"You don't want to know just about my lungs, you want to know more about me". Patients and their caregivers' evaluation of a nurse-led COPD supportive care service.

AIM: To evaluate a nurse-led model of supportive care in a COPD outpatient service from patient and caregiver perspectives. DESIGN: Case study methodology. METHODS: Data were collected from semi-structured interviews with patients (n = 12) and caregivers (n = 7) conducted between April 2020 and September 2022. A purposive sampling strategy was used. Interviews were transcribed verbatim and analysed using content analysis with an inductive approach. COREQ guidelines informed reporting of this study. RESULTS: Eight categories were identified from the data evaluating of the model of care relating to the most helpful aspects of COPD supportive care and suggested improvements to the model of care. The categories were: guidance with managing symptoms; participating in advance care planning; home visiting; expert advice; continuity and trust; caring; caregiver support and improvements to the model of care. CONCLUSION: In a nurse-led model of COPD supportive care, what patients and caregivers valued most was expert advice and guidance with symptom management, flexible home visiting, participation in advance care planning, caring and continuity within an ongoing trusted therapeutic relationship. Understanding what patients and caregivers value most is essential in designing and delivering models of care that meet the needs of patients living with chronic, life-limiting illness. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses can lead effective models of supportive care that offer valuable support to patients living with COPD and their caregivers.

Practical advice for refugees aspiring to become registered nurses in Australia.

AIMS: This paper describes practical advice for refugees aspiring to become Registered Nurses (RNs) in Australia. DESIGN: Qualitative description using a naturalistic inquiry framework. METHODS: Between February 2018 and September 2019, the lead author conducted semi-structured interviews with employed RNs that are former refugees that speak English. Interviews were 45-90 min in duration and digitally recorded. Participants provided voluntary informed consent and were sent questions beforehand. All transcription data were thematically analysed for key themes until no further themes were identified. This paper covers practical advice provided by the participants at the conclusion of their interviews. RESULTS: Twelve participants provided practical advice. Six themes were identified: (1) Find your purpose and set goals; (2) Work hard and never give up; (3) Seek support; (4) Capitalize on opportunities; (5) Be optimistic; (6) Give back. The last theme, give back, was salient across all interviews and was an inherent motivator for some participants once their RN status was achieved. CONCLUSION: Each participant set the goal of becoming a fully registered nurse and made it a life goal that provided meaning for them. Despite their experiences, the participants provided practical advice that could guide younger people aspiring to become successfully qualified RNs. IMPACT: The findings in this study are unique as they are derived from people with experiences as refugees who, despite their adversity, became RNs. The practical advice provides a framework not only for younger people from refugee backgrounds seeking to achieve their professional goals, but others looking to succeed in other workforce sectors. The practical advice for success will be useful in informing nursing authorities, tertiary institutions and private and public health organizations to develop effective approaches to guide the next generation of would-be RNs set to contribute to nursing practice in Australia. There were no patient or public contributions as the focus was the personal and professional lives of nurses with refugee backgrounds.

Embedding nurse-led supportive care in an outpatient service for patients with Chronic Obstructive Pulmonary Disease.

AIM: To describe a small multidisciplinary team's experience of the process of embedding nurse-led supportive care into an existing Chronic Obstructive Pulmonary Disease outpatient service. DESIGN: Case study methodology METHODS: Data were collected from multiple sources including key documents and semi-structured interviews with healthcare professionals (n = 6) conducted between June and July 2021. A purposive sampling strategy was used. Content analysis was applied to key documents. Interviews were transcribed verbatim and analysed using an inductive approach. RESULTS: Subcategories under the four-stage process were identified from the data. ASSESSMENT: evidence of needs of patients with Chronic Obstructive Pulmonary Disease; gaps in care and evidence of other models of supportive care. Planning: setting the supportive care service structure and intention; resources and funding; leadership, specialization and respiratory/palliative care roles. IMPLEMENTATION: relationships and trust; embedding supportive care and communication. EVALUATION: benefits and positive outcomes for staff and patients, and, improvements and future considerations for supportive care in the COPD service. CONCLUSION: A collaboration between respiratory and palliative care services resulted in successfully embedding nurse-led supportive care in a small outpatient service for patients with Chronic Obstructive Pulmonary Disease. Nurses are well placed to lead new models of care that aim to address unmet biopsychosocial-spiritual needs of patients. More research is needed to evaluate nurse-led supportive care in Chronic Obstructive Pulmonary Disease and other chronic illness settings; the effectiveness of nurse-led supportive care from the perspective of patients and caregivers and the impact of nurse-led supportive care on health service usage. PATIENT OR PUBLIC CONTRIBUTION: The development of the model of care is informed by ongoing discussions with patients with COPD and their caregivers. Data availability statement: Research data are not shared (due to ethical restrictions). IMPACT: Embedding nurse-led supportive care in an existing Chronic Obstructive Pulmonary Disease outpatient service is achievable. Nurses with clinical expertise can lead innovative models of care that address the unmet biopsychosocial-spiritual needs of patients with conditions such as Chronic Obstructive Pulmonary Disease. Nurse-led supportive care may have utility and relevance in other chronic disease contexts.

