The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population-based study of Australian teenagers.

OBJECTIVE: The aim of this study was to: (1) establish the typical experience of menstruation for senior high school girls and (2) determine how many experience considerable menstrual disturbance that could require further investigation and management of underlying pathology. DESIGN: Cross-sectional study. SETTING: Senior High Schools in the Australian Capital Territory (ACT), Australia. POPULATION: A total of 1051 girls aged between 15 and 19 years. METHODS: Data based on a quantitative survey. MAIN OUTCOME MEASURES: Self-reports of menstrual bleeding patterns, typical and atypical symptoms and morbidities. RESULTS: Typical menstruation in adolescence includes pain (93%), cramping (71%), premenstrual symptoms (96%) and mood disturbance (73%). Highly significant associations were found between increasing severity of menstrual pain, number of menstrual-related symptoms, interference with life activities and school absence. These associations indicate that approximately 25% of the sample had marked menstrual disturbance: 21% experienced severe pain; 26% school absence; 26% suffering five or more symptoms; > or =24% reporting moderate to high interference with four out of nine life activities. Approximately 10% reported atypical symptoms associated with menstruation. Diagnosis of menstrual pathology in the sample was low, even though 33% had seen a GP and 9% had been referred to a specialist. CONCLUSIONS: Menstrual pain and symptoms are common in teenagers. Girls indicating moderate to severe pain in association with a high number of menstrual symptoms, school absence and interference with life activities should be effectively managed to minimise menstrual morbidity. Those girls who do not respond to medical management should be considered for further investigation for possible underlying pathology, such as endometriosis.

Chinese nurses' experience in the Wenchuan earthquake relief.

AIM: The purpose of this qualitative study is to provide an understanding of how Chinese nurses acted in response to the 2008 Wenchuan earthquake. BACKGROUND: The literature has reported that Chinese nurses played a key role in the Wenchuan earthquake. Although these nurses' intentions were well meaning, and they made enormous efforts to save lives, they considered that disaster relief practice was beyond the scope of normal daily nursing practice and found the challenges they confronted overwhelming. China is a country prone to both natural and man-made disasters that demand a good deal of preparedness for those involved in disaster nursing. However, few studies have been conducted to investigate the knowledge, skill, experience and attitudes required for nurses responding to disasters. METHODS: Gadamer's philosophical hermeneutics was used as a framework to underpin and interpret the qualitative accounts of the practice of the ten registered nurses in this study. FINDINGS: Three themes were identified from semi-structured interviews with the participants. These are described as (1) feeling under-prepared; (2) perceived challenges and coping strategies; and (3) the rediscovery of the helping and caring role. By analysing these nurses' experiences in the Wenchuan earthquake relief operation, this study has identified the numerous roles and attributes required of nurses in response to disasters. CONCLUSION: Without education and training in disaster nursing, nurses may not be prepared to function in disaster relief, especially in a manner that is productive, efficient, collaborative and less stressful. Findings suggest that a systematic, educational approach to develop the skills required in disaster nursing is essential.

The reality of multiple casualty triage: putting triage theory into practice at the scene of multiple casualty vehicular accidents.

OBJECTIVES: The project investigated the experiences of ambulance paramedics in applying the principles and protocols of prehospital multiple casualty triage at the scene of motor vehicle accidents. Key objectives included investigation of the situational cues and other contextual factors influencing triage practice and the development of recommendations for the future education of ambulance paramedics. METHODS: A triangulated approach was used incorporating demographic data, the use of focus groups and in-depth interviews. A thematic analysis was undertaken following the well established practices of human science research. RESULTS AND CONCLUSIONS: The research describes an extended and broadened triage process returning to a more authentic definition of triage as the practice of sorting of casualties to determine priority. The findings highlight the need to consider triage as an extended and complex process that incorporates evidence based physiological cues to assist decision making and the management of the process of triage from call out to conclusion including assessment of contextual and situational variables.

Mass gathering medicine: a predictive model for patient presentation and transport rates.

