
April 2021

Social welfare needs of bereaved Australian carers: Implications of insights from palliative care and welfare workers.

Health Soc Care Community 2021 May 11;29(3):631-642. Epub 2021 Mar 11.

Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia.

An individual and psychological emphasis has influenced practice and research on bereavement following informal care provision in the context of life-limiting illness. Consideration of the potential for bereavement to be shaped by intersecting social and structural inequities is needed; and should include an understanding of interactions with government institutions and social policy. This qualitative study employed interpretive description to explore the way in which palliative care workers and welfare sector workers perceive and approach experiences and needs of bereaved carers receiving government income support or housing assistance in Western Sydney, an area associated with recognised socioeconomic disadvantage. A total of 21 palliative care workers within a public health service and welfare workers from two government social welfare services participated in in-depth interviews. Data were analysed using framework analysis. Participants highlighted social welfare policy and related interactions that may impact bereavement, potentially related to financial, housing and employment precariousness. Personal, interpersonal and structural factors perceived to shape the navigation of welfare needs were explored, alongside needed professional and structural changes envisioned by workers. With limited forms of capital, vulnerably positioned carers may encounter difficulties that heighten their precariousness in bereavement. Transactional organisational cultures alongside health and welfare agencies that function in a siloed manner appear to contribute to structural burden for carers, following death due to life-limiting illness. Palliative care and welfare workers also associated elements of their work with bereaved carers with their own experiences of helplessness, frustration and distress. Findings point to a need for the development of interagency strategies in addition to policy underpinned by more nuanced understandings of vulnerability in bereavement, post-caring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/hsc.13339DOI Listing
May 2021

Multifaceted needs of individuals living with peripheral arterial disease: A qualitative study.

Chronic Illn 2021 Mar 5:1742395321999450. Epub 2021 Mar 5.

University of Technology Sydney, Faculty of Health, IMPACCT, Broadway, NSW, Australia.

Objectives: To ascertain a comprehensive perspective of the impact of peripheral arterial disease (PAD) on people including needs for access to disease specific information, education, services, and support.

Methods: Participants were recruited from outpatient clinics at a tertiary hospital in metropolitan Australia. Telephone and face-to-face semi-structured interviews were conducted with nine individuals living with PAD and analysed using qualitative content thematic analysis.

Results: The nine participants were on average 74.2 (SD 10.9) years and predominantly women (67%). Lack of understanding of PAD and inconsistent information resulted in confusion regarding self-management strategies. Effects of pain and mobility problems were amplified for participants who lived alone and did not have an informal carer.

Discussion: Poor quality of life in PAD reflects pain, social isolation and fear of falls. Multidisciplinary teams with case managers should consider older people's living situations and needs for additional support services and education to facilitate integrated care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1742395321999450DOI Listing
March 2021

Caring precariously: An interpretive description of palliative care and welfare worker perspectives on end of life carers navigating social welfare.

Palliat Med 2021 01 28;35(1):169-178. Epub 2020 Oct 28.

Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia.

Background: Caring at end-of-life is associated with financial burden, economic disadvantage, and psychosocial sequelae. Health and social welfare systems play a significant role in coordinating practical resources and support in this context. However, little is known about social policy and interactions with public institutions that shape experiences of informal carers with social welfare needs at end-of-life.

Aim: To explore ways in which palliative care and welfare sector workers perceive and approach experiences and needs of the carers of people with life-limiting illnesses who receive government income support or housing assistance, in an area of recognised socioeconomic disadvantage.

Design: An interpretive descriptive study employed in-depth, qualitative interviews to explore participants' reflections on working with carers of someone with a life-limiting illness. Data were analysed using the framework approach.

Setting/participants: Twenty-one workers employed within three public services in Western Sydney were recruited.

Results: Workers articulated understandings of welfare policy and its consequences for carers at end-of-life, including precariousness in relation to financial and housing circumstances. Identified resources and barriers to the navigation of social welfare needs by carers were categorised as personal, interpersonal and structural.

Conclusions: Caring at end-of-life while navigating welfare needs was seen to be associated with precariousness by participants, particularly for carers positioned in vulnerable social locations. Findings highlighted experiences of burdensome system navigation, inconsistent processes and inequity. Further exploration of structural determinants of experience is needed, including aspects of palliative care and welfare practice and investment in inter-agency infrastructure for supporting carers at end-of-life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0269216320966492DOI Listing
January 2021

The Development of the Australian National Palliative Care Clinical Studies Collaborative "Integrating Qualitative Research into Clinical Trials Framework".

J Palliat Med 2021 03 20;24(3):331-337. Epub 2020 Oct 20.

IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.

Qualitative methodologies have multiple contributions to health research, including improving baseline understanding in new areas of enquiry; questioning existing assumptions; understanding viewpoints of specific subgroups; and offering complex, contextual information. While the role of qualitative research within mixed methods approaches is well documented, the contribution to clinical trial design and conduct is less well recognized. The Australian Palliative Care Clinical Studies Collaborative and Cancer Symptom Trials have developed a framework to detail how qualitative research might contribute to each key aspect of clinical trials. This practical framework provides real-world examples, including sample qualitative questions, to consider at each phase of controlled clinical trial development. As the number of randomized clinical trials in palliative care increases, a readily accessible approach to integrating qualitative research into clinical trial design and conduct is needed so that its full potential for improving study recruitment, conduct, outcomes, interpretation, and implementation may be realized.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/jpm.2020.0480DOI Listing
March 2021

'Stretched thin with little children' - smoking perceptions and experiences of families seeking help with parenting.

J Child Health Care 2020 Oct 15:1367493520967834. Epub 2020 Oct 15.

IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, 110561University of Technology Sydney, Sydney, Australia.

Cigarette smoking is the leading preventable cause of poor pregnancy outcomes. Pregnancy is a trigger for smoking cessation yet, up to 50% of parents will relapse in the early years of their child's life. This study explored the smoking-related perceptions and experiences of 11 parents seeking professional help with the care and parenting of babies and toddlers using semi-structured interviews. Inductive thematic analysis identified three themes: parenting as a change catalyst, smoking as a parenting challenge and smoking as a coping strategy. Becoming a parent is a catalyst to reduce the associated risks and stigma associated with smoking, but maintaining rules and boundaries can be perceived as a further burden for parents who are struggling to care for their infant. When faced with difficulties with parenting, parents may revert to smoking as a coping strategy. Based on these study findings, interventions targeting gender norms may be useful in addressing smoking cessation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1367493520967834DOI Listing
October 2020

An evaluation of early career academic nurses' perceptions of a support program designed to build career-resilience.

Nurse Educ Pract 2020 Oct 11;48:102883. Epub 2020 Sep 11.

School of Nursing, Johns Hopkins University, Baltimore, MD, USA. Electronic address:

Early career academic nurses can struggle to meet the demands of career development due to feelings of being overwhelmed. Studies indicate that programs targeting these challenges are often sporadic and inconsistent, leading to dissatisfaction and missed opportunities.This paper reports on findings evaluating a program designed to build career-resilience in a group of early career academic nurses who, through the provision of a structured program of support, were enabled to succeed and thrive in the academy. This six session program was informed by Knowles' adult learning theory, Mezirow's transformational learning theory and Lord's reliance on critical transactions.This study was undertaken in a large metropolitan university in Sydney, Australia. Participants included nine early career academic nurses. All had been full-time academics from one to six years. A qualitative descriptive design was employed using Braun and Clarke's six stage process for data analyses. Three themes emerged: the program fostered connections, strengthened expertise and clarified directions. This analysis provided deep insights into the value of collegial relationships to galvanise career success. The program's strength was its ability to lessen participants' feelings of isolation and to develop behaviours that enhance career-resilience.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.nepr.2020.102883DOI Listing
October 2020

Factors influencing care-seeking delay or avoidance of heart failure management: A mixed-methods study.

Int J Nurs Stud 2020 Aug 11;108:103603. Epub 2020 Apr 11.

Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, PO Box 123, Ultimo, New South Wales 2007, Australia.

Background: Delayed care-seeking for heart failure symptoms increases the risk of unplanned and frequent hospitalization. Presenting to hospital at a later stage when symptoms are severe requires more complex treatment, contributing to longer lengths of stay and higher risk of mortality. Patient-related factors such as knowledge have been highlighted as key contributors to care-seeking delay, yet little is known about how previous experiences within the healthcare setting, including relationships with providers, influence decisions to engage with health services when required.

Objective: To assess patient-related factors thought to impact care-seeking, and examine the role of previous healthcare experiences in decisions to seek or avoid professional care.

Design: Sequential mixed-methods study with a phenomenological approach.

Settings: A cardiology in-patient ward in a quaternary referral hospital in Sydney, Australia.

Participants: A total of 72 symptomatic in-patients diagnosed with heart failure.

Methods: Self-efficacy, heart failure knowledge and health literacy were assessed quantitatively. Semi-structured, in-depth interviews were undertaken with a subset of participants to elicit previous healthcare experiences and their influence on seeking care when symptoms worsened. Qualitative data were analyzed using interpretative phenomenological analysis and interpreted in the context of quantitative findings.