Being tied down-The experience of being physically restrained while mechanically ventilated in ICU.

AIMS: To explore the experience of physical restraints during mechanical ventilation in intensive care from the perspectives of patients and family members. DESIGN: This research was a qualitative study with a naturalistic inquiry framework adhering to the Consolidated Criteria for Reporting Qualitative Research guidelines. METHOD: In-depth, semi-structured conversations were conducted with five patients and six family members who had either personally experienced or witnessed their loved ones being physically restrained during mechanical ventilation in intensive care. Data collection occurred between March 2018 and June 2019. These conversations were audio-recorded and transcribed. Reflexive thematic analysis was used to analyse the data. RESULTS: Three major themes emerged from the data. These themes were: Being tied down; Feeling helpless; and Finding light in the darkness. CONCLUSION: The experience of physical restraints during mechanical ventilation in intensive care leads to traumatic experiences which can impact patients and families long after their ICU stay. Holistic care, which considers the physical, emotional and psychological needs of patients and families, should be more thoroughly explored when managing treatment interference to minimize harm. IMPACT: This study gained insight into the physical, emotional and psychological consequences of applying physical restraints to patients who are mechanically ventilated as an intervention for preventing treatment interference. The findings of this study have the potential to improve ICU patient and family outcomes by influencing current physical restraint practices. Recommendations from this research can contribute to practice change by informing policy, shifting workplace culture and norms about restraints, and encouraging education and training.

Milestones in the journey: The story of refugees becoming registered nurses in Australia.

AIMS: To explore the experiences of refugees who became registered nurses after arriving to Australia. DESIGN: Qualitative description using a naturalistic inquiry framework. METHODS: Between February 2018 and September 2019, the lead author conducted semi-structured interviews with employed registered nurses (RNs) that are former refugees and English-speaking. Interviews were 45-90 min' duration and digitally recorded. Participants provided voluntary informed consent and were sent questions beforehand. Data were collected and coded into themes. Rigor was achieved with multiple transcript readings by the research team to confirm common themes. RESULTS: Twelve participants discussed their story. Three major themes were identified: (1) Milestone of being a refugee; (2) Milestone of resettling in Australia; (3) Milestone of becoming a RN. CONCLUSION: Each participant's story started at a place of disadvantage. They progressed successfully through the three milestones; despite living with traumatic experiences, they learned new skills, developed English literacy, became a RN and juggled the demands of life. This paper highlights the poorly understood pockets of the current Australian RN workforce. IMPACT STATEMENT: The nuanced stories of RNs with refugee backgrounds in this study move beyond trauma and struggle and demonstrate the important journey this particular group of health professionals undertake. Increasing the contextual knowledge of the complex lives of former refugees turned nursing professionals will raise public awareness of the diversity of life experiences of RNs working in Australia.

Understanding nurses' perspectives of physical restraints during mechanical ventilation in intensive care: A qualitative study.