INTRODUCTION: This paper reports on research into the influence of environmental factors (including crowd size, temperature, humidity, and venue type) on the number of patients and the patient problems presenting to first-aid services at large, public events in Australia. Regression models were developed to predict rates of patient presentation and of transportation-to-a-hospital for future mass gatherings. OBJECTIVE: To develop a data set and predictive model that can be applied across venues and types of mass gathering events that is not venue or event specific. Data collected will allow informed event planning for future mass gatherings for which health care services are required. METHODS: Mass gatherings were defined as public events attended by in excess of 25,000 people. Over a period of 12 months, 201 mass gatherings attended by a combined audience in excess of 12 million people were surveyed throughout Australia. The survey was undertaken by St. John Ambulance Australia personnel. The researchers collected data on the incidence and type of patients presenting for treatment and on the environmental factors that may influence these presentations. A standard reporting format and definition of event geography was employed to overcome the event-specific nature of many previous surveys. RESULTS: There are 11,956 patients in the sample. The patient presentation rate across all event types was 0.992/1,000 attendees, and the transportation-to-hospital rate was 0.027/1,000 persons in attendance. The rates of patient presentations declined slightly as crowd sizes increased. The weather (particularly the relative humidity) was related positively to an increase in the rates of presentations. Other factors that influenced the number and type of patients presenting were the mobility of the crowd, the availability of alcohol, the event being enclosed by a boundary, and the number of patient-care personnel on duty. Three regression models were developed to predict presentation rates at future events. CONCLUSIONS: Several features of the event environment influence patient presentation rates, and that the prediction of patient load at these events is complex and multifactorial. The use of regression modeling and close attention to existing historical data for an event can improve planning and the provision of health care services at mass gatherings.

Australian nursing--moving forward? Competencies and the nursing profession.

The introduction of national competencies for registration as a nurse in Australia has been met with great enthusiasm. While this development clearly brings some positive benefits the authors believe that competencies and competency development must be carefully monitored if Australian nurses are to avoid some of the pitfalls associated with this approach.

The phenomenon of making decisions during the experience of early breast cancer.

Breast cancer patients are faced with many decisions about their treatment, relationships and lives. The aims of this study were: to provide an understanding of the phenomenon of making decisions during the experience of early breast cancer, and to describe the types of decisions these patients are typically faced with. Previous research has focused largely on describing the different ways patients behave when making choices about treatment. However, few studies provide an understanding of the range of decisions women are likely to face, or describe what the experience of making these decisions is like. Hermeneutic phenomenology was used to inform the research. In-depth interviews were conducted with 18 breast cancer patients who had completed treatment. This study provides an understanding of the broad range of decisions with which women may be faced, and presents a new interpretation of what the experience of making decisions is like for women diagnosed with breast cancer. Five existential themes were found to be representative of the experience of making decisions: being challenged, getting ready, surviving, sharing the challenge and interrogating the future. Health professionals can use the understandings presented to improve their therapeutic relationships with patients and further assist women as they work through their experience of breast cancer.

The experience of making treatment decisions for women with early stage breast cancer: a diagrammatic representation.

Women who are making decisions about treatment for early stage breast cancer interact with a number of people when they are considering their treatment options and the impact breast cancer will have on their lives. Previous research has considered patient preferences for involvement in treatment decision-making and proposed factors that may influence breast cancer treatment decisions. However, to date, there has been a paucity of research focusing on the experience of making treatment decisions from the women's perspective. The aim of this paper is to describe the relationships between the women, the medical practitioners and other people, and to consider features that may be influential in the experience of making treatment decisions. Two models are proposed to represent concepts that are linked to the experience of making treatment decisions. The first model proposed has been formulated to represent factors that may influence the treatment decision. The second model highlights aspects of the women's lives that may be affected. This paper discusses concepts that are presented in the conceptual models and makes suggestions for future studies relating to the experience of making treatment decisions for women with breast cancer.

A multi-generational staff development model for registered nurses.

The paper focuses on a significant nursing initiative for staff development undertaken in South Australia. The initiative arose out of Health Commission funded consultancy which sought to develop a staff development model for registered nurses. The outcome of this consultancy was the development of a multi-generational staff development model, known as the DPS Staff Development Model. This model provides a framework through which staff development activities can be analysed, consolidated and extended. The paper outlines the DPS Staff Development Model, the context in which it was developed and its implications for nursing staff development programmes. The development of the model was premised on a number of assumptions. These included the need to ensure flexibility, longevity, offer a perspective of staff development that is realistic and practical, and facilitate in registered nurses a sense of ownership and personal responsibility with respect to their development. The model comprises six broad areas of focus: the Career Development Model for registered nurses in South Australia, the structure of the model, locations in which staff development occurs, elements which assist in maintaining skills and knowledge, elements which enhance growth and development and the processes and relationships necessary for the successful implementation of staff development programmes.