Results: Three major themes were identified that impacted decisions to seek or avoid professional care: (i) preference for continuity; (ii) previous hospital experience and; (iii) patient-provider relationships. Avoidance of care-seeking was described, despite quantitative data reflecting high levels of self-efficacy, heart failure knowledge (12.3±1.9 out of 15), and above-average health literacy levels (75% adequate - 15% higher than average in heart failure). The qualitative and quantitative data together demonstrate that participants delayed seeking care for heart failure symptoms despite having sound knowledge and self-efficacy to seek professional care when necessary.

Conclusion: Previous healthcare experience affects patient's subsequent action, despite having skills and heart failure knowledge. Interactions with the healthcare system and those within it may impact decisions to avoid seeking treatment more than patient-related factors such as condition-specific understanding.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijnurstu.2020.103603DOI Listing
August 2020

'It's quite a complex trail for families now' - Provider understanding of access to services for Aboriginal children with a disability.

J Child Health Care 2021 06 17;25(2):194-211. Epub 2020 Apr 17.

Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia.

Aboriginal and Torres Strait Islander children experience a higher prevalence of disability and socio-economic disadvantage than other Australian children. Early intervention from across the health, education and social service sectors is vital for improving outcomes, but families face a number of barriers to service access which impede intervention. This study aimed to inform ways to improve access to services for families of urban-dwelling Aboriginal children with a range of disabilities. A qualitative approach was taken to explore providers' perceptions of factors that either impeded or enabled families' access to services. In this research, the term 'provider' refers to individuals who are employed in a range of sectors to deliver a service involving assessment or management of an individual with a disability. Semi-structured in-depth interviews with 24 providers were conducted. Data analysis was informed by the general inductive approach and then applied deductively to the candidacy framework to generate additional insights. Candidacy focuses on how potential users access the services they need and acknowledges the joint negotiation between families and providers regarding such access. Our research identified that candidacy was influenced by the historical legacy of colonisation and its ongoing socio-cultural impact on Aboriginal people, as well as funding and current policy directives. Enacting culturally sensitive and meaningful engagement to better understand families' needs and preferences for support, as well as support for providers to develop their understanding of family contexts, will contribute to facilitating service access for Aboriginal children with a disability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1367493520919305DOI Listing
June 2021

Health screening and preventative health care in refugee women: A qualitative analysis.

Contemp Nurse 2020 Feb 31;56(1):62-79. Epub 2020 Mar 31.

Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.

Regular health screening provides opportunities for early detection and effective treatment of disease. There is underutilisation of health services by migrants from culturally and linguistically diverse backgrounds, particularly refugees in Australia. To explore the beliefs, understandings, and use of health and healthcare screening services among African refugee women living in Australia. Qualitative secondary analysis. : Oral narratives derived from two primary qualitative datasets of Sub-Saharan women in New South Wales, Australia, underwent secondary thematic analysis. Twenty-two of the forty-two women had refugee status on migrating to Australia. Thematic findings reflection of misinformation, low health literacy, and health screening as not a priority. There is an urgent need to develop innovative strategies to engage refugee migrant women in health screening by provision of culturally meaningful health information. Including refugee women's suggestions for information to be provided by health services may improve attitudes towards screening and preventative health care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10376178.2020.1739543DOI Listing
February 2020

Patient preferences for heart failure education and perceptions of patient-provider communication.

Scand J Caring Sci 2020 Dec 27;34(4):1094-1101. Epub 2020 Jan 27.

Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.

Objective: For people managing chronic illness, such as heart failure, adequate health literacy is crucial to understand the complex information that underpins self-care, yet evidence suggests poor understanding in this patient population. To better understand patients' heart failure comprehension and why knowledge gaps may exist, this study sought to explore perceptions of patient-provider communication and ascertain unmet educational needs and preferences.

Methods: Semi-structured in-depth interviews were conducted with 15 symptomatic inpatients with heart failure. Data collection and analysis occurred simultaneously until saturation was reached. Transcripts were analysed using thematic analysis.

Results: Participants relied heavily on providers for HF information and support, expressed numerous unmet educational needs and had mixed feelings about quality of communication. Participants expressed the need for credible, tailored heart failure information that accounted for comorbid conditions and preference for face-to-face information delivery. Knowledge gaps included heart failure pharmacotherapy, symptom appraisal and management, cause and chronicity of heart failure, and a specific action plan for heart failure symptom exacerbation. Barriers to effective patient-provider communication included providers using complex medical terminology, lack of adequately detailed information, relationships that did not foster open communication and participants' memory problems.