AIMS AND OBJECTIVES: This study explored the experiences of nurses using physical restraints on mechanically ventilated patients in intensive care. BACKGROUND: Physical restraints are frequently used to prevent treatment interference and maintain patient safety in intensive care units worldwide. However, physical restraints are found to be ineffective in preventing treatment interference and cause negative outcomes for patients. The practices surrounding physical restraints are inconsistent due to a lack of education, training and protocols. DESIGN: This research was conducted as a qualitative study with a naturalistic inquiry framework adhering to the Consolidated Criteria for Reporting Qualitative Research guidelines. METHODS: Twelve in-depth, semi-structured conversations were conducted with registered nurses who have experience working in intensive care and have cared for patients who were physically restrained and mechanically ventilated. These conversations were audio-recorded and transcribed. Thematic analysis was used to analyse the data. RESULTS: Three major themes emerged from the data. The themes were as follows: the ICU culture and its impacts on physical restraint practices; the consequences of physical restraints through a nursing lens; and understanding the ways of learning. CONCLUSION: The insights into the ICU culture, the nurses' understanding of the consequences of physical restraints and the ways in which nurses learn physical restraint practices have provided a greater depth of knowledge and understanding of the realities of current practice in ICU. This new information demonstrates nurses' understanding of the potential harm caused by physical restraints and the way in which current practices are guided more-so by workplace norms and expectations rather than on critical thinking and decision-making. RELEVANCE TO CLINICAL PRACTICE: These insights provide valuable information to intensive care clinicians, educators and policymakers to guide future practice and improve patient outcomes by highlighting the importance of education on physical restraint practices and informing the development of policies and guidelines.

Nurse-led integration of palliative care for chronic obstructive pulmonary disease: An integrative literature review.

AIMS AND OBJECTIVES: To uncover what is known about nurse-led models or interventions that have integrated palliative care into the care of patients with chronic obstructive pulmonary disease. BACKGROUND: Chronic obstructive pulmonary disease is a highly symptomatic, incurable disease characterised by chronic symptoms that without appropriate palliation can lead to unnecessary suffering for patients and their caregivers. While palliative care practices can relieve suffering and improve quality of life, most palliative models of care remain cancer-focused. New models, including nurse-led care that integrates palliative care for patients with chronic obstructive pulmonary disease, could address patient suffering and therefore need to be explored. METHOD: A mixed-studies integrative review was undertaken. Seven databases were searched for articles published between 2008-2018. The PRISMA framework was applied to the search, and six studies met the review eligibility criteria. Content analysis of the articles was undertaken, and data were compared, looking for different nurse-led models and outcomes related to palliative care in chronic obstructive pulmonary disease. RESULTS: Nurse-led, integrated palliative care models for patients with chronic obstructive pulmonary disease are rare and just four of the six articles found in this review had published results. Advance care planning was found to be the most common focus for nurse-led interventions in chronic obstructive pulmonary disease, and in all cases, results demonstrated an improvement in end-of-life discussions and completion of advance care directives. Of the reviewed articles, none used a qualitative framework to explore nurse-led models that integrated palliative care in chronic obstructive pulmonary disease. CONCLUSION: While nurse-led advance care planning was one type of palliative care practice associated with positive patient outcomes, there is a need for deeper exploration of nurse-led models that holistically address the bio-psycho-social-spiritual needs of patients with chronic obstructive pulmonary disease, and their caregivers. RELEVANCE TO CLINICAL PRACTICE: Integrating nurse-led supportive care clinics into chronic obstructive pulmonary disease services could be a way forward to address the unmet bio-psycho-social-spiritual needs of patients with chronic obstructive pulmonary disease, and their caregivers.

Physical restraints in intensive care-An integrative review.

BACKGROUND: Physical restraints (PRs) are commonly used in intensive care units (ICUs) worldwide for the prevention of treatment interference. While PRs are fundamentally used to maintain patient safety, they can negatively impact the experiences of patients and their families and cause moral and ethical dilemmas for ICU nurses. OBJECTIVES: The aim of this integrative review was to explore the current literature on the use of PR in intensive care. METHODS: This article used an integrative review framework to explore the current literature available on the experiences of PR in ICU. Research published between January 2007 and July 2016 was considered. Databases searched included CINAHL, Proquest, Medline, PubMed, and Cochrane. Inclusion/exclusion criteria were used to screen for eligibility. Methodological quality was evaluated using a quality assessment checklist, adapted from Walsh and Downe, and based on the Critical Appraisal Skills Programme tool. The findings were analysed and synthesised into major themes. RESULTS: Seventeen articles from Europe, Asia, and the United States of America were included. Five major themes emerged: (i) prevention of treatment interference; (ii) nurses' role as primary decision-makers PR application and removal; (iii) adherence to PR protocols; (iv) moral and ethical dilemmas faced by nurses; and (v) experiences of patients and families. The literature identified the prevalence of PR in today's ICUs, the drawbacks of current practice, and the paucity of knowledge of the lived experiences of PR. CONCLUSION: PR is the first choice in preventing of treatment interference, and most clinicians believe there is a valid place for them in ICU. However, its effectiveness in preventing self-extubation is questionable, and there are obvious flaws within this practice including inconsistencies surrounding PR protocols and the shortage of education and training provided to nurses. Further research into lived experiences of PR to gain deeper insights may lead to possible solutions and improve current practice.

