The recognition and nursing management of common oncological emergencies in children.

An oncological emergency may be the initial presentation of a cancer, a sign of cancer progression, or a complication of cancer treatment. The most frequently encountered paediatric oncological emergencies include neutropenic sepsis, hyperleukocytosis, brain tumours presenting with raised intracranial pressure, tumour lysis syndrome and superior mediastinal syndrome. These are all life-threatening conditions that require urgent recognition and management. Health professionals working in an emergency department (ED) are likely to be involved in managing these children. This article brings together the current guidance and recommendations for these specific emergencies. It also includes two case studies that demonstrate the challenges health professionals can face while managing these situations. It is important that health professionals have an acute awareness of oncological emergencies. Confidence in recognising the presentations, diagnoses and initial management are essential because these conditions may be life-threatening and time critical.

Recognition and management of foreign body ingestion and aspiration.

Foreign body ingestion and foreign body aspiration commonly affect children. The most vulnerable age is between six months and four years, when children tend to explore new objects with their mouths. Many of these events remain asymptomatic, with the swallowed object passing through the gastrointestinal tract without causing harm. However, the frequency of serious complications as a result of the ingestion of hazardous objects has increased in recent years, in particular button batteries and magnets. To increase the likelihood of identifying foreign body ingestion and aspiration, healthcare professionals should maintain a high index of suspicion, be aware of the variation in presentations and include it as a differential diagnosis in children presenting with non-specific symptoms, such as fever, cough, drooling, dysphagia and abdominal pain. Management of most foreign body ingestions is conservative, using a 'watch-and-wait' approach. Children should be triaged as an emergency if they have signs or symptoms of airway obstruction or a history that indicates dangerous foreign body ingestion. Early recognition and management leads to improved outcomes for patients. Nurses have a vital role in providing education and practical advice to parents, which reduces the occurrence of these events. Stronger legislation is required to ensure manufacturers emphasise the potential dangers of certain products and design child-safe devices.

Transition of graduates of the Master of Occupational Therapy to practice.

BACKGROUND/AIM: The transition from classroom to clinical practice is a necessary and challenging journey for occupational therapy students. In recent years, worldwide trends in occupational therapy education are moving towards graduate-entry in professional preparation courses. Little is known about the journey experienced by these graduates when they enter practice. This qualitative study aimed to explore the lived experience of these graduates in their transition from student to practitioner within first six months of practice. METHODS: A phenomenological approach was adopted for this study. Using purposive sampling, eight participants from a recent graduate cohort of the Master of Occupational Therapy from the University of Sydney were recruited. Data was collected via in-depth, face-to-face interviews. The focus of inquiry was on the experience of transition. Interviews were audio-taped, transcribed and analysed thematically. Member checking and consensus coding were conducted to increase trustworthiness of the study. RESULTS: Four themes emerged from the interview data. The themes were (i) valuing maturity; (ii) being new; (iii) needing skills; and (iv) pursuing satisfaction. Participants described metaphors about their experience across and within these themes. CONCLUSIONS: Recognising the experience of transition from student to practitioner has the potential to assist university staff in the development of the educational curriculum. Understanding this transition can also help employers and therapists in providing adequate support and supervision for new graduates. Furthermore, awareness of the transition experience allows students to better prepare themselves for their own transition to practice.

A case study of occupational therapy managers in NSW: Roles, responsibilities and work satisfaction.

BACKGROUND: Job satisfaction has been shown to affect levels of staff retention and productivity, but few studies have been conducted on the work of occupational therapy managers and their job satisfaction. This study explores the roles and responsibilities of occupational therapy managers who are clinician-managers or manager-administrators, and sources of their work satisfaction. METHODS: A collective case study involved telephone interviews with 16 occupational therapy managers. Semistructured interview questions were based on an earlier discussion with a separate group of occupational therapy managers. Interview transcripts were analysed for emerging themes. RESULTS: There were no clear differences in the roles and responsibilities of the two types of managers (manager-administrators and clinician-managers); however, manager-administrators tended to be responsible for larger numbers of staff. Managers reported that taking a clinical caseload is often at their own discretion. A common challenge for managers is the balancing of priorities as a clinician and a manager. Managing people was a common source of joy and sometimes a source of frustration. Mediating between staff and senior management and the need for budget control and efficiencies was an important aspect of managers' work, as was their autonomy to make decisions. CONCLUSIONS: Occupational therapy managers assume responsibilities consistent with clinician managers across disciplines. The main sources of work satisfaction related to people management particularly when staff were working effectively as a team and there was respect from senior management. Further research will confirm whether there are no obvious differences between clinician-manager and manager-administrators, and whether there are clear differences in work-related frustration across sectors.