Conclusion: Gaps in knowledge and poor communication may indicate inadequate availability of multidisciplinary heart failure management programmes and/or fidelity to guideline recommendations.

Practice Implications: Evaluating heart failure management programmes is important to ensure consistent delivery of best-practice education and care. Nurses play a key role in the delivery of patient-focused health information.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/scs.12820DOI Listing
December 2020

Resilience of African migrant women: Implications for mental health practice.

Int J Ment Health Nurs 2020 Feb;29(1):92-101

Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia.

Migrants from areas affected by war, especially refugee migrants, are susceptible to mental health issues. In addition to recognising trauma, health professionals, such as mental health nurses, need to be aware of the strength and resilience of refugees and migrants. The capacity to provide trauma-informed care that is shaped by the recognition of clients' strength and resilience is required/paramount to meet the current demand of multiculturalism emanating from an increased global migration. To facilitate increased awareness about West African women's resilience prior to migration and support trauma-informed care, we used a qualitative strength-based storytelling approach with 22 West African women residing in Sydney, Australia. Thematic analysis of the women's stories identified two major themes: When the World Falls Apart and Battered but Strong. Findings revealed that past personal experiences significantly influenced participants' strength and resilience and contributed to their mental health. Mental health professionals such as nurses can play an important role by incorporating knowledge about the resilience of migrants and refugees into providing appropriate trauma-informed care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/inm.12663DOI Listing
February 2020

Collaborating across sectors to provide early intervention for Aboriginal and Torres Strait Islander children with disability and their families: a qualitative study of provider perspectives.

J Interprof Care 2020 May-Jun;34(3):388-399. Epub 2019 Dec 10.

Faculty of Health, IMPACCT, University of Technology Sydney, Sydney, Australia.

Aboriginal and Torres Strait Islander children experience a higher prevalence of disability than other Australian children. Early intervention from across the health, education, and social service sectors is vital for improving outcomes, but families face lack of coordination between services. This study aimed to inform improvements in service access for families of urban-dwelling Aboriginal children with disability through exploring providers' perceptions of factors that influenced working together across sectors. Semi-structured interviews were conducted. Data analysis was informed by the general inductive approach and the Collaborative Practice to Enhance Patient Care Outcomes framework. Twenty-four providers participated. Interprofessional collaborative practice was influenced by interdependent interactional and organizational factors. Interactional factors fit within one of two dimensions: the ability of providers to share common goals and vision within a complex cross-sector service landscape, and influence of interpersonal relationships on their sense of belonging working in a cross-cultural space. Organizational factors also fit within one of two dimensions: the influence of governance in relation to its role in coordination and unlocking the strength of schools as service settings, and the need to formalize processes for effective interprofessional communication. Interprofessional collaborative practice was managed within the context of systemic factors relating to policy and funding. These findings demonstrate the complex interplay of factors related to the cross-sector involvement of providers in early intervention service provision. Consideration of these factors is required to facilitate collaborative cross-sector responses to improve service access for Aboriginal families. WHO: world health organization; ACCHS: aboriginal community controlled health service; GP: general practitioner; NDIS: national disability insurance scheme.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13561820.2019.1692798DOI Listing
March 2021

Financial stress experienced by informal carers of adults with a chronic disease: Results from an Australian population-based cross-sectional survey.

Australas J Ageing 2020 Sep 3;39(3):254-262. Epub 2019 Nov 3.

Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.

Objective: To identify caregiving characteristics that are associated with financial stress in Australian carers of people with a chronic disease.

Methods: Data were collected via the South Australian Health Omnibus, an annual population-based, cross-sectional survey. Individuals who provided care to someone with prevalent chronic conditions were asked about financial stress and caregiving characteristics.

Results: Of 32.4% (988/3047) who were carers, 13.4% (132/988) experienced financial stress. Adjusting for age and household income, providing more than 20 hours of care per week (AOR = 2.39, 95% CI = 1.48-3.86), transport assistance (AOR = 1.89, 95% CI = 1.15-3.09) and assistance with household tasks (AOR = 1.92, 95% CI = 1.14-3.26) and caring for a person with a mental illness (AOR = 2.01, 95% CI = 1.24-3.28) were associated with a significant increase in odds of experiencing financial stress. Caring for a person with cancer (AOR = 0.49, 95% CI = 0.30-0.81) or dementia (AOR = 0.40, 95% CI = 0.21-0.76) was associated with decrease in odds.

Conclusions: Financial stress was reported by more than 13% of carers, and factors other than household income were implicated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajag.12739DOI Listing
September 2020

Disadvantaged and disenfranchised in bereavement: A scoping review of social and structural inequity following expected death.