"I am still passionate despite the challenges": Nurses navigating the care for refugees.

AIMS AND OBJECTIVES: To report the challenges faced by the nursing workforce in refugee health. BACKGROUND: Nurses are in the forefront of care provision for refugees who are recognised as one of the most vulnerable population groups in the world. The number of refugees in Australia is increasing, and more nurses are needed as care providers. Research on the challenges faced by refugee health nurses is sparse. DESIGN: Qualitative research methodology was used to study the experience of refugee health nurses. Using a descriptive qualitative research approach, a better understanding of the ongoing challenges of caring for refugees is presented. METHOD: Semi-structured interview with a convenience sample of registered nurses who worked in New South Wales refugee health services was conducted and digitally recorded in 2013. Responses were transcribed verbatim and analysed for themes. RESULTS: Six refugee health nurses who have been working in New South Wales refugee health services between 1-8 years participated in this study. A thematic analysis of the data led to three main themes: caring for clients with challenging needs; challenges in the course of caring for refugees; and passion in caring for refugees. Participants reported what it means to be refugee health nurses, they explored their roles and emphasised the need to understand refugee health issues. CONCLUSIONS: This study provides more insight into the unique experiences nurses have when caring for refugees. More debriefing opportunities and resources may reduce the challenges of caring. RELEVANCE TO CLINICAL PRACTICE: The refugee health nurses' stories support the need for further role refinement for nurses caring for refugees in the community, rural areas and health clinics. This is essential in promoting their well-being and that of the vulnerable population they are caring for.

Experiences of registered nurses from a refugee background: A scoping review.

AIMS AND OBJECTIVES: This scoping review presents an exploration of international literature on the factors that impact refugees' personal and professional experiences during their journey to being registered nurses in a new host country. BACKGROUND: Governments of host countries receiving refugees seek to develop strategies that facilitate the successful resettlement, employment and enculturation of refugees that arrive as skilled professionals. There is a scarcity of studies focussing on issues faced by refugees that are RNs or those pursuing nursing registration and employment in a new host country. This study is relevant for resettlement services, nursing registration authorities and education providers and informs the international nursing workforce. DESIGN: Scoping review. METHODS: Databases such as MEDLINE, EMBASE, Cochrane Library, CINAHL; Google Scholar; PubMed; Scopus and Web of Science were searched for qualitative studies published up to and including 2017. Articles that did not specify explicitly the participants as registered nurses and/or refugees were excluded. All eligible articles were analysed for collective findings, and impact factors were extracted, synthesised and illustrated diagrammatically. RESULTS: This review explored six eligible articles and six impact factors were identified. The challenging impacts were as follows: loss of control; shock in a new environment and bleak employment prospects. Equally three impact factors: reconciling new reality; establishing a new identity and hope for the future, facilitate positive experiences for nurses in their successful transition into society and the nursing workplace. CONCLUSIONS: This scoping review reports the small number of international studies on the experiences of refugees seeking to become registered and employed as registered nurses. The six impact factors identified influence the lives of the nurse participants socio-economically in and out of the workplace. RELEVANCE TO CLINICAL PRACTICE: Policymakers, managers and educators providing resettlement, registration and employment services could develop strategies that enhance integration and transition experiences of refugees aspiring to be registered nurses.

"You take the private part of her body, you are taking a part of her life": Voices of circumcised African migrant women on female genital circumcision (FGC) in Australia.

