Improving Access to Child Health Care in Indonesia Through Community Case Management.

Objectives In order to reduce infant mortality in Indonesia, community case management (CCM) was introduced. CCM is a community-based service delivery model to improve children's wellness and longevity, involving the delivery of lifesaving, curative interventions to address common childhood illnesses, particularly where there are limited facility-based services. This paper reports the findings of a qualitative study that investigated the implementation of CCM in the Kutai Timur district, East Kalimantan Indonesia from the perspective of mothers who received care. Methods Seven mothers and health workers were observed during a consultation and these mothers were interviewed in their home weeks after delivery. Field notes and the interview transcriptions were analysed thematically. Findings Mothers reported that their access to care had improved, along with an increase in their knowledge of infant danger signs and when to seek care. Family compliance with care plans was also found to have improved. Mothers expressed satisfaction with the care provided under the CCM model. The mothers expressed a need for a nurse or midwife to be posted in each village, preferably someone from that village. However two mothers did not wish their children to receive health interventions as they did not believe these to be culturally appropriate. Conclusion CCM is seen by rural Indonesian mothers to be a helpful model of care in terms of increasing access to health care and the uptake of lifesaving interventions for sick children. However there is a need to modify the program to demonstrate cultural sensitivity and meet cultural needs of the target population. While CCM is a potentially effective model of care, further integrative strategies are required to embed this model into maternal and child health service delivery.

Management and leadership in nursing: an Australian educational perspective.

AIM: In this article, we present an Australian perspective on issues influencing management and leadership education in nursing. BACKGROUND: Nurse leaders and managers work in a context of high pressure, uncertainty and rapid change, and face unprecedented challenges on a daily basis. EVALUATION AND KEY ISSUES: In the present paper, we reflect on the issues and challenges facing providers of management education for nursing, and consider these challenges in relationship to current trends and imperatives. CONCLUSIONS: Collaborative approaches between educational and clinical settings are needed to ensure quality, relevant educational support for managers and leaders, and enhance curriculum integrity. IMPLICATIONS FOR NURSING MANAGEMENT: There is a need for contemporaneous and relevant research to inform innovative models of collaborative education.

Parent satisfaction with early parenting residential services: a telephone interview study.

Early parenting residential units provide a child and family health support and education service for parents experiencing parenting difficulties. An ongoing concern of nursing staff and management is whether the parenting knowledge and skills gained are translated into sustainable parenting practices after discharge. This paper explores the response to a post discharge telephone interview about parents' experience of nursing care during their residential stay and their parenting experience since discharge. A descriptive qualitative approach identified four themes in the parents' responses: greater confidence, greater knowledge about their babies, changing expectations of parenting and their infants, and sustainability of parenting skills.

Child health and development record book: tool for relationship building between nurse and mother.

AIM: This paper is a report of a study of the role and impact of the child health and development record book in New Zealand society since its inception. BACKGROUND: Nurses working in child health roles in New Zealand use child health and development record books to record advice and developmental characteristics of children as they grow. The book has been used since 1921, but there has been no exploration of how it has been used by nurses or mothers. METHOD: Using an oral history approach, 35 participants ranging from 30 to 84 years of age were interviewed. Data were collected from November 2004 to December 2005, with follow-up interviews in 2006. FINDINGS: The book plays an important role in the relationship between mother and nurse. It is used as a point of commonality that supports the efforts of both as they work toward establishing an effective relationship, as a tool of practice, and as a means of building strength within families. CONCLUSION: Mothers read, reflect upon and reminisce with child health and development record books for generations. Nurses must consider the ways in which they currently use these record books, remaining mindful of both the short-term and potential long-term impact their notes may have on mothers.

Culture shapes nursing practice: Findings from a New Zealand study.

OBJECTIVES: This paper reports research undertaken to investigate nurses' and parents' experiences of communication about parental emotions in a hospital setting, with a focus on the environmental and cultural context within which the communication occurs. METHODS: A focused ethnography was employed as the aims were to understand the context within which nurse-parent interaction takes place, by exploring cultural factors, such as ways of living affecting nursing communication. Data collection occurred in a children's unit of a New Zealand hospital, involving 260h of participant observation field work, informal interviews with parents and nurses, followed by 20 formal interviews with nurses and parents. RESULTS: Nurses are cultural brokers, with the potential to be a link between the insider culture, the hospital and the outside, the parents. Parents look to nurses for cultural brokerage, to help them cross the strong cultural boundaries present in a hospital unit. CONCLUSION: The context and culture of a hospital unit influences nurse-parent communication. There is a disconnection between parents' emotional needs in hospital and nurses' ability to meet those needs. PRACTICE IMPLICATIONS: Nurses must be supported to provide effective cultural brokerage for parents. Unit managers need to acknowledge that meeting parents' diverse needs is vital.

Getting back to the future: a grounded theory study of the patient perspective of total knee joint arthroplasty.

PURPOSE: The purpose of this study was to describe the experience of adults with osteoarthritis who had undergone a total knee joint arthroplasty. METHOD: Grounded theory qualitative methodology was applied. SAMPLE: Purposive and theoretical sample of nine participants. FINDINGS: In managing the experience of total knee joint arthroplasty, participants expressed the basic psychosocial process, "Getting back to the future." There were three main categories identified within this process, "enduring," "thinking twice," and "keeping faith." "Enduring" conceptualized the way the participants lived their daily lives. "Thinking twice" captured the participants' processes of adaptation and problem solving. "Keeping faith" was the combination of determination, trust, and optimism that sustained participants as they progressed through the total knee joint arthroplasty experience to rehabilitation. CONCLUSION: The study provides a grounded theory of the participants' perspectives of undergoing total knee joint arthroplasty, making the process more visible for those involved in their care. Prehabilitation, postoperative care, and discharge planning can facilitate the patients' optimism and motivation to self-help. Further research to explore the process from the perspective of patients with rheumatoid arthritis and patients who have complications is recommended.

Managing it: a mother's perspective of managing a pre-school child's acute asthma episode.

Over the last decade asthma management strategies have required families to take increased responsibility for the assessment and treatment of their child's asthma. This exploratory descriptive study informed by grounded theory examines the experience of mothers in managing their pre-school child's acute asthma attack at home. The study reveals that mothers perceive that they are responsible for the management of their pre-school child during an acute asthma episode, a process they described as 'managing it'. This process involves mother in 'working on treatment', 'making the call', 'watching' and 'calming', while the husband/partner, family, friends and health professionals are 'supporting treatment'. This study suggests that nurses and doctors need to move away from the current paternalistic view of health care delivery in acute settings and embrace the concepts of support and partnership in the care of the pre-school child with asthma and their family.