Soc Sci Med 2019 12 12;242:112599. Epub 2019 Oct 12.

Faculty of Health, The University of Technology Sydney, 235 Jones St, Ultimo, NSW, 2007, Australia. Electronic address:

An emphasis on individual intervention and psychological complexity has characterised research on bereavement following an experience of life-limiting illness. Exploration of "structural vulnerability" as a positionality produced by social and structural inequity could provide insights into areas of practice and policy in need of development. This scoping review sought to summarise published research on experiences of social and structural inequities in the context of bereavement due to life-limiting illness. Underpinned by recognised methodological frameworks, systematic searches were conducted of four electronic databases. Eligible studies attended to bereavement experience following the death of an adult due to life-limiting illness, included consideration of social and structural inequities, and were undertaken in high income countries between 1990 and 2018. Following thematic analysis, a conceptual framework was developed. Of 322 records, 62 full text articles were retrieved and 15 papers met inclusion criteria. Studies highlighted unequal social status in bereavement related to gender, class, sexuality, ethnicity and age, with structural inequity experienced in interactions with institutions and social networks. Studies also identified that the experience of bereavement itself may be accompanied by exposure to disenfranchising systems and processes. Structural vulnerability appeared to be associated with outcomes including psychological distress, social disenfranchisement and practical concerns such as financial strain, housing insecurity and employment issues. Social and structural inequities potentially contribute to layered and patterned experiences of disadvantage and disenfranchisement following expected death, with implications for individual agency. Findings point to the need for consideration of socio-ecological approaches within and beyond specialist palliative care, involving development of more responsive social policy, coordinated advocacy, and systemic capacity building regarding experiences of grief, to better support populations positioned as structurally vulnerable in bereavement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.socscimed.2019.112599DOI Listing
December 2019

Health status in South Australians caring for people with cancer: A population-based study.

Psychooncology 2019 11 30;28(11):2149-2156. Epub 2019 Aug 30.

Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney (UTS), Sydney, New South Wales, Australia.

Objectives: To compare physical and mental health status between cancer carers versus non-carers in a population-based sample and explore sociodemographic and caring characteristics associated with poor carer health status.

Methods: The South Australian Health Omnibus is a population-based cross-sectional survey. Carer status was self-defined by participants as having cared for someone with cancer in the last 5 years. Health status was considered poor if it was 0.5 standard deviation lower than Australian norms on the Medical Outcomes Study 12-Item Short-Form (SF-12) physical and mental component summary scores (PCS and MCS). Regression analyses compared mean PCS/MCS between carers versus non-carers, controlling for sociodemographic variables, and explored associations between poor health status and caring and support among carers.

Results: The weighted sample included 2962 people, of whom 374 (12.6%) were cancer carers and 1993 (67.3%) non-carers. Carers had significantly worse PCS/MCS, controlling for sociodemographic variables, but did not differ significantly regarding proportions with poor health status. Carer characteristics associated with poor PCS and MCS included socio-economic indicators and involvement in medication management. Assisting with household tasks was protective.

Conclusions: This population-based study followed those previous ones in finding cancer carers to have poorer mean health status than non-carers. However, differences were less pronounced than previously reported, likely because of the sample being drawn from a general rather than cancer service population and including past as well as current carers, as well as all cancer types and stages. Future longitudinal research is needed to identify factors that predict recovery post caring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pon.5200DOI Listing
November 2019

Nurses' perceptions of the sustainability of a standardised assessment for preventing complications in a ICU: a qualitative study.

Contemp Nurse 2019 Apr - Jun;55(2-3):221-236

e Department of Sport Studies, Faculty of Educational Studies / Sport Academy, Universiti Putra Malaysia , Malaysia.

Quality improvement projects have been widely adopted to prevent complications in the ICU. This paper describes nurses' perceptions of implementation strategies and the potential sustainability of a practice change intervention to prevent complications in a Malaysian ICU. A participatory action research using five focus group discussions were undertaken with 19 nurses in a single ICU in regional Malaysia. Focus group transcripts were analysed using thematic analysis. The main themes derived from the interviews were: [1] Empowering staff to embrace evidence-based practices; [2] Staff knowledge, attitudes, and beliefs that impact on behaviour; and [3] management support and leadership are influential in staff behaviours (acceptance & perseverance of change process). Resistance to change was recognized as a barrier to adopting evidence based recommendations. There is a need to improve nurses' knowledge, attitude and awareness of the importance of assessment for VAP, CRBSI and PIs in the ICU.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10376178.2019.1643751DOI Listing
February 2020

The rapid response system: an integrative review.