Western countries working toward eradication of female genital mutilation require better inclusion of women originally from countries where the practice is prevalent. However, few authors have examined the knowledge, attitudes, and experiences of circumcised African migrant women in western countries. Our findings from 40 responses from self-reported survey and five in-depth interviews show that the participating African migrant women know the reasons behind female genital circumcision (FGC), are living with the negative consequences of FGC, and have a zero tolerance attitude toward the practice. Circumcised women are in the best position to define their health needs and champion global efforts to eradicate FGC.

Challenges in adapting a survey: ensuring cross-cultural equivalence.

BACKGROUND: The increase in the number of international research studies means more surveys need to be adapted for use in different languages. To obtain valid cross-cultural study results, researchers often use translated surveys. AIM: To describe the translation process used, and lessons learned by a bilingual English/Mandarin PhD student and her three English-speaking supervisors when developing and translating an English-language survey for use in a study in Taiwan. DISCUSSION: In evaluating the translation process in this study, the three criteria of content equivalence, semantic equivalence and conceptual equivalence are discussed in relation to the challenges these presented to the research team. Some of the ways the team addressed these challenges are also considered. CONCLUSION: The time available for the research and the ability of translators need to be assessed when adapting surveys for use in different languages and cultures. Sharing experiences and lessons learned in the translation process was worthwhile, as all members of the research team came away with new knowledge and an understanding of the need to ensure the final version of a translated survey is culturally congruent. IMPLICATIONS FOR PRACTICE: To accurately translate a survey into another language, it is essential that one of the researchers be fluent in that language. This guarantees the closest fit of content and semantic and conceptual meaning.

Developing a tool to measure the factors influencing nurses' enjoyment of nursing.

AIMS AND OBJECTIVES: To develop a tool to measure the influencing nurses' enjoyment of nursing. BACKGROUND: Enjoyment in the workplace is an influential aspect found to boost work morale, job satisfaction leading to higher work retention which is important in nursing given the availability of nurses in the workforce. This study looks to refine the determinants of enjoyment from nurses in a large metropolitan hospital in western Sydney. DESIGN: Quantitative. METHODS: A 23-item survey questionnaire was used to ask nurses to rate the determinants that affect their enjoyment of nursing on a five-point Likert scale. The survey was distributed in a hard copy and online through a hospital-wide broadcast. Demographic items were also collected. RESULTS: A total of 124 responses were received, of which 54 were from online and 70 from hard copy surveys. The data analysis found 16 determinants of enjoyment. Of these, four were perceived by over 80% of the nurses to negatively impact their enjoyment. In contrast, nine items showed a positive effect on enjoyment with educating others, connecting with others, variety of work, doing and sharing with others, supporting others being the most positive (≥89% of responses). Three items were considered neutral: criticism, busy workload and changing policies. CONCLUSIONS: This study has added to the growing evidence on nurse enjoyment and its effects on job satisfaction. Nurses enjoy caring for patients and also find enjoyment and satisfaction in teaching others to care as well as socially connecting. RELEVANCE TO CLINICAL PRACTICE: Enjoyment seems to be one of the main reasons nurses continue to stay in nursing even though the system and people are not always supportive, encouraging or conducive to career development.

The role of the breast care nurse in patient and family care.

AIMS AND OBJECTIVES: To describe the role of the breast care nurse in caring for patients and families. BACKGROUND: The breast care nurse is an expert clinical nurse who plays a significant role in the care of women/men and their families with breast cancer. The role of these nurses has expanded since the 1990s in Australia. DESIGN: Descriptive study. METHODS: An online survey was sent to breast care nurses using peak body databases (n = 100). The survey consisted of nineteen nurse roles and functions from a previous Delphi technique study. Nurses rated the importance and frequency of role elements using a five-point Likert scale and four open-ended questions relating to role. RESULTS: There were 89 respondents. Most of the sample were from remote (n = 37, 41%) and rural areas (n = 47, 52%). The majority of responses regarding importance and frequency of the BCN role had a mean score above 4, which corresponds to 'moderately important' and 'occasionally as needed'. There were significant differences between the level of importance and frequency on 10 items. Four role themes arose from the thematic analysis: Breast care nurses as patient advocates, patient educators, care coordinators and clinical experts. CONCLUSIONS: This study delineated the important nurses role in caring for patients and families during a critical time of their life. Further, it details the important nursing roles and functions undertaken by these nurses and compared this to the frequency with which these nurses perform these aspects of their role. RELEVANCE TO CLINICAL PRACTICE: This study further delineates the important role that the nurses play in caring for patients and families during a critical time of their life. It extends further the frequency and importance of the supportive care and the need to educate their nurses on their role in providing spiritual care and research.