Contemp Nurse 2019 Apr - Jun;55(2-3):139-155. Epub 2019 Jun 22.

b Faculty of Health, University of Technology Sydney , PO Box 123, Ultimo , NSW 2007 , Australia.

Clinical deterioration and adverse events in hospitals is an increasing cause for concern. Rapid response systems have been widely implemented to identify deteriorating patients. We aimed to examine the literature highlighting major historical trends leading to the widespread adoption of rapid response systems, focussing on Australian issues and identifying future focus areas. Integrative literature review including published and grey literature. Seventy-eight sources including journal articles and Australian government matierlas resulted. Pertinent themes were the increasing acuity and aging of the population, importance of hospital cultures, the emerging role of the consumer, and proliferation, evolution and standardisation of rapid response systems. Translating evidence to usual care practice is challenging and strongly driven by local factors and political imperatives. Rapid response systems are complex interventions requiring consideration of contextual factors at all levels. Appropriate resources, a skilled workforce and positive workplace cultures are needed for these systems to reach their full potential.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10376178.2019.1633940DOI Listing
February 2020

Improved adherence in older patients with hypertension: An observational study of a community-based intervention.

Int J Older People Nurs 2019 Sep 7;14(3):e12248. Epub 2019 Jun 7.

Department of Acute and Chronic Care, The Johns Hopkins University, Baltimore, Maryland.

Aims And Objectives: This study sought to assess the effect of a community-based intervention influencing adherence status at baseline, 1, 3 and 6 months, and to evaluate the impact that a community-based intervention and socio-economic factors have on adherence.

Background: Although high-quality treatment and modern hypertension clinical practice guidelines have been developed worldwide, the outcomes of patients with hypertension in Thailand are not optimal. Implementing a person-centred and integrated health services model to improve hypertension management, such as a community-based intervention, is challenging for healthcare providers in Thailand.

Design: An observational study of a community-based intervention.

Methods: The study comprised residents in 17 villages in one province of Thailand. A sample of 156 participants was allocated into the intervention and the control groups. Inclusion criteria were people aged 60 years or older diagnosed with hypertension. Exclusion criteria included the latest record of extreme hypertension and having a documented history of cognitive impairment. The intervention group received the 4-week community-based intervention programme. Multiple linear regression was applied to predict the adherence status at each phase. Multiple logistic regression was then implemented to predict influencing factors between the groups.

Results: Patients who received the intervention had significantly lower adherence scores (reflecting a higher level of adherence) at 3 and 6 months after intervention by 1.66 and 1.45 times, respectively, when adjusting for other variables. After 6 months, the intervention was associated with a significant improvement in adherence when adjusting for other variables.

Conclusion: This study provides evidence to support the use of community-based interventions as an effective adjunct to hospital-based care of hypertension patients in Thailand.

Implications For Practice: Understanding factors between health outcomes and social determinants of health is crucial for informing the development of culturally appropriate interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/opn.12248DOI Listing
September 2019

Exploring the experiences of early career academic nurses as they shape their career journey: A qualitative study.

Nurse Educ Today 2019 May 5;76:68-72. Epub 2019 Feb 5.

IMPACCT (Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Australia; Johns Hopkins University, Baltimore, MD, United States of America. Electronic address:

Objective: This study aimed to explore the experiences of early career academic nurses as they shape their career path in one Australian university.

Background: The early years of academic career development can be challenging as individuals learn to adjust to the teaching, research and service mission of universities. Tertiary institutions have an obligation to provide future nursing leaders with relevant and timely support during the formative phase of career development, to be successful in a competitive global environment.

Design: A qualitative descriptive approach was used and data were analysed thematically using Braun and Clarke (2006) six phase process.

Methods: Eleven early career academic nurses who were interviewed, had completed, or were near completion of a doctorate and were within seven years of full-time academic employment.

Results: The four themes that emerged from the analysis were: embarking on the journey; the toil of the journey; fellow travellers on the journey, and strategies for a successful journey.

Conclusions: Findings from this study can be used to inform customised mentorship programs for nurse academics during their initial stage of career employment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.nedt.2019.01.021DOI Listing
May 2019

Interacting With Providers: An Intersectional Exploration of the Experiences of Carers of Aboriginal Children With a Disability.

Qual Health Res 2018 10 12;28(12):1923-1932. Epub 2018 Aug 12.