Treatment in the home setting with intermittent pneumatic compression for a woman with chronic leg ulcers: a case report.

BACKGROUND: Intermittent Pneumatic Compression (IPC) is shown to improve the healing rate of Venous Leg Ulcers (VLU) in the hospital setting. The current Australian "Gold Standard" treatment according to the Australian and New Zealand Wound Management Associations' (AWMA) Prevention & Management of Venous Leg Ulcer guidelines is compression, generally in the form of bandaging then progressing to hosiery once wounds are healed to prevent recurrence. This is recommended in conjunction with other standards of wound management including; nutrition, exercise, client education and addressing underlying pathophysiology and psychosocial factors. Compression bandaging is predominantly attended by community nurses in the clients' home. Barriers to delivery of this treatment include; client concordance and or suitability for bandaging including client habitus, (shape of legs), client lifestyle, clinician knowledge and clinicians physical ability to attend bandaging, in particular for obese clients with limited mobility who pose a manual handling risk to the clinician themselves. The use of IPC may assist in mitigating some of these concerns, therefore it would seem wise to explore the use of IPC within the home setting. CASE PRESENTATION: This paper will present an original case report on the successful treatment of a woman living with chronic bilateral lower leg ulcers using IPC as an adjunct treatment in her home. This paper supports recommendations to explore the use of IPC therapy in the home setting, for treatment of chronic leg ulcers requiring compression. CONCLUSION: Use of IPC in the home is anticipated to improve client involvement, concordance, client outcomes and reduce risk to staff applying conventional compression bandaging systems, particularly for obese clients with limited mobility.

Nurses as participants in research: an evaluation of recruitment techniques.

BACKGROUND: Recruitment and retention of participants, as well as response rates, can be challenging in nursing research. This can be because of the questions asked; the choice of methodology; the methods used to collect data; the characteristics of potential participants; the sample size required; and the duration of the study. Additionally, conducting research with nurses as participants presents several issues for them, including the time needed to participate in the research, the competing commitments for clinical practice, the political and environmental climate, and recruitment itself. AIM: To report on research studies conducted by the authors at a tertiary teaching hospital, to show the lessons learned when recruiting nurses to participate in nursing research. DISCUSSION: The authors discuss factors that supported recruitment of nurses in these studies, including the use of the personal touch and multiple recruitment strategies in a single study. CONCLUSION: Videos and photography facilitate interdisciplinary research and can be a valuable means of non-verbal data collection, especially with participants affected by disabilities, and can support research methods, such as the use of questionnaires. IMPLICATIONS FOR PRACTICE: Recruiting nurses for research can be challenging. We suggest that researchers consider using more than one recruitment strategy when recruiting nurse participants. Recruitment is more successful if researchers align the aim(s) of the research with nurse's concerns and contexts.

A novice researcher's reflection on recruiting participants for qualitative research.

BACKGROUND: This paper is a reflection by a PhD candidate on her qualitative study involving parents, diabetes educators and school teachers who were caring for a child with type 1 diabetes using intensive insulin therapy in primary school. AIM: To reflect on a novice researcher's experience of recruiting research participants from community, health and education settings in Australia. DISCUSSION: Participants were successfully recruited for the study using internet communication tools: Facebook support groups; the Australian Diabetes Educators Association (ADEA) e-newsletter; and emails sent to school principals. These methods were successful as Facebook and online support groups are popular, the study topic was of interest, the ADEA has many members, and numerous emails were sent to schools. Potential barriers to recruitment were a lack of access to those who did not use Facebook or the internet, gatekeepers, the high workloads of diabetes educators and teachers, and the time needed to obtain ethics approval and send a large number of emails to schools. CONCLUSION: Internet communication tools were successful in recruiting participants from community, health and education settings. However, different approaches were required for each type of participant. Lessons learned from this experience were: the importance of taking time to plan recruitment, including an in-depth understanding of potential participants and recruitment tools, the benefit of being an insider, and the need to work closely with gatekeepers. IMPLICATIONS FOR PRACTICE: An understanding of recruitment is essential for ensuring access to appropriate participants and timely collection of data. The experience of the novice researcher may provide insight to others planning to use internet communication tools for recruitment.