1 University of Technology Sydney, Sydney, New South Wales, Australia.

Intersectionality has potential to create new ways to describe disparities and craft meaningful solutions. This study aimed to explore Aboriginal carers' experiences of interactions with health, social, and education providers in accessing services and support for their child. Carers of Aboriginal children with a disability were recruited from an Australian metropolitan Aboriginal community-controlled health service. In-depth, semistructured interviews were conducted with 19 female carers. Intersectionality was applied as an analytical framework due to the inherent power differentials for Aboriginal Australians and carers for people with a disability. Marginalization and a lack of empowerment were evident in the experiences of interactions with providers due to cultural stereotypes and racism, lack of cultural awareness and sensitivity, and poverty and homelessness. Community-led models of care can help overcome the intersectional effects of these identities and forms of oppression in carers' interactions with providers and enhance access to care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1049732318793416DOI Listing
October 2018

Optimal Gender-Specific Strategies for the Secondary Prevention of Heart Disease in Women: A SYSTEMATIC REVIEW.

J Cardiopulm Rehabil Prev 2018 09;38(5):279-285

Faculty of Health, University of Technology Sydney, Sydney, Australia (Ms Rao and Drs DiGiacomo, Hickman, and Davidson); Western Sydney University, Sydney, Australia (Dr Newton); St. Vincent's Hospital Sydney, Darlinghurst, Australia (Ms Hwang); and School of Nursing, Johns Hopkins University, Baltimore, Maryland (Dr Davidson).

Background: There is a paucity of evidence on gender-specific, individually tailored secondary prevention (cardiac rehabilitation [CR]) services for women with heart disease. Women participate less in CR programs, thus increasing their risk of further cardiac events. This review aims to (1) determine the effectiveness of gender-specific interventions specifically designed for women with heart disease, delivered in outpatient CR settings; and (2) classify key elements of effective CR strategies/models for women with heart disease.

Methods: Using the PRISMA guidelines, this is a systematic review of CR models tailored to women to improve cardiovascular risk. Four databases were searched for randomized controlled trials (RCTs) between January 1974 and July 2017 published in peer-reviewed English language journals.

Results: Three RCTs comprising 725 women of gender-specific CR strategies were identified. Significant improvements were found in one-third (1 study) of the included multicomponent CR strategies for outcomes including general health, social functioning, vitality, mental health, depression, and quality of life.

Conclusion: Further large-scale RCTs are required to replicate positive findings and accurately assess the capacity for gender-specific multicomponent CR programs that incorporate participant-driven collaborative models to moderate psychological risk and improve functional capacity and quality of life for women with heart disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HCR.0000000000000335DOI Listing
September 2018

Health status of people who have provided informal care or support to an adult with chronic disease in the last 5 years: results from a population-based cross-sectional survey in South Australia.

Aust Health Rev 2019 Aug;43(4):408-414

University of Technology Sydney (UTS), Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Building 10, 235 Jones Street, Ultimo, NSW 2007, Australia. Email: ;

Objective The aim of the present study was to compare the health status of South Australians with recent experience of caring for an adult with chronic disease with non-carers drawn from the same population. Methods Data were collected via the South Australian Health Omnibus, an annual population-based, cross-sectional survey. Respondents were asked whether they had provided care or support in the last 5 years to someone with cancer, heart disease, respiratory disease, mental illness, neurological disease or dementia. Health status was measured using the Short Form-12 version 1 (SF-12) physical and mental component scale summary scores (PCS and MCS respectively), with poor health status defined as ≥0.5 standard deviation below the normative mean. Logistic regression explored characteristics associated with poor health status. Results Of 3033 respondents analysed, 987 (32.5%) reported caring experience. Poor PCS and MCS were associated with carer status, lower-than-degree-level education, employment status other than employed and annual household income less than A$60000. Being Australian born was a protective factor for PCS, whereas factors protective for MCS were being married or in a de facto relationship and age ≥65 years. Conclusions Providing care or support in the last 5 years is independently associated with poorer health status, but not with the magnitude found in studies of current carers. Future research should explore health status recovery after completion of the caring role, and investigate whether relationships between health and socioeconomic status differ for carers versus non-carers. What is known about the topic? Population-based survey studies in Australia and overseas have consistently found that informal carers have worse health status than non-carers. What does this paper add? Including recent as well as current carers in a population-based sample was associated with less effect on health status compared with studies focused on current carers only. This finding is consistent with the possibility that health status recovers during the 5 years after caring. What are the implications for practitioners? Support for Australian carers is warranted to ensure their continuing contributions to society and return to productivity after their caring role is completed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1071/AH17289DOI Listing
August 2019

Improving evidence based practice in postgraduate nursing programs: A systematic review: Bridging the evidence practice gap (BRIDGE project).

Nurse Educ Today 2018 Apr 31;63:69-75. Epub 2018 Jan 31.