Older lesbian women's health and healthcare: A narrative review of the literature.

AIMS AND OBJECTIVES: The purpose of this narrative review is to locate, evaluate and synthesise the evidence presented in contemporary literature, related to the experiences of older lesbian women. BACKGROUND: Lesbian women have been identified as having unique health needs. In conjunction with the usual challenges associated with ageing, lesbian women are burdened with additional complications because of their lesbian orientation. To promote optimal health, the distinct needs of older lesbian women need to be identified and considered by those responsible for planning and delivering culturally competent services/care and allocating resources to support healthy ageing. DESIGN: Narrative review is typically used to evaluate and synthesise health-related literature and involves the critical evaluation of included, empirical studies to form innovative conclusions and perspectives. METHOD: Database searches using relevant keywords and applying specific limits yielded 55 articles for initial review. Eventually, 45 articles were excluded and 10 qualitative, empirical articles were then appraised using the Critical Appraisal Skills Program tool. Subsequently, seven articles were identified as meeting the inclusion criteria and formed the basis of this narrative review. RESULTS: Data were extrapolated from the included articles and three themes emerged: support, resilience and disclosure. These themes formulate the findings of this article. CONCLUSIONS: Remarkably, very little contemporary literature exists that addresses the health and well-being of older lesbian women, and this cohort remain positioned on the peripheries of research and society. Older lesbian women continue to be marginalised because of their lesbian identity and actively cultivate support systems, negotiate disclosure and develop resilience to minimise the effects of their marginal position. RELEVANCE TO PRACTICE: Recognition that older lesbian women often create, and draw on, a family of choice for support is imperative. In addition, the clinical environment should be safe for older lesbian women to disclose their sexual orientation and other sensitive information.

Enjoyment in nursing--experiences from the clinical milieu.

AIMS AND OBJECTIVES: To present findings from a qualitative study which aimed to explore and describe experiences of enjoyment in nursing. BACKGROUND: The topic of 'enjoying nursing' is often part of job satisfaction surveys conducted in the workplace and in some studies it has been found to be the prime reason that nurses stay in the workforce. However, there is little research which explores the concept fully. DESIGN: Qualitative in-depth interviews. METHOD: Semi-structured individual interviews were conducted with 17 nurses in a local health district in Sydney, Australia. Data from digitally recorded individual interviews were transcribed and the content was analysed for themes relating to aspects of nursing that were enjoyable and others that were not. RESULTS: The major themes to emerge from the data describing enjoyment of nursing were: doing for others, supporting others and educating others. Themes that identified not enjoying nursing were related to the aggression of others, i.e. patients/clients, families or other staff in the workplace, as well as system issues. System issues referred mainly to the need for support from other nurses and management. CONCLUSION: Nurses still enjoy caring for patients and teaching others to care. This is the reason they remain in nursing even though the system and people are not always supportive or encouraging. RELEVANCE TO CLINICAL PRACTICE: Managers and educators can use these results to assist them to understand the importance of giving support to nursing staff to optimise their enjoyment of caring for their patients/clients.

Adult Children of Parents with Mental Illness: Losing Oneself. Who am I?

There is a limited body of research that focuses on experiences of families of people with mental illness. While the body of knowledge concerning children of parents with mental illness is increasing, there remains limited discourse surrounding the experiences of adults who have lived with childhood parental mental illness. This paper examined one major theme of a study focusing on parenting narratives of adults who had experienced childhood parental mental illness. The narrative study from a metropolitan area of Australia reflects adult children's experiences of being overwhelmed with parental mental illness. They felt unsure of their own emotions and felt they had lost a sense of who they were as individual people. Adult children felt confused about their sense of reality, particularly for those whose parent had a diagnosis of schizophrenia or psychosis. Their experiences of loss were closely associated with changing self identity. Furthermore, many of the narratives demonstrated experiences of grief for adult children. Greater understanding of adult children's perceptions of being parented by a person with mental illness, alongside their experiences of loss, has the potential to help health and social care professionals to facilitate greater resilience for families who are living with parental mental illness.