Centre for Cardiovascular & Chronic Care, University of Technology Sydney, Australia. Electronic address:

Background: The nursing profession has a significant evidence to practice gap in an increasingly complex and dynamic health care environment.

Objective(s): To evaluate effectiveness of teaching and learning strategies related to a capstone project within a Masters of Nursing program that encourage the development of evidence based practice capabilities.

Design: Systematic review that conforms to the PRISMA statement.

Sample: Master's Nursing programs that include elements of a capstone project within a university setting.

Data Sources/review Methods: MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, ERIC and PsycInfo were used to search for RCT's or quasi experimental studies conducted between 1979 and 9 June 2017, published in a peer reviewed journal in English.

Results: Of 1592 studies, no RCT's specifically addressed the development of evidence based practice capabilities within the university teaching environment. Five quasi-experimental studies integrated blended learning, guided design processes, small group work, role play and structured debate into Masters of Nursing research courses. All five studies demonstrated some improvements in evidence based practice skills and/or research knowledge translation, with three out of five studies demonstrating significant improvements.

Conclusions: There is a paucity of empirical evidence supporting the best strategies to use in developing evidence based practice skills and/or research knowledge translation skills for Master's Nursing students. As a profession, nursing requires methodologically robust studies that are discipline specific to identify the best approaches for developing evidence-based practice skills and/or research knowledge translation skills within the university teaching environment. Provision of these strategies will enable the nursing profession to integrate the best empirical evidence into nursing practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.nedt.2018.01.015DOI Listing
April 2018

A framework for an asset-informed approach to service mapping.

Nurse Res 2017 12;25(3):19-25

School of Nursing, Johns Hopkins University, Baltimore, United States.

Background: Asset-informed approaches are increasingly emphasised in public health, but transferring this approach to planning health services requires prospective systematic methods. Asset-informed approaches to service-mapping have started to develop, but there are no standardised guidelines. These methods are becoming of particular interest, as nurses engage in population health activities.

Aim: To identify methods of asset-informed mapping for addressing health problems and develop a framework to support the methodological rigour of service-mapping.

Discussion: The authors undertook an integrative literature review using a systematic approach and narrative synthesis. Ten articles met the inclusion criteria. Reported methods included the formation of a core team to drive the process, as well as varying detail about methods of collecting data and forming maps. Challenges and solutions included the effectiveness of the core team depending on having a designated leader, frequent meetings and previous partnerships, using community 'cultural brokers', and determining aims and scope.

Conclusion: Results of the review can be used to modify existing generic resources for asset-informed mapping to their application in health services. Four main stages seem especially applicable and important: defining the parameters of the service-mapping process; identifying services; mapping services; and consultation and implementation.

Implications For Practice: The shift towards asset-informed approaches in community and public health is an important step in realising the potential of existing assets in communities to influence health outcomes. The framework offered in this paper is intended to assist in developing an evidence base, by promoting the systematic and rigorous reporting of methods used in asset-informed approaches to service-mapping.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7748/nr.2017.e1479DOI Listing
December 2017

Experiences and needs of carers of Aboriginal children with a disability: a qualitative study.

BMC Fam Pract 2017 Nov 29;18(1):96. Epub 2017 Nov 29.

Western Sydney University, Locked Bag 1797, Penrith, NSW, 1797, Australia.

Background: Australian parents/carers of a person with a disability experience higher rates of depression, more financial stress, and are twice as likely to be in poor physical health than the general population. Aboriginal and Torres Strait Islander peoples experience worse health, social and economic outcomes than other Australians, and those with a disability face 'double disadvantage'. This study aimed to better understand the experiences and needs of parents/carers/families of Aboriginal children with a disability.

Methods: Semi-structured in-depth interviews were conducted with parents or primary carers of Aboriginal children aged zero-eight with disability. Interviews were analysed using thematic analysis.

Results: Nineteen women (sixteen mothers and three grandmothers) were interviewed. More than half were lone carers (without a partner or spouse). Participants described their experiences, including challenges and facilitators, to providing and accessing care, impacts on their health and wellbeing, and associated economic and non-economic costs of caregiving. Financial strain and social isolation was particularly prominent for lone carers.

Conclusions: Tailoring services to the needs of carers of Aboriginal children with a disability means supporting kinship caregiving, facilitating engagement with other Aboriginal families, and streamlining services and systems to mitigate costs. The experiences described by our participants depict an intersection of race, socio-economic status, gender, disability, and caregiving. Services and funding initiatives should incorporate such intersecting determinants in planning and delivery of holistic care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12875-017-0668-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707922PMC
November 2017
-->